General & Foregut Surgery

A hernia is a hole in the muscle of the abdominal wall through which fat, intestines or other organs can push out. Some of the most common sites for a hernia include the belly button (umbilical), the groin (inguinal), or a previous incision (ventral). A hernia can cause symptoms like pain or a bulge that may or may not be able to be pushed back into your abdomen. Typically, a hernia can be repaired at your convenience, but some may require urgent or emergent surgery if the intestine becomes trapped in the hernia. Hernias are repaired by placing the contents of the hernia back into the abdomen and closing the hole in the muscle with sutures and often with a mesh. Hernias can be treated with open, laparoscopic or robotic approaches dependent on the specifics of the hernia. Recovery time can be variable depending on the size of the hernia and type of surgery performed. Usually patients will not be able to perform any heavy lifting for 2 – 6 weeks.

Mesh is a piece of fabric used to reinforce a hernia repair. Except in the smallest of hernias, the risk of recurrence increases greatly without the use of mesh. Using mesh is the gold standard for most types of hernia repair. Certain types of mesh have been recalled and are no longer in use. The mesh products used by Surgical Specialists of Colorado are FDA approved without any recalls.

The gallbladder is a small organ attached to the liver which holds bile made by the liver. When someone eats something fatty or greasy the gallbladder contracts to give a little extra bile to help digest that food. It is common for the gallbladder to develop stones within it. Sometimes these do not cause symptoms and do not require any intervention. People who develop symptoms from gallstones typically have pain in the right to middle upper abdomen that occurs a few hours after eating or at night. The pain can also radiate to the back and often is associated with nausea and vomiting. If a patient is having these symptoms a workup will be done to determine if it is the gallbladder causing the problem. The most common treatment if the gallbladder is found to be the cause is to have surgery to remove the gallbladder. When the symptoms are intermittent or manageable at home, this can be done at the patient’s convenience. Severe episodes can last longer than four hours and be associated with fevers. In this case, the gallbladder can be removed urgently or emergently. Most people do not notice any long-term consequences of not having a gallbladder. Elective gallbladder surgery is usually an outpatient procedure with patients going home the same day.

Dr Irani at Surgical Specialists of Colorado is one of the only surgeons in the state of Colorado who is specially trained to treat lower esophageal conditions such as achalasia or esophageal diverticula. Achalasia is a rare condition where an individual tries to swallow and feels like something is stuck. This is due to the lower sphincter being too tight and because of that it is unable to relax so that food can pass through. A minimally invasive surgery allows the surgeon to cut the muscle and make the area wider so that food can pass through. Patients who have this procedure can expect to have one night in the hospital and it is generally recommended that they take one to two weeks off work. Patients with achalasia can also be diagnosed with esophageal diverticula. In this case, there is a pouch that forms in a weak area in the lining of the esophagus. If the patient is having symptoms, the surgeon can remove this and staple it off. Again, the patient can expect just a night in the hospital before returning home.

Surgery on the stomach/distal esophagus, also known as foregut surgery, is used to address problems such as severe reflux/heartburn, a hiatal hernia or stomach cancer.

Reflux often can be treated with medications, reserving surgical treatment for patients who do not improve with medications or are not able to be on life-long medications.

A hiatal hernia is when a portion of the stomach slides up into the chest area through the diaphragm. It is repaired by bringing the stomach back into the abdomen out of the chest and tightening the diaphragm with sutures, and sometimes placing a mesh.

Gastroparesis is a condition where the stomach doesn’t empty, essentially paralyzed. Diabetes is a common cause because it can damage the nerves and lead to gastroparesis. It can also be genetic or induced by a virus. For individuals who suffer from this, they often experience nausea and abdominal pain. Sometimes so much that they choose to drink their calories rather than eat. A pyloroplasty is often used to treat this condition. In this procedure the surgeon releases the muscle at the bottom of the stomach to open the stomach and patients feel better almost immediately.

Stomach cancer requires removal of all or part of the stomach with the surrounding lymph nodes. The small intestine is then reconnected to the remaining portion of the stomach or to the esophagus.

Generally, stomach/foregut surgery results in a need to remain in the hospital after surgery for one or more days until specific criteria determined by your surgeon is met. During recovery, a special diet may be recommended until a regular diet can be resumed.

The small and large intestines can have problems that require surgery including obstruction, infection, inflammation, or cancer. The most common cause of obstruction is scar tissue from previous abdominal surgeries. Infections of the intestines can include appendicitis, diverticulitis, or clostridium difficile colitis. Inflammatory bowel disease includes ulcerative colitis or Crohn’s disease. Cancer can develop in either the small or large intestines. With any of these diseases, the treatment may require removing the involved portion of the intestines or possible formation of a temporary or permanent ostomy. This can be done using the open, laparoscopic, or robotic techniques. Intestinal surgery typically requires the patient to stay in the hospital during the initial recovery.

Tumors can develop in the skin, muscle, or fat which can be benign or cancerous. The most common benign growths include lipomas and sebaceous (epidermal/pilar) cysts. The skin can develop cancers like squamous cell carcinoma, basal cell carcinoma or melanoma. Fat and muscle can develop cancers called sarcomas.  General surgeons are specially trained to remove these lesions with appropriate amounts of surrounding tissue. These surgeries are most commonly performed as outpatient surgery meaning that the patient can go home the same day.  

Certain medications require special catheters placed in the blood vessels. For patients with cancer, ports allow treatment with chemotherapy medications while protecting the smaller vessels in the extremities. A port has two portions, a catheter that enters a large vein of the neck or under the clavicle (collar bone), and an access site (port or reservoir) with a rubber top that is underneath the skin on the upper chest wall. The entire port remains under the skin, but a nurse can access the port with numbing medicine and a special needle through the skin to give medications like chemotherapy drugs. These devices are placed using x-ray and/or ultrasound guidance.  When a patient is not admitted to the hospital already, this procedure can be performed as an outpatient (patient goes home the same day) and has a quick recovery.

Patients with severe kidney disease often require kidney replacement therapy/dialysis. Sometimes this therapy can be provided with peritoneal dialysis, which will be determined by the patient’s kidney doctor (Nephrologist). A peritoneal dialysis catheter is a permanent catheter that is placed in the abdomen with part of it tunneled under the skin and the end exiting the skin. This can be attached to a machine that instils a fluid that absorbs toxins and certain electrolytes from the body (serving in place of the body’s non-working kidneys). The machine removes this fluid at the end of the treatment. One major benefit of this type of renal replacement therapy is that it can be performed at home. General surgeons are specially trained to be able to place these catheters, remove them, and/or manipulate them if needed. This procedure is usually performed as an outpatient surgery (patient goes home the same day). Once the catheter is placed, peritoneal dialysis treatments typically start 2 weeks later.  

 Our surgeons are on-call at hospitals for emergencies. This includes injuries due to trauma, as well as emergent processes like appendicitis or bowel perforation. The surgeons at Surgical Specialists of Colorado take call at numerous well-respected hospitals throughout Colorado in order to help with treatment of a full spectrum of emergencies/traumas.