General Surgery

Laparoscopic surgery has several advantages over traditional, open surgery. Laparoscopic surgery is less invasive and requires only small incisions. It is associated with less pain, bleeding, complications, and scarring. Additionally, less invasive surgery methods tend to require a shorter hospital stay and have a quicker recovery time. In some cases, surgeries may be performed as outpatient procedures.

Below are conditions and treatments we perform though other than laparoscopic means:

Click on the videos and downloads for enhanced details including pictures and video animations. Please be advised that some material may be considered graphic. No information conveyed on this website should be construed as a medical diagnosis and in all cases a personal consultation with a surgeon is required.

Pilonidal Cyst

What Are Pilonidal Cysts?

Pilonidal cysts are basically pus-containing inflammations which develop in the sacral or coccygeal areas—that is, in the area about a few centimeters above the cleft of the buttocks. Pilonidal cysts are literally a pain in the butt. If you have a pilonidal cyst, you would get up on your seat or couch frequently or turn your butt to the other side to prevent your cysts from being compressed or further traumatized.

How Can Pilonidal Cysts Be Treated?

There are a number of ways you can treat a pilonidal cyst. If you have only a simple, not inflamed, dimple or sinus tract you do not need any immediate treatment.The most common form of treatment to accurately get rid of these cysts is through a surgical procedure called incision and drainage.

Incision and Drainage for Pilonidal Cysts

An inflamed pilonidal cyst is basically an abscess, therefore requires incision and drainage in order to improve. The procedure is fairly simple, but you must go through it. First of all, an anesthetic agent will be given to the area of affection. Afterwards, the surgeon, with the use of a scalpel will incise the skin in order to expose the cyst and remove the pus, hair, and other skin debris inside the cystic formation. Once everything has been drained, the surgeon will either close the incision or just leave it unstitched and just covered with gauze.

Post-Surgical Care for Pilonidal Cysts

After the surgery, the patient may leave the clinic as soon as possible. No further admission to the hospital is needed since the procedure is in fact an outpatient procedure. The patient will have to take pain medications, anti-inflammatory drugs and antibiotics to prevent discomforts during recovery.

Wound care is also an important aspect during the post-surgical phase. Thus, it is important that the patient, as well as his or her caregiver follows instructions on how to perform wound care effectively in order prevent recurrence, infection and further complications.

Recovery Period for Pilonidal Cysts Surgery

Full recovery may take from several days to weeks depending on the form of surgery performed. For cases where the wound is closed after drainage, recovery would take a lot faster while for cases wherein the wound is left open and allowing the insides to heal first would take several weeks.

Tracheostomy

A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. This tube is called a tracheotomy tube or trach tube.

Why the Procedure is Performed

A tracheostomy may be done if you have:

  • A large object blocking the airway
  • An inability to breathe on your own
  • An inherited abnormality of the larynx or trachea
  • Breathed in harmful material such as smoke, steam, or other toxic gases that swell and block the airway
  • Cancer of the neck, which can affect breathing by pressing on the airway
  • Paralysis of the muscles that affect swallowing
  • Severe neck or mouth injuries

If the tracheostomy is temporary, the tube will eventually be removed. Healing will occur quickly, leaving a minimal scar. Sometimes, a surgical procedure may be needed to close the site (stoma).Occasionally a stricture, or tightening of the trachea may develop, which may affect breathing. If the tracheostomy tube is permanent, the hole remains open.

Click on the link below for slide series:

Tracheostomy Slide Show - series
Traqueotomía - Serie
Tracheostomy Medical Animation Video

Skin Lesion

Indications for surgery

Skin surgery is indicated for the removal of skin lesions that are, or may be, malignant, or if benign, are causing concern because of symptoms or cosmetic appearance. Patients with large lesions or lesions on the face may be referred to a dermatologist or plastic surgeon for management.

The surgical management of benign and malignant skin lesions may include:

  • Incisional biopsy including punch biopsy, shave biopsy
  • Excision biopsy with primary closure
  • Shave excision
  • Curettage
  • Electrosurgery including diathermy, coagulation and cautery
  • Mohs micrographically controlled surgery
  • Complex reconstruction using flap procedure or skin graft

Combinations of these techniques are often used. The aim is for minimal scarring after any surgical procedure.

