Anal Cancer Screening
Anal cancer screening:
Some cases of anal cancer in people at high risk are diagnosed by screening tests, such as the digital rectal exam and/or anal Pap test. Sometimes a doctor will detect anal cancer during a routine physical exam or during a minor procedure, such as removing a hemorrhoid. Treating cancers found in this way is often very effective because the tumors are found early in the course of the disease. But most often anal cancers are found because of signs or symptoms a person is having. If anal cancer is suspected, exams and tests will be needed to confirm the diagnosis. If cancer is found, further tests will be done to help determine the extent of the cancer.
Bowel Cancer Screening
Bowel cancer screening
This is a method of picking up bowel cancer when it is relatively easy to cure and before it gives rise to major symptoms.
How important is bowel?
Bowel cancer kills more people than breast cancer; it kills more people than cancer of the prostate; and it kills more people than cervix cancer. Unfortunately is often forgotten and rarely talked about.
How does screening work?
Screening aims to detect a disease before symptoms appear. For cancer, this might mean catching it at an earlier stage, when treatment offers a better chance of cure.
How is bowel cancer screened for ?
Most bowel cancers cause rectal bleeding. A special test (“faecal occult blood test”) that detects tiny amounts of blood in the stools has been proven to detect cancers at an earlier stage. A colonoscope ( telescope) is used for bowel cancer screening. A thin telescope is passed into the left side of the bowel and it identifies any cancer and allows removal of any growths called polyps that may in the future become cancerous. Faecal occult blood test is the second way of screening for bowel cancer. If your test is positive you may be called for a telescope test of the bowel called a colonoscopy. It is important to not that If following a screen test you notice new symptoms such as change in bowel habit or bleeding you should still see your doctor.
Does screening for bowel cancer work?
YES. Many studies have proved that people with bowel cancer detected by screening using “faecal occult blood tests” and bowel scope screening are more likely to be cured than those who wait for symptoms to develop.
What are the benefits of screening?
You may be one of those who has a bowel cancer growing that has not yet produced symptoms. Bowel cancers detected by screening have a better outlook than cancers found in people with symptoms.
Are there disadvantages of bowel screening?
It is important to know that the majority of people with a positive bowel motion test have nothing seriously wrong with their bowel but once the bowel has been checked out they can have peace of mind.Although the bowel motion tests are better at predicting cancer than any symptom, sometimes patients with cancer can return a negative test. Therefore, you should always report any worrying bowel symptoms such as bleeding from the back passage and change in the normal bowel pattern, particularly when these have continued over a six week period or more.
Breast Cancer Screening
Breast cancer screening guidelines:
• Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so.
• Women age 45 to 54 should get mammograms every year.
• Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening.
• Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.
• All women should be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening.
Women should also know how their breasts normally look and feel and report any breast changes to a health care provider right away. Some women – because of their family history, a genetic tendency, or certain other factors – should be screened with MRIs along with mammograms. (The number of women who fall into this category is very small.) Talk with a health care provider about your risk for breast cancer and the best screening plan for you.
Colonoscopy is a procedure that enables your surgeon to examine the lining of the colon and rectum. A soft, bendable tube about the thickness of the index finger is gently inserted into the anus and advanced into the rectum and the colon.
Why is a Colonoscopy Performed?
A colonoscopy is usually done, as part of routine screening for cancer, in patients with known polyps or previous polyp removal, before or after some surgeries, to evaluate a change in bowel habits or bleeding, to evaluate changes in the lining of the colon known as inflammatory disorders.
What Preparation is Required?
The rectum and colon must be completely emptied of stool for the procedure to be performed. In general, preparation consists of consumption of a special cleansing solution or several days of clear liquids, laxatives and enemas prior to the examination. If you do not complete the preparation, it may be unsafe to perform the colonoscopy and the procedure may have to be rescheduled. You will most likely be sedated during the procedure. Sedatives will affect your judgment and reflexes for the rest of the day. You should not drive or operate machinery until the next day.
What Can Be Expected During Colonoscopy?
The procedure is usually well tolerated, but there is often a feeling of pressure, gassiness, bloating or cramping at various times during the procedure. You will be lying of your side or your back while the colonoscope is advanced through the large intestine. The lining of the colon is examined carefully while inserting and withdrawing the instrument. The procedure usually lasts for 15 to 60 minutes.
What if Colonoscopy Shows an Abnormality?
If your surgeon sees an area that needs more detailed evaluation, a biopsy may be obtained and submitted to a laboratory for analysis. A biopsy is performed by placing a special instrument through the colonoscope. Most polyps can be removed at the time of the colonoscopy.
What Happens After Colonoscopy?
