Achalasia of the esophagus is a condition characterized by a lack of peristalsis – the action that moves food through the esophagus towards the stomach – and a failure of the esophageal sphincter to relax, resulting in high pressure where the esophagus meets the stomach. Sympxoms of achalasia include difficulty swallowing (dysphagia) and vomiting undigested food. Recurrent episodes may cause pneumonia, especially in the elderly. If this condition worsens, weight loss and malnutrition may develop. Pain is infrequent but heartburn may result due to retention of food in the esophagus. If surgery is the form of treatment your doctor recommends for achalasia, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic esophagomyotomy is appropriate for you.
This operation is called the Heller Myotomy and it lasts about two hours. Laparoscopic surgery uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision at the umbilicus (belly button). The laparoscope is connected to a tiny video camera – smaller than a dime – which projects a view of the operative site onto video monitors located in the operating room. The abdomen is inflated with carbon dioxide, a gas, to allow your surgeon a better view of the operative area. Two or three additional small incisions are made near the laparoscope through which the surgeon inserts specialized surgical instruments. The surgeon uses these instruments to perform the operation. Following the procedure, the small incisions are closed with sutures and covered with surgical tape. After a few months, they are barely visible.
It is important to follow your doctor’s instructions after surgery. Although many people feel better in just a few days, you may need to take it easy for two to four weeks.
If performed by experts in this field, laparoscopic esophagomyotomy is as safe as “open” surgery in carefully selected cases.
To schedule an appointment, please call the Department of General Surgery at 216-444-6664.
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The adrenal medulla, the inner portion of the adrenal gland, secretes the stimulants epinephrine and norepinephrine. Pheochromocytoma, a tumor of the adrenal medulla, causes excessive amounts of these stimulants to be released, resulting in hypertension. Pheochromocytoma is most common in young people. Only a small percentage of the lesions is malignant.
When an adrenal tumor or malignancy is present, an adrenalectomy (removal of one or both adrenal glands) is performed to reduce excessive secretions of adrenal hormones. If surgery is the form of treatment your doctor recommends, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic adrenalectomy is appropriate for you.
An adrenalectomy is the removal of one adrenal gland (unilateral adrenalectomy), the removal of both adrenal glands (bilateral adrenalectomy), or partial removal of one or both adrenal glands. Laparoscopic adrenalectomy uses a thin, telescope-like instrument called a laparoscope. The laparoscope is connected to a tiny video camera – smaller than a dime – which projects a view of the operative site onto video monitors located in the operating room. The procedure is performed through a posterior (back), flank or transabdominal approach. The abdomen is inflated with carbon dioxide, a gas, to allow your surgeon a better view of the operative area. Two or three additional small incisions are made near the laparoscope through which the surgeon inserts specialized surgical instruments. The surgeon manipulates these instruments to perform the adrenalectomy. Following the procedure, the small incisions are closed with sutures and covered with surgical tape. After a few months, they are barely visible.
It is important to follow your doctor’s instructions after surgery. Although many people feel better in just a few days, you may need to take it easy for two to four weeks.
If performed by experts in this field, laparoscopic adrenalectomy is as safe as “open” surgery in carefully selected cases.
1. Siperstein A, Berber E, Engle KL, Duh Q-Y, Clark OH. Laparoscopic posterior adrenalectomy: technical considerations. Arch Surg 2000 Aug;135(8):967-71.
2. Berber E, String A, Engle KL, Siperstein AE. Laparoscopic management of a posterior mediastinal tumor mimicking an adrenal neoplasm. Surg Endosc 2000;14:680 (published online April 17,2000).
3. Berber E, Duh Q-Y, Clark OH, Siperstein AE. A Critical Analysis of Intraoperative Time Utilization in Laparoscopic Adrenalectomy. Surgical Endoscopy 2002;16:258-62.
4. Kebebew E, Siperstein AE, Clark OH, Duh QY.Results of laparoscopic adrenalectomy for suspected and unsuspected malignant adrenal neoplasms. Arch Surg. 2002 Aug;137(8):948-51; discussion 952-3.
