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All Posts in Category: Surgical Procedures

Surgical Options for Complex Abdominal Wall Reconstruction

Complex abdominal wall reconstruction is a medically necessary operative intervention that is performed by a highly-trained surgeon to relieve abdominal discomfort and pain that some people experience due to large, recurrent, and/or untreated hernias.

“When tissue and organs push their way through the abdominal wall, surgery is the only remedy that will provide relief from the condition and usually helps individuals remain hernia-free,” explains Amit S. Kharod, M.D., a general surgeon, board-certified in general and laparoscopic surgery, who specializes in complex abdominal wall reconstruction surgery.

There are various surgical options to fix complicated hernias, including suture repair, mesh repair, open repair, as well as laparoscopic and robotic surgery. “Determining which procedure will be most beneficial for each unique patient is my goal,” says Dr. Kharod.

Helping patients choose the right surgery is based on several variables. Read on to find out what factors to consider and what surgical choices you have.

Complex Ventral Hernias
A ventral hernia is a broad medical term consisting of several different types of hernias that slip through a weakened area in the abdominal wall. The most common complex form of a ventral hernia is referred to as an incisional hernia because, as its name suggests, it appears where scar tissue from previous surgeries have weakened the abdominal wall.

Severe ventral hernias require emergency surgery when intestinal tissue gets stuck (strangulated) in the hole of the abdominal wall and can’t be pushed back inside. “This cuts off the blood supply vital to the intestine, leaving the abdomen descended, swollen and painful,” explains Dr. Kharod. Incarcerated hernias also pose a real danger, as they obstruct the flow of the contents of the digestive tract, causing nausea and vomiting.

“Simply pulling together loose muscles like you would do for a tummy tuck is not enough to fix more complicated ventral hernias,” remarks Dr. Kharod. These hernias arise from very wide abdominal wall separations after muscles have deteriorated to the point of not being able to support the application of a mesh patch. “In these cases, identification and delicate rearrangement of interior abdominal muscles must take place before securing the mesh along the wall of the abdomen providing permanent reinforcement.”

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Open Access Colonoscopies Make It Easier for Healthy Individuals to Get Screened for Colorectal Cancer

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:

  1. Are you at least 50 years of age?
  2. Is this your first colonoscopy?
  3. Are you in good health with no major health conditions?
  4. Do you show no signs of colon cancer? Symptoms include, rectal bleeding, dark stools or blood in the stool, a change in bowel habits, weight loss, fatigue and abdominal cramping.

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.

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5 Food Types to Avoid After Gallbladder Surgery

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.

  1. Foods with manufactured trans fats. Packaged baked goods, crackers, margarine, shortening, frosting, and microwave popcorn, can all cause abdominal discomfort following surgery. Since trans fats have been linked to other health issues, such as obesity and heart disease, limit these types of foods until your ability to tolerate fat has returned.
  2. Fried foods. “Fried foods like French fries, potato chips, and donuts aren’t wise choices in general, but after gallbladder surgery your body doesn’t have the same capacity to dissolve fats, so it’s best to avoid high-fat content foods that have been deep fried,” says Dr. Kharod.
  3. Whole milk dairy products. Cheese, full-fat yogurts, and ice cream may upset your digestive tract and cause diarrhea. Eliminating them for the short term can make digesting meals less uncomfortable.
  4. High-fat meats. Sausage, bologna, ground beef, lamb, as well as poultry with skin, all raise the level of cholesterol in your bloodstream and are harder to digest. Excluding animal proteins such as these will help you feel more comfortable.
  5. Spicy foods. Foods that will set your taste buds on fire, like chili, salsa, peppers, and garlic may cause a burning sensation in your abdomen, and stomach cramping right after gallbladder surgery. Steer clear of them while you’re recovering to reduce these gastrointestinal irritations.

“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 (

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Suffering from Bowel Incontinence? This 15-Minute Minimally Invasive Procedure Could Change Your Life

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.