Your surgeon will explain the results to you after your procedure or at your follow up visit. You may have some mild cramping or bloating from the air that was placed into the colon during the examination. Do not drive or operate machinery until the next day, as the sedatives given will impair your reflexes. You will need someone to drive you home after the procedure. If polyps were found during your procedure, you will need to have a repeat colonoscopy. Your surgeon will decide on the frequency of your colonoscopy exams.
What Complications Can Occur?
Colonoscopy complications include bleeding from the site of a biopsy or polypectomy and a tear (perforation) through the lining of the bowel wall. Other complications of the procedure include the possibility of missed polyps or other lesions. Should a perforation occur, it may be necessary for your surgeon to perform abdominal surgery to repair the intestinal tear. It is important to contact your surgeon if you notice symptoms of severe abdominal pain, fevers, chills or rectal bleeding of more than one-half cup. Bleeding can occur up to several days after a biopsy.
Colon and Rectal Cancer Screening
Colon and rectal cancer and polyps:
Starting at age 50, both men and women should follow one of these testing plans:
Tests that find polyps and cancer
• Colonoscopy every 10 years, or
• CT colonography (virtual colonoscopy) every 5 years*, or
• Flexible sigmoidoscopy every 5 years*, or
• Double-contrast barium enema every 5 years*
Tests that mostly find cancer
• Yearly fecal immunochemical test (FIT)**, or
• Yearly guaiac-based fecal occult blood test (gFOBT)**, or
• Stool DNA test (sDNA) every 3 years*
*If the test is positive, a colonoscopy should be done.
** The multiple stool take-home test should be used. One test done in the office is not enough. A colonoscopy should be done if the test is positive. The tests that can find both early cancer and polyps should be your first choice if these tests are available and you’re willing to have one of them. But the most important thing is to get tested, no matter which test you choose. Talk to a health care provider about which tests might be right for you. If you are at high risk of colon cancer based on family history or other factors, you may need to be screened using a different schedule. Talk with a health care provider about your history and the testing plan that’s best for you.
Laparoscopic General Surgery
With the advent of laparoscopy (minimally invasive or keyhole surgery), indications for open surgery were redefined. With technological advances with fibreoptics and instruments, the procedure could be carried out safely and effectively. The reasons why laparoscopic surgery could not be performed became fewer, and it developed in leaps and bounds. The general philosophy is minimal trauma to the patient, which helps in a quicker recovery with lesser pain, and overall, a better patient experience. The surgical procedure that is carried out is no different from that of the open technique. However, for a variety of reasons, including safety, a keyhole procedure may have to be converted to a traditional open procedure.
Main advantages of keyhole over open surgery:
• Quicker recovery.
• Lesser pain.
• Earlier discharge from hospital.
• Lesser adhesions (scar tissue) in the belly, which can cause problems in the future e.g. blockage.
The commonest laparoscopic general surgery operations performed these days are:
• Abdominal hernia surgery.
• Laparoscopic appendicectomy.
• Laparoscopic cholecystectomy.
Laparoscopy involves direct visualization of the abdominal cavity, by using a laparoscope, which is a camera with a light source at its tip. Fibreoptic fibres carry images from a lens, also at the tip of the instrument, to a video monitor, which the surgeon and other theatre staff can view in real time. Carbon dioxide (CO2), which is put into the abdomen, helps to separate the organs inside the abdominal cavity, making it easier for the surgeon to visualise the different organs during laparoscopy, and perform a wide range of procedures. The gas is removed at the end of the procedure.
Patients may be referred to surgeons because of an undiagnosed abdominal problem. If your surgeon has recommended a diagnostic laparoscopy, this brochure will help you understand the procedure. A laparoscope is a telescope designed for medical use. It is connected to a high intensity light and a high-resolution monitor. In order for the surgeon to see inside your abdomen, a hollow tube (port) is placed through your abdominal wall, and the laparoscope is inserted into the port. The image of the inside of your abdomen is then seen on the monitor. In most cases, this procedure (operation) will be able to diagnose or help discover what the abdominal problem is.
Why is Diagnostic Laparoscopy Performed?
1. Abdominal pain: Laparoscopy has a role in the diagnosis of both acute and chronic abdominal pain. There are many causes of abdominal pain. Some of these causes include appendicitis, adhesions or intra-abdominal scar tissue, pelvic infections, endometriosis, abdominal bleeding and, less frequently, cancer. It is used in patients with irritable bowel disease to exclude other causes of abdominal pain. Surgeons can often diagnose the cause of the abdominal pain and, during the same procedure, correct the problem.
2. Abdominal mass: A patient may have a lump (mass or tumor), which can be felt by the doctor, the patient, or seen on an X-ray. Most masses require a definitive diagnosis before appropriate therapy or treatment can be recommended. Laparoscopy is one of the techniques available to your physician to look directly at the mass and obtain tissue to discover the diagnosis.
