Other Surgical Procedures

Other Surgical Procedures by Dr. Iraniha

At Newport Laparoscopy, Dr. Iraniha also performs a verity of other general surgical procedures including, thyroidectomy, parathyroidectomy, breast surgery, hemorrhoidectomy and excision of soft tissue tumors in any location.

Hemorhoidectomy

The term, "hemorrhoids" refers to groups of blood vessels in the anorectal area which are present in everyone. However, patients become symptomatic from difficulties with their hemorrhoids. There are two types of hemorrhoids: internal and external. This distinction is important, because of the possible symptoms and treatment alternatives. The division is marked anatomically by the dentate line, which embryologically delineates where skin-type structures meet with rectal lining structures. Importantly, there are many nerve endings for pain distal (beyond) to this line, where the external hemorrhoids are, whereas proximal (in front) to this line, there are no pain fibers.

Both types of hemorrhoids can bleed, thrombose (clot), and prolapse. Normally, external hemorrhoids can be uncomfortable and sometimes disabling when they thrombose.

A thrombosed external hemorrhoid may be associated with a recent change in bowel habits. It will appear as a localized swelling around the anus, the size of a pea or grape, which may be blue or purple in color, and very tender. Pain is due to the clot itself and due to swelling associated with this process. If you are found to have an acutely thrombosed external hemorrhoid, your physician may offer you a small procedure to remove the clot. Even without such a procedure, the clot and the swelling will dissipate, however, often in the first 24-48 hours, the pain can be so intense that you may be unable to complete your normal daily activity. A mild analgesic may be prescribed. Perianal ("around" the anus) care includes the avoidance of constipation, sitz baths (sitting in warm water several times a day and after bowel movements), and good hygiene. Despite the fact that you may have an open wound in a 'dirty' area, it is amazing that the infection and abscess formation are rare. A sequela of external hemorrhoidal disease includes residual skin tags. These are harmless, but may impair good hygiene.

Internal hemorrhoidal disease is managed dependant on symptoms. If medical management is optimal, that is, you have soft bowel movements without straining and have been compliant about observing recommendations to avoid constipation, your physician may offer several therapies for you. First and foremost, other possible explanations must be excluded, including malignancy. Therefore colonoscopy, or other visualization techniques must first be performed to exclude such a possibility. If your internal hemorrhoidal symptoms are more complex, or are associated with external hemorrhoidal symptoms as well, surgical removal of the hemorrhoids may be warranted. During the post-operative period, it is important to care for yourself by avoiding constipation, and continuing good perianal care.

Breast Surgery

Other than skin cancer, breast cancer is the most common cancer in American women.

The goal of screening exams for early breast cancer detection is to find cancers before they start to cause symptoms. Breast cancers that are detected because they are causing symptoms tend to be relatively larger and are more likely to have spread beyond the breast. In contrast, breast cancers found during screening exams are more likely to be small and still confined to the breast.

The size of a breast cancer and how far it has spread are the most important factors in predicting the prognosis (the outlook for chances of survival) of a woman with this disease. Finding a breast cancer as early as possible greatly improves the likelihood that treatment will be successful. Breast Cancer screening includes a Breast Self Examination, Breast X-ray (mammogram) and professional physical examination.

Once a breast lump or breast abnormality has been detected, your doctor may want to conduct a Breast Biopsy. This procedure involves taking sample tissue from the suspicious area to determine whether the breast lump is cancerous or not. While the thought of having a Breast Biopsy may be frightening to some patients, the results can provide a reassuring peace of mind. Remember, the vast majority of Breast Biopsies do not turn out to be breast cancer and a biopsy is currently the only way to achieve an accurate breast cancer diagnosis. There are two methods for producing images in minimally-invasive breast biopsies: 1. Stereotactic breast biopsy 2. Ultrasound Guided braest Biopsy. A Stereotactic [stare-ee-o-tak-tick] Biopsy uses mammography (x-rays) to locate breast abnormalities, while ultrasound biopsies use high-frequency sound waves to create breast tissue images. In a minimally-invasive breast biopsy using stereotactic imaging, a patient lies face down on a special table with their breast protruding through a hole in the table's surface. The breast is lightly compressed to immobilize it throughout the biopsy procedure. The table is connected to a computer that produces detailed x-ray images of the abnormality to be biopsied. Using these images, the doctor guides a special sampling device to collect tissue specimens. Ultrasound Guided Biopsy (UGB) is a minimally-invasive breast biopsy that is performed using ultrasound imaging and is performed on patients in an upright or reclined position. Using a hand-held transducer, a doctor will move the device back and forth across the breast to generate clear images of the abnormal breast tissue. While viewing the images on a computer monitor, the doctor will guide a small probe into the breast to retrieve sample tissue specimens.

If the biopsy shows breast cancer then the surgical intervention is needed. The surgical options would be lumpectomy (removing the breast mass) and axillary lymph node dissection (removing the lymphatic glands of the arm pit) with post-operative radiation therapy vs. modified radical mastectomy. After surgery patient may need chemotherapy or hormone therapy depending on the stage of her disease. In the cases of some pre-cancerous breast lesions or early breast cancer, sentinel lymph node biopsy will be performed to avoid complete removal of the axillary lymphatic glands. In some cases, after the lumpectomy the margin of the specimen is positive (patient has cancer cell in the margin of her specimen). Therefore she will require second operation to excise more breast tissue for negative margin or undergone total mastectomy

Other Surgical Procedures