Visit #1:
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.

Visit #2:
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.

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A Revolution in Breast Cancer Treatment? Milder Options are Emerging (Op-Ed)

Article By Dr. Amit Kharod, Bhavesh Balar, Dr. Mary Martucci and 
Dr. Kenneth Tomkovich, CentraState Medical Center

In just the past decade, there has been a rapid evolution in breast cancer diagnosis and treatment protocols. As a result, therapy today is less invasive and far more effective than in the late ’90s, when mastectomy and lumpectomy were considered the gold standard for care.

Not only are we discovering the majority of cancers in earlier stages (0-1), but also the five-year breast cancer survival rate is nearly 90 percent today. However, with more than 230,000 women expected to be diagnosed in the United States with breast cancer this year alone, treatment options will play a pivotal role in saving lives.

While breast cancer is far from the death sentence it once was, it is still nonetheless challenging to treat. Breast cancer, disguised Researchers have learned that breast cancer is not one, singular disease. Rather, breast cancer’s cell biology is composed of many subtypes of different kinds of cancer that act — and react — differently in every patient.

The more oncologists learn about each subtype, the better they can effectively treat tumors and keep cancer cells from spreading.

Studies today are focusing on understanding the molecular makeup of different types of breast cancer. Thanks to advances in genomic testing and deeper insights into the biology of these subtypes, doctors no longer use the one-size-fits-all approach.

Every cancer patient has a different profile of biological risk. Once that risk profile is identified through genetic testing, the attending oncological team uses this unique data to create a personalized treatment and preventative plan for the patient. This allows us to achieve the most promising outcome for the individual, based specifically on her DNA.

Many breast cancers are slow-growing tumors that may never cause symptoms or even threaten to shorten a patient’s life span. Conversely, other breast cancers spread very aggressively, even before they are diagnosed. [US Breast Cancer Cases May Rise 50 Percent by 2030 ]

Breast cancer in stages 0 to 3 becoming a treatable disease
Looking ahead to the next five years, earlier-stage breast cancer (stages 0-3) therapy will continue to evolve, making this a more treatable disease when diagnosed in the earlier In fact, earlier-stage cancers may not be treated with surgery at all.

Early cancer staging indicates the size of the tumor and/or abnormal cells, and whether or not those cells are still contained to the place of origin:
Stage 0: Atypical cells are non-invasive and have not spread outside milk ducts or lobules into the surrounding breast tissue.
Stage 1: Cancer is evident, but confined to the area where the first abnormal cells began to develop.
Stage 2: Cancer is growing, but still contained in the breast or nearby lymph nodes.
Stage 3: Cancer has extended beyond the immediate region of the tumor, may have invaded nearby lymph nodes and muscles, but has not metastasized into additional organs.

Beating a cancer cell at its own game
Cancer is a collection of irregular cells that grow in the body, largely ignored by the immune system and its efforts to overcome and kill invasive cellular matter. One of the most frustrating mysteries that has plagued researchers is why the body allows this to happen when it successfully fights off cold, flu and other foreign cellular combatants every day.

We now know that cancer cells are shielded by a transmembrane protein barrier, called programmed death-ligand 1 (PD-L1), which suppresses the immune system in much the same way as during a pregnancy, allowing cells to multiply and grow unabated.

But cancer researchers are conducting promising clinical trials on patients who have metastatic breast cancer. These researchers use a cocktail of intravenous “inhibitor” drugs that remove the protective cancer-cell shield and enable the immune system to do its job. As a result, the medication empowers the patient’s own defenses to kill the cancer cells, offsetting their ability to grow and spread. These drugs work by basically removing the brakes from the body’s immune system. However, it is important to note that sometimes the immune system starts attacking other parts of the body, which can cause serious, or even life-threatening, problems in the lungs, intestines, liver, hormone-making glands, kidneys or other organs.