3. Ascites: The presence of fluid in the abdominal cavity is called ascites. Sometimes the cause of this fluid accumulation cannot be found without looking into the abdominal cavity, which can often be accomplished with laparoscopy.
4. Liver disease: Non-invasive imaging techniques such as ultrasound, CT scan (computed tomography) and MRI (magnetic resonance imaging) may discover a mass inside or on the surface of the liver. If non-invasive imaging cannot give your physician enough information, a liver biopsy may be needed to establish the diagnosis. Diagnostic laparoscopy is one of the safest and most accurate ways to obtain tissue for diagnosis. In other words, it is an accurate way to collect a biopsy to sample the liver or mass without actually opening the abdomen.
5. “Second look” procedure or cancer staging: Your doctor may need information regarding the status of a previously treated disease, such as cancer. This may occur after treatment with some forms of chemotherapy or before more chemotherapy is started. Also, information may be provided by diagnostic laparoscopy before planning a formal exploration of the abdomen, chemotherapy or radiation therapy.
Laparoscopic Adrenal Gland Removal (Adrenalectomy)
What are the Adrenal Glands?
The adrenal glands are two small organs, one located above each kidney. The adrenal glands are known as endocrine glands because they produce hormones. These hormones are involved in control of blood pressure, chemical levels in the blood, water use in the body, glucose usage, and the “fight or flight” reaction during times of stress.
What Causes Adrenal Gland Problems?
Diseases of the adrenal gland are relatively rare. The most common reason that a patient may need to have the adrenal gland removed is excess hormone production by a tumor located within the adrenal. Most of these tumors are small and not cancers. They are known as benign growths that can usually be removed with laparoscopic techniques. Removal of the adrenal gland may also be required for certain tumors even if they aren’t producing excess hormones, such as very large tumors or if there is a suspicion that the tumor could be a cancer.
What are the Symptoms of Adrenal Gland Problems?
Patients with adrenal gland problems may have a variety of symptoms related to excess hormone production by the abnormal gland. Adrenal tumors associated with excess hormone production include pheochromocytomas, aldosterone-producing tumors, and cortisol-producing tumors. If an adrenal tumor is suspected based on symptoms or has been identified by X-ray, the patient should undergo blood and urine tests to determine if the tumor is over-producing hormones.
Laparoscopic adrenal gland removal:
What are the Advantages of Laparoscopic Adrenal Gland Removal?
In the past, making a large 6 to 12 inch incision in the abdomen, flank, or back was necessary for removal of an adrenal gland tumor. Today, with the technique known as minimally invasive surgery, removal of the adrenal gland (also known as “laparoscopic adrenalectomy”) can be performed through three or four 1/4-1/2 inch incisions. Patients may leave the hospital in one or two days and return to work more quickly than patients recovering from open surgery. Results of surgery may vary depending on the type of procedure and the patients overall condition.
Common advantages are:
Less postoperative pain
Shorter hospital stay
Quicker return to normal activity
Improved cosmetic result
Reduced risk of herniation or wound separation
How is Laparoscopic Adrenal Gland Removal Performed?
The surgery is performed under a complete general anesthesia, so that the patient is asleep during the procedure. A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula. This gives the surgeon a magnified view of the patient’s internal organs on a television screen. Once the adrenal gland has been dissected free, it is placed in a small bag and is then removed through one of the incisions.
What is the Appendix?
The appendix is a long narrow tube that attaches to the first part of the colon. It is usually located in the lower right quadrant of the abdominal cavity. Its function, however, is not essential.
What is a Laparoscopic Appendectomy?
Appendicitis is one of the most common surgical problems. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall. In most laparoscopic appendectomies, surgeons operate through 3 small incisions (each ¼ to ½ inch) while watching an enlarged image of the patient’s internal organs on a television monitor.
Advantages of Laparoscopic Appendectomy:
Results may vary depending upon the type of procedure and patient’s overall condition.
Common advantages are: Less postoperative pain, May shorten hospital stay, May result in a quicker return to bowel function, Quicker return to normal activity and Better cosmetic results.
Are You a Candidate for Laparoscopic Appendectomy?
Although laparoscopic appendectomy has many benefits, it may not be appropriate for some patients. Early, non-ruptured appendicitis usually can be removed laparoscopically. Laparoscopic appendectomy is more difficult to perform if there is advanced infection or the appendix has ruptured. A traditional, open procedure using a larger incision may be required to safely remove the infected appendix in these patients.
How is a Laparoscopic Appendectomy Performed?
