Specialty Surgical Care to Meet Your Needs

Albany Surgical provides a full range of general surgery services.

Breasts

 

Breast problems are very common.

 

Many breast problems are benign, and some of these may be treated surgically (by removing the problem).

 

The most concerning breast problem is, of course, cancer. Unfortunately, breast cancer is the most common cancer in women other than skin cancers. Breast cancer can also occur in men, but this is much less common because men have much less breast tissue and a lot less of the hormones that frequently stimulate the growth of breast cancers.

 

Breast cancer occurs most commonly in the milk gland tissue, or the milk duct tissue, of the breast. It may be noticed by the patient because of a change in the way the breast feels, a change in the skin of the breast, or a new discharge from the nipple. Very small, early breast cancers may be detected by x-ray (mammograms) before they are noticeable by the patient.  Aggressive use of mammograms to screen for early breast cancer has actually resulted in a significant decrease in breast cancer deaths over the last twenty or thirty years, because many cancers were discovered while they could still be cured.

 

The treatment of breast cancer varies based on the size and nature of the cancer, whether or not it has spread, how far it has spread (this is the stage of the cancer), and the patient's age and physical condition. Many breast cancers are treated with chemotherapy and/or radiation.  Some breast cancers do not require either of these types of treatment. Virtually all breast cancers will require some type of surgical treatment, however, since removal of the cancer itself is almost always beneficial to the patient. The nature and size of the operation varies, according to the individual characteristics of the cancer and the patient. We tailor surgical therapy to fit the problem.

Parathyroid/ Thyroid Parathyroid disease is usually manifested by high blood calciums and the consequences of such, including but not limited to: kidney stones, brittle bones and fractures, constipation, muscle weakness and oftentimes some type of mental problem that may vary from sleepiness and fatigue, to altered mental consciousness. The cause of these symptoms is overactive parathyroid gland/glands, which live beside the thyroid. The cause of usual hyperparathyroidism is not clearly known, but we believe it is due to long-standing Vitamin D deficiency or borderline deficiency. There are also genetic syndromes that cause hyperparathyroidism, but they are extremely rare. Diagnosis is made by finding elevated blood calcium along with a high PTH (parathyroid hormone) level, low phosphorus, and high chloride levels.  A nuclear scan is used to locate which of the usual 4 glands is the culprit so it can be removed in the operating room.  There is no medical treatment for this, unless the problem is discovered early and high doses of Vitamin D are successful in bringing  a remission. Unfortunately, this is uncommon.  It is possible to have parathyroid cancer, but this is extremely rare and - to present - has never been seen in Albany.  After surgery, it is important to remain on adequate amounts of Vitamin D and get blood tests to prove you are taking a sufficient amount. This should be yearly.  When this is not done, hyperparathyroidism will come back with another gland acting up. The main complication of surgery is hoarseness from damage to the nerves of the voice box.  But, as with the 811 commercials, we look for the nerves before we dig. The thyroid is a gland in the neck, over the voice box. It makes thyroid hormone, which acts as a helper for lots of processes in the body. Too much, and you feel jittery and weak; but too little, and you feel sluggish, cold and can bring about hair and skin problems. In addition, the gland can get enlarged (called a goiter) which could be a failing gland, an overactive gland, or a cancer. Here in the south, we commonly see lots of lumps in the thyroid. 90% of these are benign (no cancer), but some are due to cancer, which require surgery. Most goiters are due to under-functioning glands, which a combination of lab and x-ray tests can determine. We treat this by replacing the thyroid hormone that the gland is struggling to make. Hyperthyroidism is almost always associated with a large thyroid. The symptoms are: tremors, shakes, sweats, weight loss, rapid pulse or heart rate and hair loss. Here, the diagnosis is made with blood tests and a nuclear scan.  There are 3 causes: Graves’ Disease, toxic nodular goiter and Hashimoto's Disease. All are treated with a combination of radioactive iodine (RAI) and beta blockers, which are usually used to treat high blood pressure.  If the disease does not respond to RAI, then surgery may be necessary. In all cases, the patient will end up on lifelong thyroid hormone replacement, which is inexpensive. Thyroids with lumps are a "whole ‘nother story"! Remember: most are not cancer, but 15-20% are cancer, so we have to try to find out what is what. The first thing we do is feel the gland.  Soft bumps can be cysts which, when stuck with a needle, will resolve. Hard ones need a sonogram and a nuclear scan occ. If the lumps are solid, then needle aspiration biopsy is done to see if there are cancer cells, or other abnormalities that could force surgery.  If it is a benign goiter, as mentioned above, the treatment is thyroid hormone replacement. If the biopsy is suggestive of cancer, then the treatment is to remove all (or part) of the thyroid, possibly followed by RAI and thyroid hormone replacement. The main complication with surgery, is injury to the nerves to the voice box, injury to all the parathyroid glands and post-op bleeding.  Most patients are kept in the hospital overnight after surgery.  They can return to work in a few days. 

