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Our mission is to personalize our treatment plan to each patients individual needs maintaining the

highest standards of medical care.

Medical team

At our office you will meet our receptionist, Mrs. Heather Ackerman, who will assist you during your visit

and dealing with your insurance company. Our nurse, Debby Nagy, will finish the medical history that

you prepared for us and will obtain your vital signs. Additional staff who may be present in the office

include a medical assistant, medical students and surgery residents.

Patient conditions

Introduction: Our practice covers the spectrum of general surgery with the exception of breast surgery.

There are certain conditions that elicit a number of questions on patients for which we decided to

provide some basic information that addresses many of these questions. The list is not at all inclusive,

the fact that you dont see your condition listed does not mean that we dont offer care for it.

Colonic dysmotility

This name refers to chronic constipation. The colon has the job of absorbing all the fluid and

electrolytes that were poured into the gut for digestion of nutrients. Bacteria coexist in symbiosis within

the colon and process the residue of the diet, which is mostly dietary fiber. Once the colon is done with

absorption of fluid and fermentation of fiber the matter left inside the colon becomes more solid. The

colon moves stool by rhythmic contractions of short segments. For these contractions to be effective

there has to be an intact autonomic nervous system and muscle layer in the bowel. When contractions

are not effective stool cannot be expelled. Various conditions affect this process, e.g., gymnasts candevelop compression of nerve roots with their landing from heights and this results in loss of

contractions. Pregnancies of large babies, complicated labor and delivery can also affect the nerves

supplying the colon and rectum. There are many ways of dealing with this problem, including dietary

adjustments, laxatives, and enemas. When these measures no longer work surgery becomes an option.

Before proceeding with surgery we perform some studies. A typical study is the colonic transit time by

Sitz Marks. This study involves ingesting some markers that can be identified through plain radiographs

so they are counted and localized over time. Failure of medical therapy and studies confirming a colonic

dysmotility are an indication for surgery.

Cholelithiasis

The gallbladder serves the purpose of delivering bile into the intestine when we ingest a fatty meal.

Through various mechanisms stones form inside the gallbladder in some individuals. Many individuals go

through life with stones in the gallbladder without ever having any symptoms and the gallstones are

found incidentally in a study or in autopsy. In others, however, stones move around inside the

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gallbladder and get pushed into the outlet of the gallbladder to be expelled. Because of a size disparity

the stones cannot pass, the gallbladder keeps contracting producing colicky pain while it gets filled with

more fluid and becomes a vicious cycle of distention and pain. Occasionally, infection sets in over this

colicky situation, named acute cholecystitis, and patients become sicker with fever and chills. In some

patients, the stones pass out of the gallbladder and then get stuck at the end of the common bile duct

which drains all bile from the liver and merges with the pancreatic duct. This complication, named

choledocolithiasis, can result in jaundice and pancreatitis. The only solution for symptomatic gallstones,

meaning recurrent colicky pain in right upper abdomen associated with gallstones, is removal of the

gallbladder, i.e., cholecystectomy. As opposed to kidney stones that can be shattered from the outside

and urinated out, the nature of the disease with gallstones is that the gallbladder is ill and will keep

producing stones forever. Interestingly, the gallbladder seems to be another spare part in the body.

Surgeons have been doing cholecystectomies for a century and no ill effects have been reported from

missing the gallbladder.

A totally different scenario is the patient with pain in the right upper abdomen who undergoes studies,

typically and ultrasound, and is found to have no stones. Usually, the next step is to obtain a HIDA scanwhich is a study of the contractility of the gallbladder in response to a medicine injected intravenously.

The interpretation of these studies varies from center to center but essentially a calculation is done of

the percent of isotope excreted by the gallbladder in a certain period of time. Then a certain value is

considered normal and anything below it is abnormal. The problem is that the results of these studies

cannot predict the success of surgery in relieving pain in patients without gallstones confirmed by

ultrasound. Not only patients may continue to have the same type of pain but also seem to develop

complications of surgery more often than patients with gallstones. Therefore, our general rule is only

offer cholecystectomy to those patients with either confirmed or highly suspected gallstones, and these

can be very small producing sludge instead of typical stones.

Pelvic floor dysfunction: