Advanced Surgical Health Associates
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Contact : +1-732-308-4202
If you’ve noticed a bulge under your skin near your belly button or abdomen, or perhaps felt a pop in your groin area after lifting something heavy, don’t be surprised if your doctor says you have a hernia. A hernia is when an internal organ, fat, or tissue breaks through a weak spot in a muscle; a condition that never goes away on its own and requires surgery to fix.
Hernias are more common in certain parts of the body like the abdominal wall (ventral hernia), belly button area (umbilical hernia), groin (inguinal hernia), and diaphragm (hiatal hernia). Some hernias don’t cause physical discomfort and are only visually detected when you notice a bulge under the skin.
Other hernias are extremely painful and tender to the touch. In some cases, the lump may disappear when you lie down, and then reappear or enlarge when you put pressure on your abdomen or groin area, such as when you stand, or lift or push something heavy. Hiatal hernias, when a piece of your stomach pokes through the small opening connecting your esophagus to your diaphragm, do not have symptoms you can see. They do, however, cause heartburn, and gastroesophageal reflux disease (GERD), because they can cause food and acid to back up into the esophagus.
So how can you tell if you can leave your hernia alone, or if you need to make an appointment with a surgeon who can repair it before it gets worse and requires emergency surgery?
“One way to judge if ventral, umbilical or inguinal hernia surgery is necessary is the push test”, says Amit S. Kharod, M.D., a general surgeon, board-certified in general and laparoscopic surgery, who specializes in laparoscopic hernia repair. “When a painful hernia cannot be pushed back into the body using gentle pressure, it’s time for surgery.” This is a sign that the hernia has become incarcerated – when the hernia contents get stuck in the surrounding weak spot of tissue or muscle. An incarcerated hernia can lead to strangulation, where blood flow is cut off to tissue in the hernia, and requires immediate surgical treatment.
Experiencing severe pain, nausea, vomiting, skin discoloration around the bulge, as well as the inability to pass gas or empty your bowels are other signs that it is time to have a ventral, umbilical, or inguinal hernia fixed. Some people choose to fix their hernia before it expands, while it’s still small and not painful. “It can be advantageous to repair a hernia when a patient is healthy, before the hernia becomes bigger or requires emergency surgery due to strangulation,” explains Dr. Kharod. However, some people may be able to ward off surgery for a time, and some even altogether with help of a hernia aid.
There are several over-the-counter hernia support aids that do not require a doctor’s prescription. However, it’s recommended that you talk to your doctor before purchasing any form of an aid. Those suffering from inguinal hernias might find temporary relief of discomfort using a hernia truss, a compression undergarment designed for men, which forces the bump back into place. Abdominal hernia belts are designed for both men and women. The padded flexible belt wraps around the abdomen and presses on the hernia to stop the lump from popping out.
When it comes to hiatal hernias, the signs you need it surgically fixed are different than with the other types of hernias, because the symptoms are not seen but felt. When self-care techniques like change in diet, over-the-counter drugs, or prescription medications don’t control your heartburn, or when asthma and laryngitis develop, surgery can be effective in eliminating the discomfort.
A hiatal hernia can be fixed through a minimally invasive procedure called Transoral Incisionless Fundoplication (TIF), which corrects GERD by creating a valve mechanism at the bottom of the lower esophageal sphincter. In the past, this was accomplished either through open abdominal surgery or through tiny laparoscopic incisions in the abdomen. “TIF is performed under general anesthesia and most patients can return to work within a few days,” says Dr. Kharod.
Minimally invasive laparoscopic surgery is the most common surgery method used to fix ventral, umbilical and inguinal hernias. Surgeons make a few small incisions in the abdomen, navel, or groin area. Then, by using long, thin surgical instruments and a small camera that guides the doctor, he/she can close the weak spot in the muscle wall. Robotic surgery offers an innovative approach to hernia repair. The surgeon uses small tools attached to a robotic arm that is controlled by a computer. The treatment is similar to laparoscopic repair but allows for more precision to service hard-to-reach spaces in the body. For a very large hernia, traditional open hernia repair may be the best option. A patch is placed over the whole hernia to reinforce the fragile area.
After surgery, it is rare for a hernia to come back. Dr. Kharod suggests following these hernia aftercare strategies in order to ensure it doesn’t.
· Maintain a healthy weight
· Avoid straining when moving your bowels
· Use proper technique when lifting something heavy
· Stop smoking to reduce coughing
· Treat coughs before they become chronic or hacking coughs
Even straightforward surgeries can result in complications; so make sure you choose your surgeon carefully. Research providers by asking your social network, as well as medical office and hospital based nurses for recommendations, and make sure you choose a quality surgeon with whom you feel comfortable entrusting your life. Don’t hesitate to ask a surgeon for patient references. You want to make sure that the surgeon you choose is regularly performing the operation you need with consistently successful outcomes.
This year alone, hundreds of thousandsof women will hear the startling words, “you have breast cancer”. If you are one of them, it’s important to understand how to determine if you’re at high or average risk for getting cancer in your healthy breast, and what options mightbe best for you if surgery is needed.
“When first diagnosed with breast cancer, a common desire is to want to remove both breasts to be safe,” says Amit Kharod, M.D., a general surgeon, board-certified in general and laparoscopic surgery, who also performs breast surgery. “While this may seem like a preventative measure, it’s not always prudent to remove the unaffected breast.”
Recently the American Society of Breast Surgeons cautioned against this ongoing trend of removing the healthy breast, known as contralateral prophylactic mastectomy (CPM), and determined that it’s unnecessary for the majority of individuals who are at average risk of developing cancer in their other breast.
“Removing the breast without cancer does not reduce the chance of a recurrence or cause the disease to spread,” explains Dr. Kharod. The risk of a local recurrence (the cancer coming back in the same place) and metastasis (when the breast cancer spreads) varies from patient to patient and depends on the type of breast cancer and treatment a person had. According to the Susan G. Komen Foundation, the risk of developing breast cancer in the healthy breast is just 0.1 to 0.6 percent per year for breast cancer survivors at average risk.
However, women with a known genetic risk for breast cancer — those who have tested positive for the BRCA1/2 gene or other genetic mutations — are considered to be at high risk and can lower their chances of developingbreast cancer in their healthy breast by having it removed preemptively.
How do you know if you’re ataverage risk? Your medical team might use a breast cancer risk assessment tool to calculate your individual risk, but you’re likely to be at average risk in the healthy breast if:
1. There is no suspicion of an inherited genetic link to your breast cancer;
2. You do not carry the BRCA1/2 gene;
3. You do not have a first-degree family member who has had breast cancer under the age of 50;
4. You never had radiation on the chest wall in childhood or adolescence.
If you determine that you are at average risk of developing breast cancer in your healthy breast over your lifetime, only surgery on your affected breast is recommended. Depending on your age, grade and type of breast cancer, your doctor will perform either a lumpectomy (partial mastectomy), a surgery that spares the breast with cancer by removing only the tumor and some neighboring tissue, or a mastectomy, the removal of the whole breast with cancer.
“The goal of the surgery is to remove the cancer,” says Dr. Kharod. To ensure that all the cancer is removed, in most cases women undergo additional therapies such as chemotherapy, radiation, and hormone therapy depending on their breast cancer diagnosis.
Knowing your risk is a helpful tool for making surgical decisions. For some women, other considerations like breast appearance and symmetry, as well as anxieties about future screenings, are also things to think about when deciding on the best overall surgical treatment for them.
Do you suffer from chronic heartburn? Unexplained coughing fits? Hoarseness or a sore throat? These could all be signs that you’re one of the more than seven million Americans who suffer from Gastroesophageal Reflux Disease (GERD).
GERD, the more severe form of acid reflux, occurs when your lower esophageal sphincter — the band of muscle between your esophagus and stomach — does not squeeze itself closed. This forces your food and stomach acids up instead of down your digestive tract, causing that sour taste you may have experienced after eating foods like tomato-based sauces, spicy or fried foods, high-fat meat/dairy products, or drinking caffeinated products, such as coffee, tea or soda.
