Wednesday, September 17, 2014
Inquirer Daily News

Q&A: Surgeries

Drexel Health Q&A Series

I'm considering weight loss surgery. How do I know which kind is right for me?

Answer: Having weight loss surgery is a big decision. There are several choices: gastric bypass, gastric sleeve and gastric banding, to name a few. I really believe that there is not a perfect operation; there are good candidates and bad candidates. A good candidate is going to be successful independent of the choice of surgery. What's most important is choosing the right program ó one that focuses on long-term outcomes, includes education and preparation for the future ó and provides personalized care to help you reach your goals beyond surgery. Working with an integrated team of physicians, nutritionists, nurses and other health care providers who are dedicated to your long-term success will help provide you with an optimal outcome.

 

Paul Nyirjesy, M.D.Andres Castellanos, M.D., is assistant professor and chief of the Division of Bariatric Surgery at Drexel University College of Medicine. He is also director of minimally invasive surgery at the Center for Surgical Weight Loss at Hahnemann University Hospital. Dr. Castellanos specializes in gastro-intestinal surgeries in obese patients using the latest minimally invasive techniques. He sees patients in Center City.


My wife was just diagnosed with colon cancer and needs to have surgery. Can this be done laparoscopically?

Answer: Dealing with a new diagnosis of colon cancer is never easy. Patients have numerous questions about how their life may be impacted by surgery. Fears range from how big the scar will be; how much time will be missed from work; and is there a need for a colostomy bag (rarely for colon cancer). There is good news on all of these fronts. Today we offer laparoscopic or minimally invasive surgery for all colon cancers. Small incisions ó often the size of a dime, are used to introduce a camera and instrumentation into the abdomen. The operation performed is the exact same operation that would be performed with an old-fashioned big scar; there is just less trauma to the body. Although a new diagnosis of colon cancer is scary, in a skilled surgeon's hands, a minimally invasive approach will help allay some of the fears and help patients quickly get back to their usual routines.

 

Paulina Gorodin Kiliddar, MDDavid Stein, M.D., is chief of the Division of Colorectal Surgery at Drexel University College of Medicine. His focus is on the laparoscopic treatment of colorectal cancer and inflammatory bowel disease. He also has expertise in prevention strategies and identifying risk factors for colorectal cancer in younger patients, as well as outcomes analysis in colorectal surgery. Dr. Stein sees patients in Center City and in Wilmington, Delaware.


I keep hearing about robotic surgery. Do you really use a robot? What's the benefit?

Answer: Though it is often called a robot, it cannot act on its own. The surgeon controls the robot and performs the surgery. The robot is designed to provide surgeons with enhanced capabilities, including high-definition 3D vision and a magnified view. The surgeon maneuvers the robot, which translates a surgeon's hand movements into smaller, more precise movements of tiny instruments inside the patient's body. That means complex procedures can be done with just a few tiny openings rather than long incisions. As a result, the patient may be able to get back to his or her life without the usual recovery time following major open surgery. Other benefits include less pain, fewer complications, minimal scarring and a shorter hospital stay.

 

Howard J. Eisen, MDJuan Lucas Poggio, M.D., is director of robotic colon and rectal surgery at Drexel Medicine. His clinical expertise includes both advanced laparoscopic and open surgical management of primary and recurrent colon and rectal cancer and also anal sphincter preserving procedures for distal rectal cancer. He also specializes in the laparoscopic treatment of diverticulitis, inflammatory bowel disease, colorectal polyps, & anal sphincter incontinence. He sees patients in Center City.


Can bypass surgery be done with a minimally invasive approach or is open-heart surgery still the preferred method?

Answer: Conventional heart surgery involves dividing the sternum (breastbone) to allow the surgeon to directly operate on the heart and its vessels. This standard approach, which has been used for many years, has proven to be extremely reliable and effective. Recently, less invasive approaches have been developed that allow the surgeon to operate on the heart through a partial incision in the sternum or between the ribs either directly or with the use of robots. These minimally invasive approaches have a similar benefit to the patient in restoring adequate blood flow to jeopardized areas of the heart. Although these techniques are not appropriate for all patients who require bypass surgery, when appropriate they have potential advantages. As the incisions are smaller, the trauma to the patient is usually significantly less, allowing the recovery to be faster with a shorter length of stay and more rapid return to full activities. Additionally, patients frequently have less discomfort, require fewer blood tranfusions and have fewer infections.

 

Steven P. Kutalek, MDGlenn Laub, M.D., is chairman of the Department of Cardiothoracic Surgery at Drexel University College of Medicine. He has performed over 5,000 cardiac surgery operations and has pioneered minimally invasive and valve procedures. He currently holds more than 40 patents for medical devices, including a less invasive catheter used to connect patients to a heart-lung machine, and one that measures blood flow in a patient’s leg. He sees patients in Center City. 


I have to have a lump removed from my breast. What should I expect in terms of pain and recovery?

Answer: Lumpectomy or surgical removal of a breast mass is performed as an outpatient procedure. The procedure can be done under local or general anesthesia depending on the size and depth of the lump in the breast. While pain thresholds vary, most women have pain following lumpectomy that is controlled with analgesics (e.g, acetaminophen or ibuprofen) and an ice pack. Occasionally, some women will require narcotics post-procedure. If you have the procedure performed on a Friday, you may be able to return to work on Monday depending upon how physically strenuous your job is. Things to report to your surgeon after lumpectomy include redness and drainage at the incision site.

 

Steven P. Kutalek, MDD. Scott Lind, M.D., is chairman of the Department of Surgery at Drexel University College of Medicine. He specializes in breast cancer, melanoma, and surgical oncology. He is a member of the editorial boards of the Journal of Surgical Oncology and Breast Journal. Dr. Lind sees patients in Center City.

 


The information on this page is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.