The words “laparoscopic” and “open” appendectomy describes the techniques a surgeon uses to gain access to the internal surgery site. Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through a cannula, giving the surgeon a magnified view of the patient’s internal organs on a television monitor. Several other cannulas are inserted to allow the surgeon to work inside and remove the appendix. The entire procedure may be completed through the cannulas or by lengthening one of the small cannula incisions.
What Happens if the Operation Cannot Be Completed by the Laparoscopic Method?
In a small number of patients the laparoscopic method is not feasible because of the inability to visualize the organs effectively. Factors that may increase the possibility of converting to the “open” procedure may include: Extensive infection and/or abscess, a perforated appendix, Obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs, Bleeding problems during the operation.
What Complications Can Occur?
As with any operation, there are risks of complications. However, the risk of one of these complications occurring is no higher than if the operation was done with the open technique.
Bleeding, Infection, A leak at the edge of the colon where the appendix was removed, Injury to adjacent organs such as the small intestine, ureter, or bladder.
It is important for you to recognize the early signs of possible complications. Contact your surgeon if you have severe abdominal pain, fever, chills or rectal bleeding.
Laparascopic Ventral Hernia Repair
Laparoscopic ventral hernia repair is a technique to fix tears or openings in the abdominal wall using small incisions, laparoscopes and a patch (mesh) to reinforce the abdominal wall. It may offer a quicker return to work and normal activities with decreased pain for some patients.
What is a Ventral Hernia?
It usually arises in the abdominal wall where a previous surgical incision was made. In this area the abdominal muscles have weakened; this results in a bulge or a tear. This can allow a loop of intestines or other abdominal contents to push into the sac. If the abdominal contents get stuck within the sac, they can become trapped or “incarcerated.” This could lead to potentially serious problems that might require emergency surgery.
How Do I Know If I Have a Ventral Hernia?
A hernia is usually recognized as a bulge under your skin. Occasionally, it causes no discomfort at all, but you may feel pain when you lift heavy objects, cough, strain during urination or bowel movements. Any continuous or severe discomfort, redness, nausea or vomiting associated with the bulge are signs that the hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon is recommended.
What Causes a Ventral Hernia?
An incision in your abdominal wall will always be an area of potential weakness. Hernias can develop at these sites due to heavy straining, aging, obesity, injury or following an infection at that site following surgery. Certain activities may increase the likelihood of a hernia including persistent coughing, difficulty with bowel movements or urination, or frequent need for straining.
What are the Advantages of Laparoscopic Ventral Hernia Repair?
Common advantages may include: Less post-operative pain, Shortened hospital stay, Faster return to regular diet, Quicker return to normal activity, Less wound infections.
How is Laparoscopic Ventral Hernia Repair Performed?
Ventral hernias do not go away on their own and may enlarge with time. Surgery is the preferred treatment and is done in one of two ways:
The traditional approach is done through an incision in the abdominal wall. The surgeon may choose to sew your natural tissue back together, but frequently, it requires the placement of mesh (screen) in or on the abdominal wall for a sound closure.
The second approach is a laparoscopic ventral hernia repair. In this approach, a laparoscope is inserted through a cannula (a small hollow tube). The laparoscope and TV camera allow the surgeon to view the hernia from the inside. Other small incisions will be required for other small cannulas for placement of other instruments to remove any scar tissue and to insert a surgical mesh into the abdomen. This mesh is fixed under the hernia defect to the strong tissues of the abdominal wall. It is held in place with special surgical tacks and in many instances, sutures. In a small number of patients the laparoscopic method cannot be performed. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment.
Laparoscopic Gallbladder Removal (Cholecystectomy)
Gallbladder removal is one of the most commonly performed surgical procedures and is usually performed with minimally invasive techniques and the medical name for this procedure is Laparoscopic Cholecystectomy.
What is the Gallbladder?
The gallbladder is a pear-shaped organ that rests beneath the right side of the liver. Its main purpose is to collect and concentrate a digestive liquid (bile) produced by the liver. Bile is released from the gallbladder after eating, aiding digestion.
What Causes Gallbladder Problems?
Gallbladder problems are usually caused by the presence of gallstones which usually consists primarily of cholesterol and bile salts that form in the gallbladder. It is uncertain why some people form gallstones but risk factors include being female, prior pregnancy, age over 40 years and being overweight. There is no known means to prevent gallstones. These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting, indigestion and, occasionally, fever. If the gallstone blocks the common bile duct, jaundice (a yellowing of the skin) can occur. Surgical removal of the gallbladder is the time-honored and safest treatment of
How is Laparoscopic Gallbladder Removal Performed
Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen in the area of the belly-button. A laparoscope connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient’s internal organs on a television screen. After the surgeon removes the gallbladder, the small incisions are closed with absorbable stitches. In a small number of patients the laparoscopic method cannot be performed for gallbladder removal.