Mohs surgery is a technique used in the treatment of several skin cancers that allows for complete removal of the lesion while minimizing removal of otherwise normal adjacent skin. Any location in the body can be treated with Mohs surgery, but it is typically reserved for nonmelanoma skin cancers occurring on the following locations:

  • Ears
  • Eyelids
  • Nose
  • Lips
  • Any sensitive location on the body that would have a higher risk of complications with regular surgical excision

Mohs surgery is a convenient and safe surgical technique that provides precise and complete removal of common nonmelanoma skin cancers while preserving as much normal skin surrounding the lesion as possible. Skin cancers removed typically include:

  • Primary basal cell carcinoma
  • Primary squamous cell carcinoma
  • Recurrent nonmelanoma skin cancers
  • Skin cancers with ill-defined borders
  • Skin cancers with high recurrence rates

Lipoma

A Lipoma is a benign (noncancerous) tumor made up of fat tissue. The typical Lipoma is a small, soft, rubbery lump located just beneath the skin. They are usually painless and are most often found on the upper back, shoulders, arms, buttocks, and upper thighs. Less commonly, these tumors can be found in deeper tissue of the thigh, shoulder, or calf.

Although Lipomas can occur at any age, they most often appear between the ages of 40 and 60 years. They are the most common soft tissue tumor found in adults, and occur slightly more often in men than in women. It is possible to have more than one Lipoma.

Lipomas typically do not change after they form, and have very little potential for becoming cancerous. They often require no treatment other than observation. However, if a Lipoma is painful or continues to grow larger, it can be removed with a simple excision procedure.

There has been no proven connection between the development of Lipomas and any particular occupation or exposure to chemicals or radiation. Some doctors think that Lipomas occur more often in inactive people.

Biopsy. A biopsy is sometimes necessary to confirm the diagnosis of Lipoma. In a biopsy, a tissue sample of the tumor is taken and examined under a microscope. Your doctor may give you a local anesthetic to numb the area and take a sample using a needle. Biopsies can also be performed as a small operation.

In most cases of Lipoma, a biopsy is not necessary to confirm the diagnosis. After the Lipoma is removed, a biopsy will be done on a sample of the tissue.

Under a microscope, Lipomas often have a classic appearance with abundant mature fat cells. Sometimes there can be a small amount of other cell types, too, such as cartilage or bone.

Treatment

Excision (Removal)
The only treatment that will completely remove a Lipoma is a simple surgical procedure called excision.

Procedure. In this procedure, a local anesthetic is typically injected around the tumor to numb the area. Large Lipomas or those that are deep may require regional anesthesia or general anesthesia. Regional anesthesia numbs a large area by injecting numbing medicine into specific nerves. General anesthesia puts you to sleep.

After the anesthesia is given, your doctor will make an incision in your skin and cut the tumor out.

Recovery. You should be able to go home soon after the procedure. You will have a few stitches, which your doctor will remove within a couple of weeks.

How long it takes you to return to most daily activities will depend on the size and location of your Lipoma. If you have any pain or discomfort, you may want to limit some activity. Your doctor will provide you with specific instructions to guide your recovery.

Recurrence. Lipomas are almost always cured by simple excision. It is unusual for a Lipoma to grow back, but if it does recur, excision is again the best treatment option.

Portacath Insertion

A Portacath is an implanted venous access device for patients who need frequent or continuous administration of chemotherapy. Drugs used for chemotherapy are often toxic, and can damage skin, muscle tissue, and sometimes veins. They often need to be delivered into large central vein where the drugs are immediately diluted by blood stream and delivered efficiently to the entire body. Cancer patients also require frequent blood tests to monitor their treatments. For patient with difficult veins, it can be used for withdrawing blood for blood tests.

Using modern technique, the Portacaths we have inserted are highly appreciated by patients, oncology nurses and doctors. The procedure is easily performed with minimal risk and pain, a very small price for the convenience and safety months and years ahead.