5. Cheah WK, Clark OH, Horn JK, Siperstein AE, Duh QY.Laparoscopic adrenalectomy for pheochromocytoma. World J Surg. 2002 Aug;26(8):1048-51. Epub 2002 Jun 6.
6. Kebebew E, Siperstein AE, Duh QYLaparoscopic adrenalectomy: the opximal surgical approach. J Laparoendosc Adv Surg Tech A. 2001 Dec;11(6):409-13.
7. Shen WT, Lim RC, Siperstein AE, Clark OH, Schecter WP, Hunt TK, Horn JK, Duh QY.Laparoscopic vs open adrenalectomy for the treatment of primary hyperaldosteronism. Arch Surg. 1999 Jun;134(6):628-31; discussion 631-2.Appointment
To schedule an appointment, please call the Department of General Surgery at 216-444-6664.
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Abdominal pain can have many causes. Accurate diagnosis is an important first step to determine the correct treatment to resolve your pain. Diagnostic laparoscopy helps your doctor differentiate between pain caused by gynecologic conditions (endometriosis, ovarian cysts, or ectopic pregnancy) and other surgical conditions (appendicitis, gallstones, abscess, stricture, diverticulitis, tumor, etc.). If surgery is the form of treatment your doctor recommends, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic surgery is appropriate for you.
How is diagnostic laparoscopy performed?
Laparoscopic surgery uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision at the umbilicus (belly button). The laparoscope is connected to a tiny video camera – smaller than a dime – which projects a view of the operative site onto video monitors located in the operating room. The abdomen is inflated with carbon dioxide, a gas, to allow your surgeon a better view of the operative area. If additional intervention is indicated, additional small incisions are made in the abdomen through which the surgeon inserts specialized surgical instruments to correct the cause of your pain. Following the procedure, the small incisions are closed with sutures or surgical tape.
What are the benefits?
• Two or three tiny scars instead of one large abdominal scar
• Shorter hospital stay – you may leave the hospital on the same day
• Reduced postoperative pain
• Shorter recovery time and quicker return to daily activities, including work
What can I expect after surgery?
You will receive instructions on post-operative activity before you are discharged from the hospital. Although many people feel better in just a few days, you may need to take it easy for a week or two.
How safe is a diagnostic laparoscopy?
If performed by experts in this field, diagnostic laparoscopy is as safe as “open” surgery in carefully selected cases.
Appointment
To schedule an appointment, please call the Department of General Surgery at 216-444-6664.
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Gallbladder Surgery
The gallbladder is a small, pear-shaped organ positioned under the liver in the upper right portion of the abdomen. Its main purpose is to collect bile, a digestive agent that is produced by the liver. Gallbladder problems usually are the result of gallstones, small masses that form in the gallbladder or in the bile duct. Gallstones may block the flow of bile from the gallbladder, causing it to swell. Sympxoms may include sharp abdominal pain, vomiting, and indigestion. Gallbladder pain may start after a meal and it may be a severe, steady pain. If left untreated, sympxoms may worsen.
Gallbladder doesn’t need to be removed unless the gallstones are causing sympxoms. However, when severe obstruction of the gallbladder occurs, removal is the only opxion. If surgery is the form of treatment your doctor recommends, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic surgery is appropriate for you.
How is laparoscopic cholecystectomy performed?
Laparoscopic surgery uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision at the umbilicus (belly button). The laparoscope is connected to a tiny video camera – smaller than a dime – which projects a view of the operative site onto video monitors located in the operating room. The abdomen is inflated with carbon dioxide, a gas, to allow your surgeon a better view of the operative area. Three additional small incisions are made near the laparoscope through which the surgeon inserts specialized surgical instruments. The surgeon uses these instruments to remove the gallbladder. Most of the time, an x-ray of the bile duck (cholangiogram) is obtained by injecting dye to rule out stones in the main bile ducts. Following the procedure, the small incisions are closed with sutures and covered with surgical tape. After a few months, they are barely visible.
What are the benefits of laparoscopic cholecystectomy?
• Four tiny scars instead of one large abdominal scar
• Shorter hospital stay – you may leave the same day or the day after surgery
• Reduced postoperative pain
• Shorter recovery time – days instead of weeks – and quicker return to daily activities, including work
What can I expect after surgery?