Hernia

 

A hernia is a hole in the muscle of the abdominal wall. Hernias are classified and treated according to their location, size, and symptoms. Hernias of the upper abdominal wall are called ventral hernias. Hernias at the belly button are called umbilical hernias. Hernias associated with a previous incision are called incisional hernias. Groin hernias are most commonly called inguinal and are associated with a tunnel through the muscle that is more prominent in men. Occasionally, hernias in the groin called femoral hernias, occur where the blood vessels flowing to the leg exit the abdomen. Different types of hernias require different operations, and the closure of the hole in the muscle may need reinforcement with mesh.

 

At Albany surgical, we are experts in evaluating and treating different types of hernias. Many hernias can be repaired laparoscopically, without large abdominal incisions. Some hernias can be left alone. The plan for treating any hernia depends on a detailed history, physical exam, and occasionally, radiographic imaging.

 

Gall Bladder

 

The liver makes bile.  The bile flows down tubes (ducts) to the very beginning of the small intestine, to mix with food leaving the stomach.  The food and bile flow through the intestine, and bile helps the intestine absorb oil and fat.  When we aren't eating, the bile flow backs up into the gallbladder to be stored.  At the next meal, the gallbladder squeezes and the stored bile flows down through the system into the small intestine.  So, the gallbladder can be viewed as a little storage tank for bile.

 

However, the gallbladder can stop functioning well, and this is usually due to some level of inflammation.  This may occur for many reasons.  Most commonly, it is because the bile has turned solid and formed stones within the gallbladder.  These are gallstones.  Gallstones can irritate the gallbladder, leading to symptoms such as pain in the right upper abdomen, nausea, and vomiting.  Frequently the pain will radiate to the right mid-back.  Gallstones can also escape into the downstream bile ducts, creating further problems such as backup of bile in the liver, or inflammation of the pancreas (pancreatitis).

 

Whether the gallbladder inflammation is associated with stones or not, removal of the gallbladder is frequently indicated to alleviate symptoms.  This operation used to be done through a relatively large incision in the right upper abdomen, which frequently led to a lot of pain and sometimes hospitalizations lasting for days.  Fortunately, the development of laparoscopic techniques has made removal of the gallbladder much less traumatic and painful.  This type of surgery uses several small incisions and a camera in the abdomen.  It allows the surgeon to remove the gallbladder from its attachments and remove it through one of the small incisions and extract it from the abdomen with minimal distress to the patient.  If needed, the bile ducts can be x-rayed during the operation to verify that there are no stones in the duct system.  This operation is frequently done on an outpatient basis, with most patients returning to work in as little as a few days.

 

Like any operation or procedure, laparoscopic removal of the gallbladder has certain risks.  Fortunately, because this operation is so common, General Surgeons have developed the experience required to accomplish it very safely.  As a result, complications are very rare.

Gastrointestinal Surgery

 

Gastrointestinal Surgery refers to any operation done on the digestive system.  This can include the esophagus, stomach, small intestine, or large intestine (colon).

 

Many problems with the esophagus occur in the chest, and are therefore treated by chest surgeons.  Problems with the  abdominal portion of the esophagus and the stomach, such as gastroesophageal reflux (GERD), are often treated by general surgeons. Other stomach problems, such as ulcers, gastritis, and some stomach tumors, are also frequently treated by general surgeons. Testing of the esophagus and stomach may be extensive and may involve measurement of acid in the esophagus, how well the esophagus moves food down to the stomach, x-rays of the esophagus and stomach, and placement of a scope down the esophagus into the stomach (EsophagoGastroDuodenoscopy, or EGD) to take pictures and look for abnormalities.