It’s also important to note that these drugs are not chemotherapy; rather, they are an innovative immunotherapy that targets tumors and is markedly less harmful to patients. Similar trials were previously conducted to combat melanoma, bladder cancer and lung cancer, and these tests have yielded positive results.
This drug protocol holds tremendous promise for the treatment of all kinds of cancers. It has the potential to revolutionize the way we treat people who have been diagnosed with any kind of cancer. (Side effects from these drugs can include fatigue, cough, nausea, itching, skin rash, decreased appetite, constipation, joint pain and diarrhea.)

Targeting immune system checkpoints is quickly becoming an important part of treatment for some cancers, such as melanoma and lung cancer. Unlike other cancer drugs, these checkpoint inhibitors seem to be helpful against many different types of cancer. Only a few of these treatments have been approved for use so far, but others are now being evaluated in clinical trials. Overall, it offers additional options for treatment; it remains to be seen if it would replace current chemotherapy in certain types of cancers or if it would complement existing treatments for other cancers.

Surgery will be less common and less invasive
Surgery has traditionally been the first treatment protocol after a breast cancer diagnosis. Not so long ago, a woman with a suspicious lump went into surgery with no idea if she would awaken without a breast.

As breast cancer specialists, we see our jobs changing significantly down the road. We will continue to use fewer and fewer invasive procedures to fight cancer of the breast. And, if all goes well, most of us should be out of a job at some point.

In the future, breast surgeons may see their role evolve into a more educational one — working with patients and health care providers to help those affected make the right choices for their particular situations.

These less-invasive surgical approaches not only cause less trauma to women, but they also achieve outcomes comparable to previous, more-invasive surgeries. For example, a 20-year study showed that women with early stage breast cancer (stage 0-2) who underwent mastectomies (breast removal) had about the same prognosis and cancer-recurrence rates as women who underwent breast-conserving lumpectomy (removing only the tumor and an area of surrounding tissue).

Still, today, the health care community is not completely up to speed on newer treatment options. It’s the job of breast cancer physicians to educate other health care professionals, along with patients and families, about the myriad treatment, preventive and diagnostic choices available.

Disintegrating smaller breast cancers without surgery
One of us at Statesir Cancer Center, interventional radiologist Dr. Kenneth Tomkovich, is co-principal investigator overseeing a promising national clinical research trial that uses a cell-freezing technique called cryoablation. This method can extinguish breast tumors no larger than 1.5 centimeters (0.6 inches).

Cryoablation has been previously tested and approved to treat liver, prostate, kidney, skin and cervical cancer. Testing this technique to treat tumors in the breast was a logical follow-up.

Today, women are more diligent about getting routine mammograms and performing self-care exams, and this helps physicians catch more cancers in earlier stages. Our research trial hopes to confirm that freezing these small breast tumors — in lieu of surgically removing them — is less invasive for the patient but ultimately yields comparable long-term patient outcomes against cancer recurrence.
Compared to traditional surgery, cryoablation is less risky and more cost-effective; it also offers faster recovery and improved cosmetic results, resulting in greater patient comfort.

The nationwide trial includes women age 65 and older. That’s because patients in this age group often have additional health issues, such as heart or lung disease, that make them poor candidates for the rigors of traditional breast surgery. While these trial participants were also offered chemotherapy and radiation in lieu of surgery, those treatments come with significant short- and long-term side effects.

Breast cryoablation is similar to a needle biopsy procedure, which is performed in the doctor’s office under local anesthesia.
Using ultrasound guidance, an FDA-approved cryoprobe (thin needle) is inserted until it reaches the center of the tumor. Liquid nitrogen, chilled to minus 160 degrees Celsius (minus 256 degrees Fahrenheit), is injected into the center of the tumor. The goal is to kill the cancerous tumor, along with a thin rim of normal tissue surrounding it, to ensure that the cancer is fully treated (i.e., frozen).