It is important to follow your doctor’s instructions after surgery. Although many people feel better in just a few days, you may need to take it easy for two to four weeks.
How safe is laparoscopic cholecystectomy?
If performed by experts in this field, laparoscopic cholecystectomy is as safe as “open” cholecystectomy in carefully selected cases.
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Common Bile Duct Exploration
The common bile duct is a tube that connects the liver, gallbladder, and pancreas to the small intestine and helps to deliver fluids that aid digestion. A cholangiogram is an x-ray that determines if a stone is blocking the flow of bile from the liver and gallbladder to the intestines. A common bile duct exploration is indicated if a stone is blocking the common bile duct. One of the complications of common bile duct blockage is jaundice, a condition that results in a yellow color of the skin and whites of the eyes. If a stone in the common bile duct is not removed, the duct may become infected, resulting in emergency surgery. Common bile duct exploration is often done during surgery to remove the gallbladder. If surgery is the form of treatment your doctor recommends, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic surgery is appropriate for you.
How is laparoscopic common bile duct exploration performed?
Laparoscopic surgery uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision in the abdomen. The laparoscope is connected to a tiny video camera – smaller than a dime – which projects a view of the operative site onto video monitors located in the operating room. Two or three additional small incisions are made near the laparoscope through which the surgeon inserts specialized surgical instruments. The surgeon uses these instruments to explore the common bile duct and adjacent structures. Once the stones are located, they are removed using a number of instruments including special balloons, stone baskets or a flexible endoscope. A temporary tube, called a T-tube, may be in place after the operation to drain excess bile. Following the procedure, the small incisions are closed with sutures and covered with surgical tape. After a few months, they are barely visible.
ERCP, which is another minimally invasive method to treat CBD stones is also performed by the physicians at the MIS center.
What are the benefits?
• Three or four tiny scars instead of one large abdominal scar
• Shorter hospital stay – you may leave the same day or the day after surgery
• Reduced postoperative pain
• Shorter recovery times – days instead of weeks – and quicker return to daily activities, including work
What can I expect after surgery?
It is important to follow your doctor’s instructions after surgery. Although many people feel better in just a few days, you may need to take it easy for two to four weeks.
How safe is laparoscopic common bile duct exploration?
If performed by experts in this field, laparoscopic common bile duct exploration is as safe as “open” surgery in carefully selected cases.
The following reference list is included for your convenience :
1. Berber E, Engle KL, String A, Garland AM, Chang G, Macho J, Pearl JM, Siperstien AE: Selective use of tube cholecystostomy with interval laparoscopic cholecystectomy in acute cholecystitis. Archives of Surgery 2000 Mar;135(3):341-6.
2. Berber, E, Garland A, Foroutani A, String A, Siperstein AE. Laparoscopic ultrasound appearance of the common bile duct mucosa: a predictor of choledocholithiasis. Journal of Ultrasound in Medicine 2001;20:15-19.
3. Berber E, Engle KL, Pearl JM, Siperstein AE. A critical analysis of intraoperative time utilization in laparoscopic cholecystectomy. Surg Endosc 2001;15:161-5.
4.
Siperstein A, Pearl J, Macho J, Hansen P, Gitomirsky A, Rogers S. Comparison of laparoscopic ultrasonography and fluorocholangiography in 300 patients undergoing laparoscopic cholecystectomy. Surg Endosc. 1999 Feb;13(2):113-7.
Appointment
To schedule an appointment, please call the Department of General Surgery at 216-444-6664.
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Laparoscopic Gastric Surgery
Laparoscopic gastrectomy is removal of all or part of the stomach. This procedure is performed to treat recurrent pepxic ulcer disease, to remove a chronic gastric ulcer, to stop hemorrhage in a perforated ulcer, or to remove a malignancy. If surgery is the form of treatment your doctor recommends, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic surgery is appropriate for you.
How is laparoscopic gastrectomy performed?
Laparoscopic surgery uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision at the umbilicus (belly button). The laparoscope is connected to a tiny video camera – smaller than a dime – which projects a view of the operative site onto video monitors located in the operating room. The abdomen is inflated with carbon dioxide, a gas, to allow your surgeon a better view of the operative area. Two or three additional small incisions are made near the laparoscope through which the surgeon inserts specialized surgical instruments. The surgeon uses these instruments to remove all or a portion of the stomach and to attach any remaining portion of the stomach to the small intestine. Following the procedure, the small incisions are closed with sutures and covered with surgical tape. After a few months, they are barely visible.
