New Jersey General Surgery NJ

Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy, the removal of the gallbladder with very small incisions, is one of the most commonly performed surgical procedures in the United States.

The gallbladder is a small pear-shaped pouch situated under the liver in the upper right part of the abdomen. It stores bile, a liquid produced by the liver, and then releases it into the intestine to help digestion.

Gallstones are small, hard stones, which can sometimes develop in the gallbladder. They can result in a blockage of the flow of bile out of the gallbladder and symptoms that can include pain, jaundice (yellowed skin), and fever. The body can function well without a gallbladder and removing it is a common treatment for gallstones that are causing symptoms.

Laparoscopic cholecystectomy uses approximately 4 small incisions to extract the gall bladder. In most cases, the surgery is well tolerated and the patient is discharged home the day after surgery. Although there are many advantages to laparoscopy, the procedure may not be appropriate for some patients who have had previous upper abdominal surgery or who have some pre-existing medical conditions. A thorough medical evaluation by your personal physician, in consultation with a surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal is an appropriate procedure for you.

Laparoscopic Hernia Repair

A hernia describes a weakness of the inside layers of abdominal muscle, which creates a bulge or tear. Similar to an inner tube which pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened abdominal wall to form a small balloon-like sac. A loop of intestine or abdominal tissue can push into the sac, which could cause potentially serious problem requiring surgery. A hernia may be present since birth, or may develop over time. A hernia will not go away by itself; the only way to repair a hernia is with surgery.

The common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and the site of a previous operation (incisional). It is usually easy to recognize a hernia. You may notice a bulge under the skin. You may feel pain when you lift heavy objects, cough, strain during urination or bowel movements, or during prolonged standing or sitting. Severe, continuous pain, redness, and tenderness are signs that the hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon.

Laparoscopic hernia repair is a technique to fix tears in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). It may offer a quicker return to work and normal activities with decreased pain for some patients. The laparoscopic approach uses a laparoscope (a tiny telescope) connected to a special camera to view the hernia and surrounding tissue on a video screen. Other cannulas are inserted which allow your surgeon to work "inside." Three or four quarter inch incisions are usually necessary. The hernia is repaired from behind the abdominal wall. A small piece of surgical mesh is placed over the hernia defect and held in place with small surgical staples.

Laparoscopic Nissen Fundoplication (GERD Repair)

Gastroesophageal reflux is the most common gastrointestinal disorder of the western world. Gallup poles have elucidated that approximately 44 % of the adult population in the U.S. has some abnormal reflux of acidic gastric juices into the esophagus on a monthly basis. Roughly 10% of patients require daily acid suppression medication for relief of symptoms. GERD accounts for over 1.0 million out patient visits to physicians every year!

Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly, and stomach contents splash back, or reflux, into the esophagus. The LES is a ring of muscle located at the far end of the esophagus as it leads into the stomach. It's normal function is to act as a physical barrier between the esophagus and the stomach, protecting the esophagus from harmful gastric acid, and preventing food from being regurgitated. It does this by involuntary tonic contraction. When one eats, food is propelled into the esophagus toward the stomach. It is during swallowing that the LES relaxes and allows passage of food and liquids into the stomach.

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, which can eventually lead to more serious health problems.

Surgical therapy for GERD has made a sort of resurgence over the last several years, as a result of the introduction of minimally invasive surgery. There is increasing patient and doctor satisfaction with surgical therapy and many more patients and there physicians entertain surgery as an excellent therapeutic option for GERD.

The goals of surgical therapy are identical to those of medical therapy. Patients are considered for surgical therapy of GERD if:

Medical therapy fails to control their symptoms despite large doses of PPI, or prevent complications of GERD such as Barret's esophagus (thought to be a precancerous lesion), esophageal stricture (leading to obstruction and inability to eat), ulcer formation, and bleeding.
Atypical symptoms persist (asthma, sinusitis, cough, hoarseness, etc...)
A patient cannot take mediation because of undesirable side effects, poor compliance, or unwilling or unable to pay for long-term medical treatment. (Annual cost of PPI can be $1200.00) This may prove cost effective to patients, considering presently many insurance companies do not include medication coverage in their policies, but do provide for surgery and hospitalization if indicated.
A patient prefers surgery rather than life long medical therapy.