What are the Advantages of Performing Laparoscopic Gallbladder Removal?
The operation requires only four small openings in the abdomen.
Patients usually have minimal post-operative pain.
Patients usually experience faster recovery than open gallbladder surgery patients.
Quicker return to normal activities.
What Should I Expect after Gallbladder Removal Surgery (Cholecystectomy)?
Most patients who have a laparoscopic gallbladder removal go home from the hospital the day of surgery once liquids are tolerated. Some patients remain in the hospital overnight and go home the next morning. Patients will probably be able to return to normal activities within a week’s time. The onset of fever, yellow skin or eyes, worsening abdominal pain, distention, persistent nausea or vomiting, or drainage from the incision indicate that a complication or other problem has occurred. Most patients can return to work within seven days following the laparoscopic procedure.
What Complications Can Occur from Laparoscopic Gallbladder Removal?
The vast majority of laparoscopic gallbladder removal patients experience few or no complications. Complications of laparoscopic gallbladder removal are infrequent, but include bleeding, wound infection, hernias, blood clots, or heart problems. Unintended injury to adjacent structures such as the common bile duct, colon, or small intestine may occur and may require another surgical procedure to repair it. The overall rate of severe complications is low.
Laparoscopic colorectal surgery avoids the need for a long incision (cut) in the abdomen and so there is much less pain after the operation from the wound. It also means that you stay in hospital a shorter time and can return to normal activities in a few weeks.
What is the colon and rectum?
The colon and rectum refers to the large intestine or bowel. It forms the lowest part of the digestive system after the small bowel and it ends at the anus.
What is laparoscopic colorectal surgery?
Laparoscopic or ‘keyhole’ surgery allows the surgeon to carry out surgery through four or five small (one-centimetre) cuts in the abdomen (tummy). A telescope camera, put into one of these small cuts, shows an enlarged image of the internal abdominal organs on a television screen. The other cuts allow the surgeon to use special operating instruments.
What are the advantages of laparoscopic colorectal surgery?
• Less pain after the operation
• A shorter hospital stay
• A quicker return to eating, drinking and bowel function (going to the toilet normally)
• A quicker return to normal activity
• Less scarring after the operation
Could I have laparoscopic colorectal surgery?
Although there are many benefits of this type of surgery, it is not always possible for every patient. Each case has to be looked at, so you will need to discuss this option with your surgeon and find out if this way of operating is best for you.
Will I need any special preparation before surgery?
You will have the same investigations and tests to prepare you for your operation as patients who have ‘open’ surgery. These are to confirm the diagnosis and extent of the disease and to assess how fit and well you are for the proposed treatment.
How is laparoscopic colorectal surgery performed?
Laparoscopic surgery is the name given to the telescopic method a surgeon uses to enter the abdomen. Through a small cut often close to your tummy button the surgeon will make a small cut and pass gas (carbon dioxide) into the abdominal cavity, making a space into which the surgeon can place a laparoscope (a narrow telescope joined to a video camera). The surgeon then sees a magnified view of your abdominal organs on a television screen. Other small cuts are made to pass small operating instruments.
What if the surgery cannot be completed by laparoscopy?
The following may cause surgery to be changed to open procedure:
• Being very overweight
• A history of abdominal surgery which has caused a lot of scar tissue
• Where the surgeon cannot see the organs clearly
• Bleeding problems during the operation and large tumours.
Laparoscopic Spleen Removal (Splenectomy)
What is the Spleen?
The spleen is a blood filled organ located in the upper left abdominal cavity. It is a storage organ for red blood cells and contains many specialized white blood cells which act to filter blood. The spleen is part of the immune system and also removes old and damaged blood particles from your system. The spleen helps the body identify and kill bacteria.
How Do I Know If My Spleen Should Be Removed?
There are several reasons why a spleen might need to be removed, and the following list, though not all inclusive, includes the most common reasons.
Auto-immune thrombocytopenia purpura (ITP): This is the most common reason. In this disease, a patient’s platelet count is low because the body makes antibodies to the platelets which cause them to be destroyed in the spleen.
Hemolytic anemia: In this disease the body makes antibodies to red blood cells which are subsequently destroyed in the spleen.
Hereditary (genetic) conditions: In these patients, the spleen recognizes the red cells as abnormal and may bring them down, possibly requiring splenectomy to improve the symptoms.
Malignancy: Rarely, patients with cancers of the cells which fight infection, known as lymphoma or certain types of leukemia, require spleen removal
What are the Advantages of Laparoscopic Splenectomy?
Individual results may vary depending on your overall condition and health but the usual advantages are: Less postoperative pain, Shorter hospital stay, Faster return to a regular, solid food diet, Quicker return to normal activities, Better cosmetic results.