Another technique is endoluminal gastric surgery where small benign lesions can be removed by inserting the trocars into the stomach, filling the stomach with gas and doing the procedure inside the stomach.
What are the benefits?
• Three or four tiny scars instead of one large abdominal scar
• Shorter hospital stay – you may leave the same day or the day after surgery
• Reduced postoperative pain
• Shorter recovery time – days instead of weeks – and quicker return to daily activities, including work
What can I expect after surgery?
It is important to follow your doctor’s instructions after surgery. Although many people feel better in just a few days, you may need to take it easy for two to four weeks.
How safe is laparoscopic gastrectomy?
If performed by experts in this field, laparoscopic gastrectomy is as safe as “open” surgery in carefully selected cases.
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Pepxic Ulcer Disease
The right and left vagus nerves have many motor and sensory functions. One of these functions is to aid in gastric acid secretion and gastric empxying. There is an increase in gastric acid production when these nerves are over-stimulated. Over time, an increased gastric acid production may lead to pepxic ulcer disease. A vagotomy is the removal of a section of the vagus nerves. This procedure eliminates the increased secretion of gastric acid.
Laparoscopic vagotomy is usually an opxion for those individuals who have failed medical management (antacids, H2 blockers, proton pump inhibitors, or helicobacter pylori treatment), or those who require indefinite drug therapy to control their sympxoms, or those who have developed a complication (bleeding, perforation, or obstruction). If surgery is the form of treatment your doctor recommends, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic surgery is appropriate for you.
How is laparoscopic vagotomy performed?
Laparoscopic surgery uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision at the umbilicus (belly button). The laparoscope is connected to a tiny video camera – smaller than a dime – which projects a view of the operative site onto video monitors located in the operating room. The abdomen is inflated with carbon dioxide, a gas, to allow your surgeon a better view of the operative area. Three or four additional small incisions are made near the laparoscope through which the surgeon inserts specialized surgical instruments. The surgeon uses these instruments to perform the operation. Following the procedure, the small incisions are closed with sutures and covered with surgical tape. After a few months, they are barely visible.
In emergency conditions as well, such as perfrated pepxic ulcer disease, the surgical procedure can be performed laparoscopically. This entails closure of the hole in the stomach or duodenum using laparoscopic techniques.
What are the benefits of laparoscopic vagotomy?
• Four or five tiny scars instead of one large abdominal scar
• Shorter hospital stay – you may leave the same day or the day after surgery
• Reduced postoperative pain
• Shorter recovery time – days instead of weeks – and quicker return to daily activities, including work
What can I expect after surgery?
It is important to follow your doctor’s instructions after surgery. Although many people feel better in just a few days, you may need to take it easy for two to four weeks.
How safe is laparoscopic vagotomy?
If performed by experts in this field, laparoscopic vagotomy is as safe as “open” surgery in carefully selected cases.
Appointment
To schedule an appointment, please call the Department of General Surgery at 216-444-6664.
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Heartburn
The word “heartburn” is often used to describe a variety of digestive problems. In medical terms, heartburn is a sympxom of gastroesophageal reflux disease (GERD), a condition in which stomach acids reflux, or push upward, from the stomach into the esophagus. A common sympxom of GERD is a harsh or burning sensation in the chest, throat, and neck. Other sympxoms may include regurgitation, difficulty swallowing, and chronic coughing or wheezing. Reflux problems can be treated with lifestyle changes, drug therapy, or surgery. If surgery is the form of treatment you doctor recommends, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic surgery is appropriate for you.
NOTE : Be sure to have chest pain evaluated by your doctor immediately. Chest pain or discomfort caused by your heart may feel similar to the pain caused by GERD.
What causes GERD?
Located at the bottom of the esophagus is a valve called the lower esophageal sphincter (LES). Normally, the LES remains closed until swallowing forces it to open. It closes immediately after swallowing to prevent reflux. If the LES fails to close properly after swallowing, stomach acids can reflux into the esophagus. These acids irritate the lining of the esophagus and cause discomfort.