If GERD is at its primary stage, dietary and lifestyle modifications, such as eliminating foods known to aggravate the condition is an effective way of controlling it. For others, an over-the counter antacid can usually relieve the discomfort. If you suffer from frequent heartburn that occurs more than twice a week, you may be prescribed daily medications, such as H2 blockers, that can generally relieve heartburn and treat reflux, especially if you’ve never had treatment before.
But when prescription drugs aren’t enough to control the condition, and symptoms that may include asthma and laryngitis begin to reduce your quality of life, it’s time to talk to your doctor about surgical treatments.
There are several invasive and non-invasive techniques through which GERD can be treated, but a very successful and minimally-invasive procedure that’s often performed is called Transoral Incisionless Fundoplication (TIF), says ASHA’s Dr. Michael J. Menack, a board-certified, fellowship-trained surgeon practicing in the area of general surgery and minimally-invasive and incisionless surgery that corrects GERD.
The TIF procedure corrects GERD by creating a valve mechanism at the bottom of the lower esophageal sphincter. “In the past, this was accomplished either through open abdominal surgery or through tiny laparoscopic incisions in the abdomen,” explains Dr. Menack. The innovative TIF uses a EsophyX device and endoscope that is gently inserted through the mouth restoring the natural flow of food and acid down the digestive tract.
TIF is performed under general anesthesia and most patients return to work within a few days. “There are many benefits of an incisionless approach to GERD surgery, but most patients really appreciate the quick recovery time,” says Dr. Menack. Surgeons do not cut into the abdomen, which means faster recovery and fewer post-surgical complications. “Patients also need be aware that prescription drugs, including proton pump inhibitors (PPIs) used to treat heartburn, GERD and gastric ulcers, can have severe side effects from prolonged use, so a procedure like this offers a safe and effective solution.”
For more info about GERD and the TIF procedure, please call our office at 732.308.4202 to schedule a consultation with Dr. Menack and/or visit http://www.gerdhelp.com/.
Of all the things to expect when you’re expecting, you may not have been prepared for varicose veins – those large bulging blood vessels that twist and turn on your legs. About 30 percent of women develop venous insufficiency in their first pregnancy, and up to 55 percent of moms see an increase in varicose and spider veins (small red, purple, or blue twisted blood vessels that have a spider web pattern) with each subsequent pregnancy.
Even before pregnancy, the veins in your lower body are working against gravity to return blood to the heart. Once you’re pregnant, the hormone progesterone causes blood to pool down there, and the increased pressure from your growing uterus compresses some of the blood flow returning to the heart, leading to an increased risk of varicose veins.
While many women are concerned about what their legs look like, varicose veins can be more than just a cosmetic issue. “These veins can actually signal a serious medical condition (venous insufficiency) that can result in uncomfortable leg pain, skin damage, ulcers and open wounds if they aren’t treated,” warns ASHA’s Michael J. Menack, M.D. FACS, a board-certified, fellowship-trained surgeon specializing in general and laparoscopic surgery with a focus on patients with venous diseases.
If your varicose veins don’t go away within a few months after your baby is born, there are a few treatment options that can help. A common treatment for uncomplicated small varicose and spider veins is called Sclerotherapy. A special chemical solution is injected into the vein causing it to close and disappear. “This is a virtually painless office procedure that has excellent cosmetic results,” says Dr. Menack.
If your varicose vein clusters are too large for Sclerotherapy, a recommended treatment option is Trivex ™ Ambulatory Phlebectomy. It is a minimally-invasive surgical technique that uses a tiny-lighted instrument to illuminate the location of the diseased vein. Under local anesthesia, another instrument called a resector permanently removes the diseased varicose vein. “There are many fewer incisions with this procedure, as compared to stripping and ligation, so there is less scarring,” explains Dr. Menack. “Patients typically recover very quickly, which is a key factor for mothers who have to tend to their children.”