How is Laparoscopic Removal of the Spleen Done?
You will be placed under general anesthesia and be completely asleep. A cannula (hollow tube) is placed into the abdomen by your surgeon and your abdomen will be inflated with carbon dioxide gas to create a space to operate. A laparoscope (a tiny telescope connected to a video camera) is put through one of the cannulas which projects a video picture of the internal organs and spleen on a television monitor. Several cannulas are placed in different locations on your abdomen to allow your surgeon to place instruments inside your belly to work and remove your spleen. A search for accessory (additional) spleens and then removal of these extra spleens will be done since 15% of people have small, extra spleens. After the spleen is cut from all that it is connected to, it is placed inside a special bag. The bag with the spleen inside is pulled up into one of the small, but largest incisions on your abdomen. The spleen is broken up into small pieces (morcelated) within the special bag and completely removed.
What Happens If the Operation Cannot Be Performed or Completed by the Laparoscopic Method?
In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.
Benefits of laparoscopic include less post operative discomfort since the incisions are much smaller, quicker recovery times, shorter hospital stays, earlier return to full activities and much smaller scars. Furthermore, there may be less internal scarring when the procedures are performed in a minimally invasive fashion compared to standard open surgery.
The laparoscopic procedures which we perform are:
• Drainage of liver abscesses.
• Drainage or removal of over cysts.
• Liver Biopsy.
Liver Cyst Drainage
Cysts in the liver are frequently found in normal people. Liver cysts should only be treated if they are causing significant symptoms to the patient. The symptoms found with liver cysts include pain, bleeding into the cysts causing pain, and digestive complaints that are unexplained by other findings. If a liver cyst requires treatment, surgical treatment should include removal of the wall of the cyst. Removal of the fluid only from the cyst is not recommended since the cyst fills up rapidly after the procedure. Furthermore this procedure puts the patient at risk for infection of the cyst. We offer a laparoscopic approach to patients who require treatment of liver cysts. The procedure involves removing part of the wall of the cyst so that the liquid that is in the cyst can freely drain into the abdominal cavity. The body then removes the liquid from the abdominal cavity.
Laparoscopic Nissen Fundoplication/Surgery for Heartburn:
Patients who have GERD/HEARTBURN who do not respond well to lifestyle changes or medications or those who do not wish to continually require medications to control their symptoms, may consider undergoing a surgical procedure. Surgery is very effective in treating GERD. The most commonly performed operation for GERD is called a fundoplication (usually a Nissen fundoplication. A fundoplication involves fixing your hiatal hernia, if present, and wrapping the top part of the stomach around the end of the esophagus to reinforce the lower esophageal sphincter, and this recreate the “one-way valve” that is meant to prevent acid reflux.
What are the Advantages of the Laparoscopic Method?
The advantage of the laparoscopic approach is that it usually provides: reduced postoperative pain, shorter hospital stay, a faster return to work, improved cosmetic result.
How is Laparoscopic Anti-Reflux Surgery Performed?
Laparoscopic anti-reflux surgery (commonly referred to as Laparoscopic Nissen Fundoplication) involves reinforcing the “valve” between the esophagus and the stomach by wrapping the upper portion of the stomach around the lowest portion of the esophagus. In a laparoscopic procedure, surgeons use small incisions to enter the abdomen through trocars (narrow tube-like instruments). The laparoscope, which is connected to a tiny video camera, is inserted through the small incision, giving the surgeon a magnified view of the patient’s internal organs on a television screen. The entire operation is performed “inside” using narrow instruments that are passed through the trocars. In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. Factors that may increase the possibility of converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, or bleeding problems during the operation.
What Should I Expect after Surgery?
Patients are encouraged to engage in light activity while at home after surgery, and should avoid heavy lifting or strenuous activity for a short period of time. Post operative pain is generally mild although some and anti-reflux medication is usually not required after surgery. Most surgeons temporarily modify patient’s diet after surgery beginning with liquid followed by gradual advance to solid foods. You will probably be able to get back to your normal activities within a short amount of time.
Are There Side Effect to This Operation?
Studies have shown that the vast majority of patients who undergo the procedure are either symptom free or have significant improvement in their GERD symptoms. Some patients develop temporary difficulty swallowing immediately after the operation. This usually resolves within one to three months after surgery. Occasionally, patients may require a procedure to stretch the esophagus or rarely re-operation. The ability to belch and or vomit may be limited following this procedure. Some patients report stomach bloating. Although the operation is considered safe, complications may occur as they may occur with any operation. Complications may include but are not limited to: bleeding injury to the esophagus, spleen, liver, stomach or internal organs infection of the wound, abdomen, or blood.other less common complications may also occur. Your surgeon will discuss these with you. They will also help you decide if the risks of laparoscopic anti-reflux surgery are less than non-operative management.