How is laparoscopic Nissen fundoplication performed?
Laparoscopic surgery uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision at the umbilicus (belly button). The laparoscope is connected to a tiny video camera – smaller than a dime – which projects a view of the operative site onto video monitors located in the operating room. The abdomen is inflated with carbon dioxide, a gas, to allow your surgeon a better view of the operative area. Four additional small incisions are made near the laparoscope through which the surgeon inserts specialized surgical instruments. The surgeon uses these instruments to recreate the lower esophagus sphincter by wrapping the very top of the stomach around the esophagus. Following the procedure, the small incisions are closed with sutures and covered with surgical tape. After a few months, they are barely visible.
What are the benefits of laparoscopic nissen fundoplication?
• Five tiny scars instead of one large abdominal scar
• 90 to 95 percent of patients report good to excellent relief of sympxoms
• Shorter hospital stay – most people leave one to three days after surgery
• Less postoperative pain
• Clear diet the within 24 hours followed by a gradual progression to solid food
• Shorter recovery time – days instead of weeks – and quicker return to daily activities, including work
What can I expect after surgery?
It is important to follow your doctor’s instructions after surgery. Although many people feel better in just a few days, you may need to take it easy for one or two weeks.
How safe is laparoscopic surgery for heartburn?
If performed by experts in this field, laparoscopic surgery for heartburn is as safe as “open” surgery in carefully selected cases.
Appointment
To schedule an appointment, please call the Department of General Surgery at 216-444-6664.
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Hernia Repair
A hernia develops when a portion of the abdominal wall weakens, permitting the inner lining of the abdomen to push through the weakened area. A balloon-like sac or tear may form in the weakened area. A loop of intestine or abdominal tissue may slip into the sac or tear, causing severe pain or other potentially serious health problems.
Men and women of all ages can develop a hernia. Hernias usually result from a natural weakness in the abdominal wall, or from excessive strain on the abdominal wall, including strain from heavy lifting, substantial weight gain, persistent coughing, or difficulty with bowel movements or urination. Eighty percent of all hernias are located near the groin. Hernias may also develop below the groin (femoral), through the navel (umbilical), or along a previous surgical incision (incisional). If surgery is the form of treatment your doctor recommends, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic surgery is appropriate for you.
How is laparoscopic hernia repair performed?
Laparoscopic surgery uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision at the umbilicus (belly button). The laparoscope is connected to a tiny video camera – smaller than a dime – which projects a view of the operative site onto video monitors located in the operating room. The abdomen is inflated with carbon dioxide, a gas, to allow your surgeon a better view of the operative area. Two additional small incisions are made near the laparoscope through which the surgeon inserts specialized surgical instruments. The surgeon uses these instruments to open the peritoneum, the inner lining of the abdomen, and to expose the weakened area. A mesh patch is affixed to reinforce the weakness. Following the procedure, the small incisions are closed with sutures and covered with surgical tape. After a few months, they are barely visible.
What are the benefits of laparoscopic hernia surgery?
• Three tiny scars instead of one large abdominal scar
• Shorter hospital stay – you may leave the same day or the day after surgery
• Reduced postoperative pain
• Shorter recovery time – days instead of weeks – and quicker return to daily activities, including work.
What can I expect after surgery?
It is important to follow your doctor’s instructions after surgery. Although many people feel better in just a few days, you may need to take it easy for two to four weeks.
How safe is laparoscopic surgery for hernia repair?
If performed by experts in this field, laparoscopic hernia repair is as safe as “open” hernia repair in carefully selected cases.
The following reference list is included for your convenience:
Rosen M, Brody F, Ponsky J, span Walsh RM, Rosenblatt S, Duperier F, Fanning A, Siperstein A. Recurrence after laparoscopic ventral hernia repair. Surg Endosc. 2003 Jan;17(1):123-8. Epub 2002 Sep 23.
Appointment
To schedule an appointment, please call the Department of General Surgery at 216-444-6664.
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Laparoscopic Liver Resection
With the advent of technology, laparoscopic techniques are being applied to liver resection as well. The lesions that are amenable to laparoscopic liver resection include those at the edges of the liver (segment II, III, V and VI).