A procedure for patients who have varicose veins as well as true venous insufficiency – a progressive disease marked by the backward flow of blood that drives blood down the vein in the legs instead of up – is called Venefit ™. A quick office procedure is done under local anesthesia to close and seal the affected veins through a tiny venous puncture in the leg. A device called the VNUS ClosureFAST ™ catheter is inserted, and using gentle radiofrequency thermal energy, the vein is sealed with minimal discomfort. You can return to normal activities the next day, and it is fully covered by most insurance carriers, according to Dr. Menack.
While treatment during your pregnancy isn’t recommended, if you have varicose veins and plan to have more children, you don’t have to wait until your last pregnancy to get treated. “For women suffering from venous reflux disease, treatment between pregnancies may make future pregnancies more comfortable,” advises Dr. Menack.
Varicose veins are a chronic medical condition that can progress without treatment, so it is important to talk to your doctor to find the best ways to alleviate your symptoms. Contact our office today to schedule a free vein screening.
We all have a network of deep and superficial veins in our legs that contain valves that open and close to allow blood to flow from our toes back up to our heart. But over 25 million Americans have valves that have weakened and deteriorated causing venous reflux – the backward flow of blood that drives blood down the veins instead of up.
As blood collects in a vein, it pushes the walls of the vein out, causing the sometimes blue, swollen distortion of veins in the lower legs, known as varicose veins. “It’s more than just an issue about vanity, embarrassment and unsightliness,” says ASHA’s Michael J. Menack, M.D. FACS, a board-certified, fellowship-trained surgeon specializing in general and laparoscopic surgery with a focus on patients with venous diseases. “Venous insufficiency” is a progressive disease that can continue to become more severe causing leg cramps, skin color changes, leg ulcers and even blood clots.”
When self-care steps like wearing compression stockings, losing weight, and not sitting for long periods of time can no longer help manage the disease, it’s time to talk to your doctor about surgical treatments.
Profound advances in surgical procedures that repair chronic venous insufficiency have been made in recent years. The old days of vein stripping and vein ligation of the saphenous vein are behind us with new less invasive treatments, like the popular Venefit ™ procedure, also known as the VNUS Closure ™ procedure, taking their place.
Here’s a primer on the treatment:
“In addition to eliminating the health risks, discomfort and pain associated with the disease, the cosmetic results are remarkable,” says Dr. Menack. “In time, the appearance of the affected leg transforms, and in most cases, looks like it did before the onset of vein disease.”
This March marks the third year of “80% by 2018,” an initiative started by The National Colorectal Cancer Roundtable(NCCRT), in which hundreds of organizations – including medical professional societies, academic centers, survivor groups, government agencies, cancer coalitions, etc. – have committed to eliminating colorectal cancer as a major public health problem. They are all working toward the shared goal of reaching 80% of adults aged 50 and older screened for colorectal cancer by 2018.
In 2016, over 134,000 cases of colorectal cancer will be diagnosed in the U.S., and over 49,000 people are expected to die from colon cancer. Colorectal cancer often starts as a non-cancerous polyp on the inner wall of the colon or rectum. Data indicates that 50% of colon cancers could be prevented through regular screening to find and remove these pre-cancerous polyps.
By banding together to ensure that Americans are able to easily get preventative colorectal cancer screenings by 2018, we can prevent 277,000 cases and 203,000 colorectal cancer deaths by 2030, according to the NCCRT.
Get More People Screened Through Open Access Colonoscopies
To encourage more people aged 50 and older to get screened, a growing number of doctors are offering “open access” colonoscopies. A colonoscopy is a test that detects colon cancer, as well as precancerous colon polyps that can be removed during the test. An open access colonoscopy allows patients the opportunity to schedule a screening colonoscopy without a consultation or office visit before the test.
“This open access program reduces one of the main obstacles to getting a screening – the hassle and time it takes scheduling your colonoscopy,” says Thomas J. Kayal, M.D., a board-certified colon and rectal surgeon who specializes in laparoscopic colon surgery, and minimally invasive robotic-assisted surgery that treats diseases of the colon and rectum, fecal incontinence, Crohn’s disease, diverticulitis, and chronic constipation. “Allowing healthy, age-appropriate patients to easily schedule a colonoscopy, usually without a pre-procedure visit, will help save even more lives,” says Dr. Kayal.