What is a Portacath?

A Portacath consists of a reservoir (the portal) and a tube (the catheter). The portal is implanted under the skin in the upper chest. It may appear as a bump under the skin in thin patients, less visible in patients with thicker subcutaneous fat. The catheter runs in a tunnel under the skin, going over the collar bone and then enters the large vein in the lower neck (the internal jugular vein). Since it is completely internal so swimming and bathing are not a problem. The septum of the portal is made of a special self-sealing silicone rubber. It can be punctured up to one thousand times and therefore can be used for many years.

What preparation is required?

You need to avoid solid food from midnight. Clear fluid and medications are allowed up to the time of procedure. If your are on aspirin, Warfarin or plavix, check with your own doctor if these can be stopped for 5 days. You can resume these medications the day after insertion. Insertion is best delayed if you have active infection.

What are the aftercares required?

When the Portacath are no longer used, it need to be flushed with saline and locked with heparinised saline once per month to keep it patent.

If the Portacath is no longer required, it can be removed by us. The procedure is performed under sedation and local anesthetic, similar to insertion.

Central Line Insertion

In medicine, a central venous catheter ("central line", "CVC", "central venous line" or "central venous access catheter") is a catheter placed into a large vein in the neck (internal jugular vein ), chest (subclavian vein or axillary vein) or groin (femoral vein). It is used to administer medication or fluids, obtain blood tests (specifically the "mixed venous oxygen saturation"), and directly obtain cardiovascular measurements such as the central venous pressure.

Medicines are injected through the skin into the catheter. Some implanted ports contain a small reservoir that can be refilled in the same way. After being filled, the reservoir slowly releases the medicine into the bloodstream. An implanted port is less obvious than a tunneled catheter and requires very little daily care. It has less impact on a person's activities than a PICC line or a tunneled catheter. Surgically implanted infusion ports are placed below the clavicle with the catheter threaded into the right atrium through large vein. therapy.

Ports are typically used on patients requiring only occasional venous access over a long duration course of therapy. Since the port must be accessed using a needle, if venous access is required on a frequent basis a catheter having external access is more commonly used

Click on the link below for video and slide series:

Chest tube insertion – series
Inserción de una sonda torácica - Serie

Central Line Medical Animation Video

Decubitus Ulcer Treatment (Pressure Ulcers)

Pressure sores (bedsores, decubitus ulcers, pressure ulcers) are areas of skin damage resulting from a lack of blood flow due to pressure.

  • Sores often result from pressure but may also result from pulling on the skin or friction, particularly over bony areas.
  • The diagnosis is usually based on a physical examination.
  • Treatment includes cleansing, removal of pressure from the affected area, special dressings, and, sometimes, surgery.

Pressure sores can occur in people of any age who are bedridden, chairbound, or unable to reposition themselves. They are more common among older people. They tend to occur over bony projections where pressure on skin can be concentrated, such as over the hip bones, tailbone, heels, ankles, and elbows. They occur where there is pressure on the skin from a bed, wheelchair, cast, splint, or other hard object. Pressure sores can be life threatening if they are untreated or if underlying health conditions prevent them from healing

Even with optimal medical management, many patients require a trip to the operating room for débridement, diversion of the urinary or fecal stream, release of flexion contractures, wound closure, or amputation.

Click on the link below for video

Sores That Will Not Heal

Brochure Downloads:

Preventing and Caring for Pressure Sores

Treatment of Hemorrhoids

Hemorrhoids are swollen, inflamed veins around the anus or lower rectum. They are either inside the anus or under the skin around the anus. They often result from straining to have a bowel movement. Other factors include pregnancy, aging and chronic constipation or diarrhea.

Hemorrhoids are very common in both men and women. About half of all people have hemorrhoids by age 50. The most common symptom of hemorrhoids inside the anus is bright red blood covering the stool, on toilet paper or in the toilet bowl. Symptoms usually go away within a few days.

Click on the link below for video and slide series:

Interactive Video Introduction to Hemorrhoid Surgery

Hemorrhoid Surgery Slide Series

Cirugía de hemorroides – Serie