How is laparoscopic liver resection performed?
Most of the lesions that are located in the left lobe of the liver can be resected using 4-5 incisions 5 to 12 mm in size. For complex left lobe lesions and for those located in the right lobe, a hand-assisted technique is used, meaning that a 7 to 10 cm incision in the right lower quadrant or the midline is used to insert the surgeons hand inside the abdomen to perform the procedure.
What are the benefits?
Potential benefits include a smaller incision, resulting in reduced postoperative pain, shorter hospital stay and faster recovery.
What can I expect after surgery?
Faster recovery compared to patients with larger incisions.
How safe is laparoscopic liver resection?
As explained above, this minimally invasive technique is used in selected patients whose tumors are located in certain locations in the liver. With these selection criteria, it is as safe as “open surgery” in the hands of surgeons trained in this specialty.
Appointment
To schedule and appointment, please call the Department of General Surgery at 216-444-6664.
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Morbid Obesity
Laparoscopic Gastric Bypass Surgery
Obesity is a common problem in the United States. The U.S. Surgeon General, in a 1988 report on nutrition and health, estimated that one-fourth of adult Americans are overweight. The treatment of obesity is very difficult, especially in the absence of correctable endocrine problems. Low-calorie, low-fat balanced diets are usually recommended, along with exercise. “Crash” diets and diet drugs are usually discouraged.
What is morbid obesity?
Patients weighing more than 100 pounds over their ideal body weight or a calculation of the body mass index (BMI = weight in kilograms divided by height in centimeters squared) greater than 35-40. Your doctor will explain BMI in greater detail and carefully assess your need for surgery. You may be considered for surgical intervention and treatment if attempxs at restrictive diets and exercise have failed.
Will my insurance company cover this surgery?
In recent years, it has been clearly recognized that obese individuals have a shortened life span. Many insurance companies are paying for this type of surgery and now consider obesity a substantial risk. Massively obese persons have an increased risk of diabetes, hypertension, heart disease, lymphoma, sleep apnea, and osteoarthritis.
Please contact your insurance company to determine if they will cover this type of medical care. The Cpx code is 43999, an unlisted laparoscopic procedure, compared to Cpx codes 43846 and 43847 (open codes). To speak with a financial counselor at the Cleveland Clinic, please call 216/445-1745.
What is involved preoperatively, operatively and postoperatively?
Preoperative
Persons considered for surgery are carefully evaluated. Studies are performed with special attention to cardiac, pulmonary, and endocrine status. A psychological evaluation is considered essential by most physicians to determine a potential patient’s response to weight loss and change in body image. Nutritional counseling is also a must preoperatively.
Operative
Various laparoscopic (minimally invasive) surgical procedures have evolved in an effort to “shunt” or bypass a portion of the stomach. The procedure we perform at the Cleveland Clinic Foundation is a Laparoscopic Isolated Gastric Bypass.
• Five small surgical instruments the diameter of a pencil are introduced into the abdomen through 1-cm incisions.
• These five openings allow for the surgeon to pass a light, camera and instruments into the abdomen.
• The abdomen is inflated with gas (carbon dioxide) in order to allow the surgeon better visualization of your stomach and internal structures.
• Greater than two thirds of the stomach is “bypassed” and a small portion (large enough to hold a cup of liquid) remains functional.
Postoperative
Most patients have an uneventful recovery.
• The hospital stay is usually about 5-7 days.
• You will usually be off work for 3 to 4 weeks.
• Follow up requires periodic clini- cal evaluation, long-range meta- bolic, nutritional and psychologi- cal follow-up due to the change of life style and body image.
• Vitamin and mineral supplements may be added to your diet postoperatively.
What are the benefits to laparoscopic gastric bypass surgery?
Most patients benefit from decreased postoperative pain, shorter hospital stay, quicker return to activities of daily living, and less scarring. Laparoscopic Gastric Bypass Surgery eliminates 15 to 25 percent of hernias that can be seen after open traditional surgery for morbid obesity, which necessitates reoperation. Typically the patient’s weight reduction occurs during the first year following surgery. Many patients require plastic surgery (abdominoplasty or removal of skin folds) 1-2 years after the weight loss. Often, losing significant weight will facilitate the treatment of or eliminate complicating medical problems such as diabetes, hypertension, or coronary artery disease.