How Do You Know if You Qualify for an Open Access Colonoscopy?
Answer these four questions:
If you answered yes to all of the above questions, you’re likely a good candidate for an open access colonoscopy, making it easy for you to get this potentially life-saving screening.
How Do You Schedule an Open Access Colonoscopy?
Most medical professionals who perform the test will either refer patients to their website to fill out an open access request form online, take the information over the phone, or send a questionnaire in the mail for you or your primary care physician to be fill out and return. Most often, a nurse will review your information and have someone from the doctor’s office contact you to schedule your test with the physician of your choice or the next available physician.
“If you find yourself unable to qualify for an open access screening, it’s still important to contact your doctor and arrange for a consultation and get your screening colonoscopy,” advises Dr. Kayal. “Open access colonoscopies make them simpler to plan, but that doesn’t mean that you shouldn’t get a colonoscopy if you’re unable to participate.”
It’s the colorectal cancer screening itself that detects colon polyps and reduces incidences of colon cancer, not the open access colonoscopy program. In recognition of National Colorectal Cancer Awareness Month, do yourself a favor and arrange to get screened now.
Fortunately, most of the 20.5 million Americans who have gallstones, tiny hard stones that slow down or block the flow of bile from the liver to the gallbladder, don’t experience much discomfort. However, for some gallstone sufferers, a Cholecystectomy (surgical removal of the gallbladder) may be necessary to ease their pain.
Whether you’re considering gallbladder surgery through one large incision, minimally invasive laparoscopic surgery, or the state-of-the-art precision instrument guided da Vinci Single-Site Surgery procedure, it will be tough to digest certain foods for about a month post-op, according to Amit S. Kharod, M.D, a general surgeon, board-certified in general and laparoscopic surgery, who specializes in gallbladder removals.
Your gallbladder is a small pear-shaped organ that sits under the liver and stores bile, a fluid that is a mixture of cholesterol, body salts, and bilirubin pigment (which gives bile its yellowish-green color). Bile is produced in the liver and stored in the gallbladder until it is released to break down fatty foods passing through the small intestine. “After surgery, your gallbladder is no longer controlling the release of bile to help aid digestion, so it takes the body some time to adjust to this change of bile flow,” explains Dr. Kharod. “In most cases, you should be able to return to normal healthy eating within a month.”
As your body gradually readjusts to life without its gallbladder, it’s best to stick to a light diet. To avoid excessive gas, slowly begin eating high-fiber foods such as whole-grain breads, beans and legumes, fruits, and fiber-rich dark-colored vegetables. While you’re recuperating, here are 5 types of food you should definitely stay away from.
“Over time, post-surgical problematic foods can be incorporated back into your diet as long as they don’t cause diarrhea and abdominal pain,” says Dr. Kharod. Another strategy to use while recovering from gallbladder surgery is to eat several small meals each day. “Doing so puts less strain on the digestive tract and makes it easier to comfortably digest food.”
Article courtesy: The website of the National Cancer Institute (http://www.cancer.gov)
About 18 million Americans are faced with the psychological strain, inconvenience, and embarrassment of bowel incontinence (fecal incontinence). This condition is usually caused by injury to the rings of the muscle at the end of the rectum (anal sphincter) that make it difficult to hold stool back properly.
Bowel incontinence is more common in women and older men. In fact, as many as one in 10 women over the age of 40 are living with this condition. Muscle and nerve damage to the anal area is often brought on by women who have had vaginal deliveries and episiotomies, forceps used during childbirth, or a weakened pelvic floor. It’s also caused by diseases such as diabetes, multiple sclerosis, or late-stage Alzheimer’s.
Those who live with this condition not only have to deal with the physical symptoms, but also the mental anguish it causes, including social isolation, which can lead to a diminished quality of life and depression. “Fortunately, there are several procedures that can help you overcome this all-consuming condition so you can start living a normal life again,” says Thomas J. Kayal, M.D., a board-certified colon and rectal surgeon who specializes in laparoscopic colon surgery, and minimally invasive robotic-assisted surgery that treats diseases of the colon and rectum, fecal incontinence, Crohn’s disease, diverticulitis, and chronic constipation.