According to trial patients, there are few unpleasant side effects with this treatment, and the patient can go home immediately after the procedure. Over the course of several months, the tumor gradually dissolves away.

If you’re a topical expert — researcher, business leader, author or innovator — and would like to contribute an op-ed piece, email us here.
While long-term outcomes will be studied in years to come, we anticipate cancer-recurrence rates comparable to those of traditional surgical tumor removal. This forecast is based upon longer-term outlooks from previous patients who have undergone cryoablation therapy for other types of cancer.

Cancer treatment no longer means just calling a breast surgeon
The diagnostic focus of breast cancer is still centered on staging, but now includes a molecular evaluation of the tumor as well. These priorities take precedence over more-traditional markers such as the size of the tumor or whether it has entered the lymph nodes or other parts of the body.

Additionally, the days of receiving a cancer diagnosis and automatically assuming one will lose the breast are certainly over.
Physicians can now manage this disease so differently because current treatment options are so plentiful. The cancer treatment community now concentrates on the staging and molecular (genetic) makeup of the tumor first and foremost. After this is determined, the patient partners with a cancer team — medical oncologist, breast surgeon, radiation oncologist and holistic therapy professionals — who collectively devise a multipronged treatment strategy. This is an improved method for fighting cancer that is still big news to a large part of the public.

Follow all of the Expert Voices issues and debates — and become part of the discussion — on Facebook, Twitter and Google+. The views expressed are those of the author and do not necessarily reflect the views of the publisher. This version of the article was originally published on Live Science.

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Breast Conserving Surgery: Surgical Procedures for Early-Stage Breast Cancer

As Breast Cancer Awareness Month comes to a close, we shift our attention to breast conserving options for the more than 200,000 women in the United States who are diagnosed with invasive breast cancer each year.

“When breast cancer is invasive it moves beyond the milk ducts or lobules into the nearby breast tissue,” says Amit Kharod, M.D, a general surgeon, board-certified in general and laparoscopic surgery, who specializes in breast procedures such as mastectomy, partial mastectomy, lumpectomy, and cyst removals.

For these type of patients, many surgeons recommend breast conserving surgery before radiation therapy because they have similar overall survival rates as those who undergo a mastectomy, a surgical removal of the breast. Favorable survival rate statistics is just one reason the majority of early-stage breast cancer patients choose breast sparing surgery, according to Dr. Kharod.  “Other reasons include consideration of the cosmetic appearance of the breast, and a shorter, easier recuperation period.”

The two types of breast conserving surgeries include a lumpectomy and a partial mastectomy. While these surgeries are similar, a partial mastectomy is a more involved procedure. Your doctor will help you determine which procedure best suits your condition. Here’s what you need to know about both surgical methods:

Lumpectomy: A surgeon removes the cancerous tumor along with some surrounding normal breast tissue. The tissue is then sent to a pathology laboratory for detailed testing. The procedure, which typically lasts from 1-2 hours, is most often done with local anesthesia and sedation or general anesthesia (where the patient is put to sleep).  “Your surgeon will remove several lymph nodes in the underarm and have them tested,” says Dr. Kharod. The surgery is followed by radiation. Some patients may also need chemotherapy, and/or hormone therapy after the removal of the tumor.

Partial Mastectomy: Similar to a lumpectomy, your surgeon will remove the tumor and some normal tissue around it, along with several lymph nodes for pathology testing. However, with this procedure, your surgeon will remove more breast tissue and some lining over the chest muscles under the tumor. A partial mastectomy is also followed by radiation. Some patients may also need chemotherapy, and/or hormone therapy as an additional treatment adjunct to surgery to ensure the best survival outcomes.

“When performing breast conserving surgery, a surgeon’s ultimate goal is to deliver completely cancer-free and clear margins of breast tissue around the site of the tumor in order to ensure a low recurrence rate,” says Dr. Kharod.

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