Abdomen

The abdomen contains digestive organs including the stomach, liver, pancreas, gallbladder and small and large intestines. KSC provides procedures and treatment including:

Exploratory laparotomy
Cholecystectomy (laparoscopic, robotic and open)
Bile duct surgery
Splenectomy (spleen removal)
Kidney repair/resection (trauma)
Gastrostomy (feeding tube) and PEG tube
Peptic ulcer disease surgery
Hernia (ventral, incisional, inguinal, umbilical, and hiatal)

Gastric resection (benign/malignant)
Small bowel obstruction (e.g. lysis of adhesions)
Small bowel resection (benign/malignant)
Ileostomy (stoma)
Colostomy (stoma)
Colon resection (for colon cancer, diverticulitis, etc.)
Nissen fundoplication (for reflux)

Hernias

A hernia is a weakness or defect in the abdominal wall. It may be present from birth, or develop over a period of time. If the defect is large enough, abdominal contents such as the bowels may protrude through the defect causing a lump or bulge felt by the patient.

Hernias develop at certain sites which have a natural tendency to be weak; the groin, umbilicus (belly button), and previous surgical incisions.

Signs and Symptoms

Lump in the groin area when standing/straining & disappears when reclining
Pain at the site of the lump, especially when lifting a heavy object
Swelling of the scrotum
Excruciating abdominal pain (if you have strangulation)
Nausea, vomiting, loss of appetite & pain (if intestinal obstruction occurs)

Course of Hernia

A hernia occurs when an organ or fatty tissue pushes through a weak spot or opening in the muscle or tissue that holds it in place. Once a hernia has developed, it will tend to enlarge and cause discomfort. If a loop of bowel gets caught in the hernia, it may become obstructed or its blood supply may be cut off. This could then become a life-threatening situation.

Since hernias can be repaired effectively and with minimal risk, most surgeons, therefore, recommend that hernias be repaired when diagnosed, unless there is a serious medical problem which makes it too risky.

Treatment

KSC treatments include an open laparoscopic and robotic approach for inguinal, ventral, incisional and umbilical hernia repair.

The standard method of hernia repair involves making an incision in the abdominal wall. Normal healthy tissues are cut until the area of weakness is found. This area, the hernia, is then repaired with sutures. Often a prosthetic material, or another plastic material, is sutured in place to strengthen the area of weakness. Finally, the skin and other healthy tissues that were cut at the beginning are sutured back together to complete the repair.

Newer hernia repair involves minimally invasive laparoscopic techniques. However, hernia operation with open techniques is still a valid option reaching the highest standards of care. Laparoscopic techniques of hernia repair are especially attractive when patients are dealing with recurrent hernias or bilateral inguinal hernias.

Gastroesophageal Reflux Disease (GERD)

The esophagus carries food from the mouth to the stomach. The lower esophageal sphincter is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach.

Gastroesophageal Reflux Disease, or GERD, is a chronic disease that occurs when the lower esophageal sphincter does not close properly and stomach contents leak back, or reflux, into the esophagus.

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, and it can eventually lead to more serious health problems. Anyone, including infants, children, and pregnant women, can have GERD.

Symptoms

The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

The most frequent symptoms of GERD are so common that they may not be associated with a disease. Self-diagnosis can lead to mistreatment. Consultation with a physician is essential to proper diagnosis and treatment of GERD.

Causes

Hiatal hernia- hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest (link to hernia section)
Alcohol use
Overweight

Pregnancy
Smoking
Certain food and drinks are associated with reflux

Treatment

Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

Upper GI Endoscopy or EGD

Upper GI endoscopy is a procedure performed by a doctor, a well-trained subspecialist who uses the endoscope to diagnose and – in some cases – treat problems of the upper digestive system.

The endoscope is a long, thin, flexible tube with a tiny video camera and light on the end. By adjusting the various controls on the endoscope, the doctor can safely guide the instrument to carefully examine (link to endoscopy section) the inside lining of the upper digestive system.

Lower Gastrointestinal (GI) or Colorectal Surgery

Kansas Surgical Consultants specialize in the treatment of issues affecting the colon, rectum or anus. The American Society of Colon and Rectal Surgeons is a national association of colon and rectal surgeons and other surgeons dedicated to advancing and promoting the science and practice of the treatment of patients with diseases and disorders affecting the colon, rectum and anus.

Colorectal Diseases and Procedures Resources:

Gallstones

A gallstone is a lump of hard material usually ranging in size from a grain of sand to 3-4 cms. They are formed inside the gallbladder formed as a result of precipitation of cholesterol and bile salts from the bile.

Types of gallstones and causes:

Cholesterol stones
Pigment stones
Mixed stones – the most common type comprised of cholesterol and salts

Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.

Pigment stones are small, dark stones made of bilirubin. The exact cause is not known. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia in which too much bilirubin is formed.

Other causes are related to excess excretion of cholesterol by the liver through bile. They affect the following:

Gender – Women between 20 and 60 years of age are twice as likely to develop gallstones as men.
Obesity – Obesity is a major risk factor for gallstones, especially in women.
Estrogen – excess estrogen from pregnancy, hormone replacement therapy, or birth control pills
Cholesterol-lowering drugs.
Diabetes – People with diabetes generally have high levels of fatty acids called triglycerides.
Rapid weight loss – As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.

Symptoms

Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called “silent stones.” Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis and hepatitis. Accurate diagnosis is imperative.
Symptoms may vary and often follow fatty meals, and they may occur during the night.

Abdominal bloating
Recurring intolerance of fatty foods
Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
Pain in the back between the shoulder blades
Pain under the right shoulder
Nausea or vomiting
Indigestion & belching

Diagnoses

Ultrasound is the most sensitive and specific test for gallstones.
Other diagnostic tests may include:

Computed tomography (CT) scan may show the gallstones or complications
HIDA scan to evaluate gallbladder filling and function
Endoscopic retrograde cholangiopancreatography (ERCP). The patient swallows an endoscope-a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. ERCP is used to locate and remove stones in the ducts
Blood tests. Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice

Course of Illness

Bile-duct blockage and infection caused by stones in the biliary tract can be a life-threatening illness. With prompt diagnosis and treatment, the outcome is usually very good.

Complications

The obstruction caused by gallstone may lead to Biliary colic, Inflammation of gallbladder (Cholecystitis). Other complications may include:

Cirrhosis- Cirrhosis is the result of chronic liver disease that causes scarring of the liver (fibrosis – nodular regeneration) and liver dysfunction
Cholangitis- Cholangitis is an infection of the common bile duct, which carries bile (which helps in digestion) from the liver to the gallbladder and then to the intestines

Surgery

Surgical removal of the gallbladder – or cholecystectomy – is the most widely recognized and accepted form of laparoscopy treatment.

Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. The most common operation is called laparoscopic cholecystectomy. For this operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen.

The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures.

If gallstones are in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove them before or during the gallbladder surgery.

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