If dietary changes, physical therapy, and medication prescribed to change the consistency of your stool doesn’t alleviate the problem, there is a simple two-step minimally invasive outpatient surgical procedure that can help. “Colorectal surgeons can perform a 15-minute treatment called Interstim® Therapy (also known as Sacral Nerve Stimulation) that strengthens the nerve stimulus to the anal muscles and significantly improves your ability to control bowel movements,” explains Dr. Kayal.
Interstim® Therapy can be accomplished in two visits. Here’s what you need to know about each visit.
Part one of the treatment is done under local anesthesia where a miniature electrode is inserted under the skin in your lower back. Once this procedure is complete, you can go home and rest comfortably. No hospitalization is required.
After a successful seven-day trial of the newly-implanted miniature electrode, a second procedure is performed in which a half dollar-sized battery is implanted into your buttocks, again under local anesthesia. This provides an electrical stimulus to the anal sphincter continuously, which results in the end of your fecal incontinence episodes. Once the procedure is over, you can go home. “You should start to experience significant improvement in the ability to control your bowel movements, and within a few days, you’ll be able to feel completely secure that you’ll never have an accident again,” adds Dr. Kayal.
There’s no reason to suffer in silence. If you or someone you know is experiencing bowel incontinence, please contact us to discuss how we can help improve your quality of life.
Everyone experiences the temporary discomfort of an upset stomach, bloating, gas, heartburn, diarrhea or constipation, but how do you know when your symptoms warrant calling a medical professional?
First, it’s helpful to understand how your digestive system functions so you’re more aware of when it isn’t working properly. Your gastrointestinal system consists of a group of organs working together to absorb the food you eat, and then turns it into nutrients that fuel your body. The part of the food that your body can’t use is passed out as waste.
“When the absorption process does not work smoothly, or if the digestive system passageway becomes clogged, you’re likely to suffer from more than just your average stomach ache,” warns Amit Kharod, M.D., a general surgeon, board-certified in general and laparoscopic surgery, who specializes in intestinal and colon surgery, gallbladder removals, laparoscopic hernia repairs, and complex abdominal wall construction surgery.
According to the National Institute of Diabetes and Digestive and Kidney Disease, 60 to 70 million people are affected with some form of a digestive disease. Here are four warning signs that shouldn’t be ignored:
1. Sharp pain in the upper right abdomen. If you experience a sharp pain in your upper right abdomen that is sometimes accompanied by nausea and vomiting or jaundice (the yellowing of the skin and eyes), you may be suffering from gallstones. If this is the case, you’ll need medicine to dissolve them or surgery to remove your gallbladder.
2. Bulging lump around your navel. This could be a sign of an umbilical abdominal hernia. “Along with this condition comes a risk of obstruction of the intestines and surgery is often required to avoid the threat of hernia strangulation,” explains Dr. Kharod.
3. Pain in the lower left abdomen. Abdominal pain most often in the lower left abdomen, mucus in the stool, or severe rectal bleeding could be signs that you have a colorectal condition such as Crohn’s disease, ulcerative colitis, rectal prolapse, or diverticulitis. Depending on the severity, treatment might include medication, dietary changes, or even surgery. Current advances in less-invasive surgical procedures, like the da Vinci ™ system, combines the use of high-tech robotic surgery with a minimally invasive surgical procedure. The system is guided by a surgeon and offers patients many benefits over traditional open abdominal operations.
4. Blood in your stool. If you feel like you need to have a bowel movement right after you’ve had one, or spot blood in your stool, your doctor may test your red blood cell count for anemia. He or she may also check your liver function and your bloodstream for tumor markers. Depending on the outcome of the blood test, further testing for colorectal cancer may be done.
“Some of the risks for even the most serious digestive diseases, like colorectal cancer, can be reduced with dietary changes,” says Dr. Kharod. According to the World Health Organization, red and processed meats like beef, pork, veal, bacon, sausage and hot dogs contain chemicals that have been known to cause cancer in humans. Reducing or eliminating consumption of these foods is a step in the right direction towards keeping your gastrointestinal system working efficiently.