 

Surgical problems with the small intestine commonly include obstruction (due most frequently to a hernia or scar tissue from previous surgery) or inflammation (as in Crohn's disease). Tumors may grow in the small intestine, but this is fortunately rare.  General surgeons treat virtually all problems of the small intestine in some way.  The small intestine is difficult to reach with a scope, but is frequently imaged using CT scan or a series of X-rays that can see contrast material move through the system after it has been ingested by the patient.

 

The large intestine, or colon, is a part of the digestive system that is very frequently evaluated and treated by general surgeons. Colon cancer is common, and it is the reason for many colon operations. Colon cancer is a serious problem, but fortunately it can be detected early with a simple scope procedure (colonoscopy).  Early detection of colon polyps, that may transform later into cancer, allows removal of the problem before it becomes dangerous. Other colon problems include inflammation (as in Crohn's disease or ulcerative colitis), diverticulosis, diverticulitis, and problems with the colon's ability to move material through and eliminate waste. All of these problems are commonly evaluated and treated by general surgeons.

Hemorrhoids and Anorectic Problems

 

Many people have "hemorrhoid “ problems, but of those who have frequent symptoms, there are other causes for these symptoms other than hemorrhoids, even no rectal bleeding pain, itching lumps, and bumps can all be caused by other issues.

 

Hemorrhoids are only varicose veins of the anus caused by constipation, pregnancy, heavy lifting, sedentary lifestyle, and prolonged sitting vocations such his truck driving. Over 50% of all people have some hemorrhoid symptoms during their lifetime. They don't cause cancer but they do cause a lot of symptoms such as bleeding pain itching rectal seepage and prolapse.

The biggest problem is to exclude other more serious problems that may cause the same symptoms. Bleeding from the rectum can be caused by hemorrhoids but also by cancer anal warts fissures and rectal infection and inflammation such as Crohn's disease and ulcerative colitis. It is important for everyone fifty years of age, and some over 40 who have a family history, to have a colonoscopy at least every 10 years and anorectal exam by a trained general or colorectal surgeon will be able to make a proper diagnosis.

 

So, if it is hemorrhoids, what do we do about them? There are suppositories Tucks and Preparation H pads that contained witch hazel, compounding ointments, suppositories, surgery and rubber band ligation. We currently recommend CRH O' Reagan ligation with rubber bands. This is not a new procedure but a new technique that is more precise and less painful. We are able to ligate hemorrhoids well up in the rectum without pain or anesthesia the office. No preparation is required; no time off work is needed. There are usually three large groups of hemorrhoids which are banded one at a time every 2-3 weeks. This allows the lower external hemorrhoids to dry up. Most insurance companies reimburse this very well because there is no hospital charge.

 

Open surgical hemorrhoidectomy requires general anesthesia and usually an overnight stay in the hospital with 2-3 weeks off work. There are times when this is the only option.

 

Anal Fissures

 

Anal fissures are common problems and cause an awful lot of pain. They are caused by severe constipation with very hard stools. Initial treatment is to first fix the constipation with bulking agents and lots of water. Use of special compounded ointments and suppositories will relieve the pain and the rectal muscle spasm that is associated with the fissure and is the primary cause of the pain. Rarely these processes do not work and surgery to partially cut the rectal sphincter is required to relieve the pain

 

Anal Cancer

 

Anal Cancer is not recognized by the patient and sometimes but not well by a primary care physician. The only symptom is that of pain and bleeding the same as hemorrhoids and fissures. It usually begins as a sore in anal canal. It is associated with anal and perinea! condyloma (warts). Treatment is primarily nonsurgical with chemotherapy and radiation simultaneously. Any anal sore that will not heal, requires evaluation by a surgeon to exclude this problem.

 

Anal Warts

 

These are fairly common and are caused by a virus called HPV, the same virus that causes cervix cancer and other cancers as well as usually anal cancer. They need to be aggressively treated. Most require laser or cautery therapy in the operating room to remove .

 

Hemorrhoid Tags

 

These are fairly common after previous episode of thrombosed hemorrhoids and tend to cause itching and seepage and can be removed easily in the office under local

 

 

Rectal Abscess

 

These fairly common. They result from infection in glands that surround the rectum and also by skin oil glands. They cause a good bit of pain, sometimes fever and swelling. They require prompt surgical drainage. They will not get well with antibiotics without surgery. These are especially problematic in diabetics.

ALBANY SURGICAL