Upper Endoscopy (also known as gastroscopy) is a procedure that enables your surgeon to examine the lining of the esophagus (swallowing tube), stomach and duodenum (first portion of the small intestine). A bendable, lighted tube about the thickness of your little finger is placed through your mouth and into the stomach and duodenum.
Why is an Upper Endoscopy Performed?
Upper endoscopy is performed to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, difficulty swallowing or heartburn. It is an excellent method for finding the cause of bleeding from the upper gastrointestinal tract. It can be used to evaluate the esophagus or stomach after major surgery. It is more accurate than X-rays for detecting inflammation, ulcers or tumors of the esophagus, stomach and duodenum. Upper endoscopy can detect early cancer and can distinguish between cancerous and noncancerous conditions by performing biopsies of suspicious areas. Biopsies are taken by using a specialized instrument to sample tissue. These samples are then sent to the laboratory to be analyzed. A biopsy is taken for many reasons and does not mean that cancer is suspected. A variety of instruments can be passed through the endoscope that allows the surgeon to treat many abnormalities with little or no discomfort. Your surgeon can stretch narrowed areas, remove polyps, remove swallowed objects, or treat upper gastrointestinal bleeding. Safe and effective control of bleeding has reduced the need for transfusions and surgery in many patients.
What Preparation is Required?
The stomach should be completely empty. You should have nothing to eat or drink for approximately 8 hours before the examination. Medication may need to be adjusted or avoided. It is best to inform your surgeon of ALL your current medications as well as allergies to medications a few days prior to the examination. Most medications can be continued as usual. Also, if you have any major diseases, such as heart or lung disease that may require special attention during the procedure, discuss this with your surgeon. You will most likely be sedated during the procedure and an arrangement to have someone drive you home afterward is imperative. Sedatives will affect your judgment and reflexes for the rest of the day. You should not drive or operate machinery until the next day.
High Resolution Anoscopy
High Resolution Anoscopy, or HRA, is a procedure that allows for examination and evaluation of the anal canal. Using a small thin round tube called an anoscope, the anal canal is examined with a high resolution magnifying instrument called a colposcope. Application of a mild acidic liqud onto the anal canal facilitates evaluation of abnormal tissue such as anal dysplasia. If indicated, a biopsy can be obtained. A digital rectal examination is also done at the time of the procedure. The procedure is performed in the office and generally lasts about 15 minutes. It is usually very well tolerated with mild if any discomfort. Significant risks such as bleeding or infection are extremely rare. Note should be taken that HRA is very different from colonoscopy or flexible sigmoidoscopy, neither of which can adequately examine the anal canal for the problems being detected by HRA. No bowel prep is needed for this examination. The procedure is used in the treatment and surveillance of anal dysplasia and the prevention of anal cancer. It is performed on patients with an abnormal anal cytology or anal Pap test. Anal Pap tests are obtained on individuals who are at risk for genital or anal HPV (Human Papilloma Virus) infections, even in the absence of signs or symptoms of infection.
Liver Cancer Screening
It is often hard to find liver cancer early because signs and symptoms often do not appear until it is in its later stages. Small liver tumors are hard to detect on a physical exam because most of the liver is covered by the right rib cage. By the time a tumor can be felt, it might already be quite large. There are no widely recommended screening tests for liver cancer in people who are not at increased risk. But testing might be recommended for some people at higher risk. Many patients who develop liver cancer have long-standing cirrhosis (scar tissue formation from liver cell damage). Doctors may do tests to look for liver cancer if a patient with cirrhosis gets worse for no apparent reason. For people at higher risk of liver cancer due to cirrhosis (from any cause) or chronic hepatitis B infection (even without cirrhosis), some experts recommend screening for liver cancer with alphafetoprotein (AFP) blood tests and ultrasound exams every 6 to 12 months. In some studies, screening was linked to improved survival from liver cancer. AFP is a protein that can be present at increased levels in patients with liver cancer. But looking at AFP levels isn’t a perfect test for liver cancer. Many patients with early liver cancer have normal AFP levels. Also, AFP levels can be increased from other kinds of cancer as well as some noncancerous liver conditions.
We also assist patients from outside `South Africa who are looking for medical care in South Africa. These may be patients who want to come for specific operations or want to consult specific doctors in South Africa. If the condition of the patients fall within our discipline, we will be more than happy to see the patients unless they want assistance in consulting specific doctors.
Our services in this area include the following:
◦ Assistance in supplying basic information on the health care services in South Africa.
◦ Advices on specialists who can best help you.
