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Abdominal Surgery

Call our office today at (425) 899-5500; we will discuss your symptoms and the available treatment options to get you back to your healthiest best.

EvergreenHealth Surgical Care specializes in a variety of abdominal procedures. Click on the + to learn more:

Anti-reflux repair 

Indication

Patients with persistent, severe reflux of acid from the stomach up into the esophagus (gastroesophageal reflux disease or GERD) which does not respond to aggressive medical treatment. This may include patients whose symptoms persist despite medication or just as importantly patients whose symptoms improve but continue to have irritation of the esophagus despite medication.

Preoperative evaluation

All patients receive upper endoscopy (EGD) as well as a measurement of how well the esophagus moves (esophageal manometry). Additionally, some patients require a measurement of how much acid enters the esophagus (24 hour pH probe).

Procedure

Through five very small incisions the abdomen is inflated with carbon dioxide and using a television camera and long, thin instruments the stomach is wrapped around the lowest part of the esophagus.

Length of stay

Average length of stay is two days.

Recovery

Usually two to three weeks with regards to activity. Recovery varies depending on how quickly certain types of foods are eaten. Nearly all patients can permanently stop their anti-ulcer medications (Maalox, Pepcid, Zantac, Prilosec, etc.).

Gallbladder removal (cholecystectomy)

Indication

Commonly, patients with gallbladder problems have nausea, vomiting, or various types of pain due to their gallbladder improperly functioning. In the majority of patients, the problem is the presence of stones within the gallbladder (cholelithiasis) although in some patients, the problem is that the gallbladder doesn’t contract, (or squeeze) normally. This is termed biliary dyskinesia, and is another indication for gallbladder removal.

Preoperative evaluation

Blood work to evaluate the liver enzymes are checked in all patients. The gallbladder is imaged using ultrasound or in some cases a CAT scan. If biliary dyskinesia is suspected a HIDA scan is performed to evaluate the gallbladder function.

Procedure

In the vast majority of patients, the gallbladder can be removed laparoscopically using small incisions, a television camera, and long thin instruments. In some patients a longer, traditional incision is required.

Length of stay

Outpatient or sometimes overnight stay after laparoscopic surgery, three to five days after open surgery.

Recovery

Activity as tolerated after laparoscopic surgery, though patients are unable to drive on prescription pain medication. After open surgery, driving is not permitted for two weeks and patients are to refrain from lifting over five pounds for six weeks.

Pancreatic procedures

Indication

Most commonly pancreatic surgery is for cancer; however, severe or recurrent inflammation of the pancreas (pancreatitis), persistent pain coming from the pancreas, and fluid collections arising from the pancreas (pseudocysts) can also require surgery.

Preoperative evaluation

All patients require a CAT scan and blood tests. Some will also require a special endoscopy (ERCP) to evaluate the ducts in and around the pancreas.

Procedure

Procedure varies with the indication. For cancer, the entire pancreas along with part of the stomach, adjacent intestine, and bile duct are removed (Whipple procedure). For pain from the pancreas, only part of the gland itself is removed. For pseudocysts or recurrent pancreatitis, the gland is opened and adjacent intestine is sewn in place.

Length of stay

Variable depending upon which of the above operations is performed. However, all require stays of at least five days.

Recovery

Four to six weeks with no driving for two weeks and no lifting over ten pounds for six weeks.

Peritoneal dialysis catheter placement

Indication

Patients with kidney failure who need dialysis and can perform the steps required for using the abdomen to dialyze.

Preoperative evaluation

First a kidney specialist (nephrologist) determines that the patient needs dialysis. The abdomen is evaluated by history and physical examination to be sure there is no problem that excludes a patient from this type of dialysis.

Procedure

Under general anesthetic, the catheter is passed through a tunnel created under the skin and then into the lower portion of the abdominal cavity.

Length of stay

This is an outpatient procedure; you'll return home afterward.

Recovery

Two to three days. The catheter can be used within three to four weeks.

Spleen removal (splenectomy)

Indication

There are two categories of indications for splenectomy. In some situations the spleen is diseased (Hodgkin’s lymphoma, splenic cysts or abscesses) or injured (trauma) whereas in other situations the spleen is removing more blood cells than it should (certain leukemias and lymphomas, certain blood clotting problems and some red blood cell abnormalities).

Preoperative evaluation

This varies depending upon the indication. Most patients will require several blood tests as well as a CAT scan. With leukemias and some lymphomas, most patients will require a sampling of their bone marrow.

Procedure

The entire spleen is removed and the abdomen is inspected for any additional collections of splenic tissue (accessory spleens) which, if present, are also removed.

Length of stay

Variable depending upon overall patient health however the average is about five days.

Recovery

4 to 6 weeks with no driving for 2 weeks and no lifting over 10 pounds for 6 weeks. Patients must receive certain immunizations and follow strict antibiotic precautions after surgery.

Spleen repair (splenorrhaphy)

Indication

Spleens that have been injured and are bleeding require splenorrhaphy (repair of the spleen) or if this is not successful a splenectomy. Most commonly these injuries are from car or bike accidents, falls, kicks, etc.

Preoperative evaluation

All patients require blood tests to verify that they are bleeding internally despite blood transfusions and medications. Frequently a CAT scan is used to locate the spleen as a cause of internal bleeding.

Procedure

The cracks in the spleen, which cause the bleeding, are repaired using sutures. Frequently this doesn’t completely stop the bleeding and additional techniques must be used including blood-clotting agents applied to the bleeding areas, mesh wrapped around the spleen to hold it together or removal of small fragments of the spleen.

Length of stay

The average stay is about five days. However, this is variable depending upon overall patient health including additional injuries sustained at the time of the accident.

Recovery

Four to six weeks with no driving for two weeks and no lifting over 10 pounds for six weeks.

Ulcer repair

Indication

Patients with an ulcer that fails to heal despite exhaustive medical treatment require scheduled ulcer repair. Patients with an ulcer that perforates (forms a hole in the intestine) or bleeds repeatedly or excessively require emergency surgery.

Preoperative evaluation

In emergency situations patients only need a few simple X-rays and occasionally an upper endoscopy called an EGD. In elective situations all patients receive either an upper endoscopy or upper GI barium study. In some cases blood tests are used to look for the causes of the ulcers.

Procedure

Depending upon the individual situation, the procedure can range from simply patching the hole with adjacent fatty tissue (Graham patch) to cutting the nerves which cause ulcers (vagotomy) and rerouting the intestine (pyloroplasty), to removing the part of the stomach which produces the acid (antrectomy) and rerouting the intestine.

Length of stay

Length of stay is variable depending upon overall patient health and whether the surgery was elective or emergent. The average stay for elective surgery is about five days, whereas the stay for an emergency surgery may be longer.

Recovery

Four to six weeks with no driving for two weeks and no lifting over 10 pounds for six weeks.

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