The following reference list is included for your convenience.
1. Gleysteen, J, Barboriak, J, Sasse, E. Sustained coronary-risk-factor reduction after gastric bypass for morbid obesity.
Am J Clin Nutr 1990; 51:774-8.
2. Benotti, P, Bistrian, B, Benotti, J, Blackburn, G, Forse, R. Heart disease and hypertension in severe obesity: The benefits of weight reduction.
Am J Clin Nutr 1992; 55:586s-90s.
3. NIH consensus statement. Gasterintesinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement.
Am J Clin Nutr 1992; 55:615s-61s.
4. Rhode, B, Arseneau, P, Cooper, B, Katz, M, Gilfix, B, MacLean, L. Vitamin B- 12 deficiency after gastric surgery for obesity.
Am J Clin Nutr 1996; 63:103-9.
5. MacLean, LD, Rode, BM, Samoalis, J, Forse, RA. Results of surgical treatment of obesity.
Am J Surg 1993; 165:155-162.
6. Halverson, JD. Micronutrient deficiencies after gastric bypass for morbid obesity.
Am Surgeon 1986; 11:594-8.
7. Sarr, MG, Felty CL, Hilmer, DM, Urban, DL, O’Connor, G, Hall, BA, Rooke, TW, Jensen, MD. Technical and practical considerations involved in operations on patients weighing more that 270 kg.
ARCH Surg 1993; 130:102-105.
8. Hoekstra, SM, Lucas, CE, Ledgerwood, AM, Lucas, WF. A comparsion of the gastric bypass and the gastric wrap for morbid obesity.
Surgery 1993; 176:262-6. 9. Ledgerwood, AM, Harrigan, C, Saxe, JM, Lucas, C. The influence of an anesthetic regimen on patient care, outcome and hospital charges.
Am Surg 1992; 58:527-53.
Appointment
To schedule an appointment, please call the Department of General Surgery at 216-444-6664.
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Splenectomy
The spleen is an organ located in the upper left portion of the abdomen, behind the stomach. Its functions are to filter blood, remove bacteria, make blood, and store blood.
If your physician diagnoses any of the following diseases, you may be a candidate for splenectomy (removal of the spleen): acute and chronic leukemia, cysts, primary s plenic thrombocytopenia, idiopathic thrombocytopenic purpura (ITP), primary splenic neutropenia, Felty’s syndrome, Banti’s disease, congestive splenomegaly, splenic tumors, splenic artery aneurysms, lymphomas, thrombolytic thrombocytopenic purpura (TTP), HIV splenomegaly, splenomegaly, splenocytosis, or a variety of anemias. If surgery is the form of treatment your doctor recommends, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic surgery is appropriate for you.
How is laparoscopic splenectomy performed?
Laparoscopic surgery uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision in the flank (the fleshy part of the side between the ribs and hip). The laparoscope is connected to a tiny video camera – smaller than a dime – which projects a view of the operative site onto video monitors located in the operating room. The abdomen is inflated with carbon dioxide, a gas, to allow your surgeon a better view of the operative area. Two or three additional small incisions are made near the laparoscope through which the surgeon inserts specialized instruments. The surgeon uses these instruments to remove the spleen. Following the procedure, the small incisions are closed with sutures and covered with surgical tape. After a few months, they are barely visible.
What are the benefits of laparoscopic splenectomy?
• Three or four tiny scars instead of one large abdominal scar
• Less risk of hernia
• Shorter hospital stay – you may leave one to two days after surgery
• Reduced postoperative pain
• Shorter recovery time and quicker return to daily activities, including work
What can I expect after surgery?
It is important to follow your doctor’s instructions after surgery. Although many people feel better in just a few days, you may need to take it easy for two to four weeks.
How safe is laparoscopic splenectomy?
If performed by experts in this field, laparoscopic splenectomy is as safe as “open” surgery in carefully selected cases.
Appointment
To schedule an appointment, please call the Department of General Surgery at 216-444-6664.
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