◦ Will make an appointment for you to see the best specialists in South Africa.
◦ Assistance with suitable and affordable accommodation next to the intended hospitals of consultation.
◦ Advice on places of interest to visit while you recuperate
Oesophageal Cancer Screening
Screening is the process of looking for cancer or pre-cancer in people who have no symptoms of the disease. No screening test has been shown to lower the risk of dying from oesophageal cancer in people who are at average risk. However, people who have a high oesophageal cancer, such as those with Barrett’s oesophagus, are often followed closely to look for early cancers and pre-cancers. Many experts recommend that people with a high risk of oesophageal cancer, such as those with Barrett’s oesophagus, have upper endoscopy regularly. For this test, the doctor looks at the inside of the oesophagus through a flexible lighted tube called an endoscopy. The doctor may remove small samples of tissue (biopsies) from the area with Barrett’s so that they can be checked for dysplasia (pre-cancer cells) or cancer cells. Doctors aren’t certain how often the test should be repeated, but most recommend testing more often if areas of dysplasia are found. This testing is repeated even more often if there is high-grade dysplasia (the cells appear very abnormal). If the area of Barrett’s is large and/or there is high-grade dysplasia, treatment of the abnormal area might be advised because of the high risk that an adenocarcinoma is either already present (but was not found) or will develop within a few years. Treatment options for high-grade dysplasia might include surgery to remove part of the oesophagus with the abnormal area, endoscopic mucosal resection (EMR), photodynamic therapy (PDT), or radiofrequency ablation. The outlook for these patients is relatively good after treatment. Careful monitoring and treatment (if needed) may help prevent some oesophageal cancers from developing. It may also detect some cancers early, when they are more likely to be treated successfully.
Pancreatic Cancer Screening
Pancreatic cancer is hard to find early. The pancreas is deep inside the body, so early tumors can’t be seen or felt by health care providers during routine physical exams. People usually have no symptoms until the cancer has already spread to other organs.
Screening tests or exams are used to look for a disease in people who have no symptoms (and who have not had that disease before). At this time, no major professional groups recommend routine screening for pancreatic cancer in people who are at average risk. This is because no screening test has been shown to lower the risk of dying from this cancer. Sometimes when a person has pancreatic cancer, the levels of certain proteins in the blood go up. These proteins, called tumor markers, can be detected with blood tests. The tumor markers CA19-9 and carcinoembrogenic antigen (CEA) are the ones most closely tied to pancreatic cancer. But these proteins don’t always go up when a person has pancreatic cancer, and even if they do, the cancer is often already advanced by the time this happens. Sometimes levels of these tumor markers can go up even when a person doesn’t have pancreatic cancer. For these reasons, blood tests aren’t used to screen for pancreatic cancer, although a doctor might still order these tests if a person has symptoms that might be from pancreatic cancer. These tests are more often used in people already diagnosed with pancreatic cancer to help tell if treatment is working or if the cancer is progressing. For people in families at high risk of pancreatic cancer, newer tests for detecting early pancreatic cancer may help. One of these is called endoscopic ultrasound scan. This test is not used to screen the general public, but it might be used for someone with a strong family history of pancreatic cancer or with a known genetic syndrome that increases their risk. Doctors have been able to find early, treatable pancreatic cancers in some members of high-risk families with this test.
Skin Cancer Screening
Skin Cancer Prevention and Early Detection
Skin cancer is a common condition. The number of skin cancer cases has been going up over the past few decades. Most skin cancers are caused by too much exposure to ultraviolet rays (UV). Most of this exposure comes from the sun, but some may come from man-made sources, such as indoor tanning beds and sun lamps. The good news is that you can do a lot to protect yourself and your family from UV rays, as well as to catch skin cancer early so that it can be treated effectively. You don’t need x-rays or blood tests to find skin cancer early – just your eyes and a mirror. If you have skin cancer, finding it early is the best way to make sure it can be treated with success.
Thyroid Cancer Screening
Many cases of thyroid cancer can be found early. In fact, most thyroid cancers are now found much earlier than in the past and can be treated successfully. Most early thyroid cancers are found when patients see their doctors because of neck lumps or nodules they noticed. If you have unusual symptoms such as a lump or swelling in your neck, you should see your doctor right away. Other cancers are found by health care professionals during a routine checkup. There is no recommended screening test to find thyroid cancer early. Some doctors also recommend that people examine their necks twice a year to look and feel for any growths or lumps. Early thyroid cancers are also sometimes found when people have ultrasound tests for other health problems. Blood tests or thyroid ultrasound can often find changes in the thyroid, but these tests are not recommended as screening tests for thyroid cancer unless a person is at increased risk, such as because of a family history of thyroid cancer.