'surgery' posts

The most common thing that I see as a pediatric surgeon is a child with a lump that is thought to be a hernia. A hernia is a bulging of tissue through an opening in the muscle layers that isn’t normally present. In children, these openings are usually the result of a developmental process that just didn’t quite reach completion. Some hernias need surgery emergently, while others are observed for years with the expectation that they will close on their own.

Here are some pointers to help understand this wide range of approaches to hernias:

Location is very important in considering how aggressive to be with hernias. Belly button (umbilical) hernias are...

SEATTLE, Sept. 11, 2012 - For patients too sick to undergo open-heart surgery, a new, FDA-approved, minimally invasive aortic valve replacement procedure - now being performed by Swedish Heart & Vascular Institute (SHVI) providers - is offering new hope to patients whose life-threatening heart condition was previously inoperable.

Rib fractures are the most common chest injury accounting for 10 to 15 percent of all traumatic injuries in the U.S. Nearly 300,000 people are seen each year for rib fractures and 7 percent of this population will require hospitalization for medical, pain, and/ or surgical management.

Rib fractures can cause serious complications including: bleeding in the chest (hemothorax), collapse of the lung (pneumothorax), or result in a fluid accumulation in the chest (pleural effusion), just to name a few. As well, rib fractures may contribute to the development of a lung infection or pneumonia. These problems are important to diagnose following chest trauma and even more importantly, when present, they need to be followed closely in the early post-traumatic period.

The most common symptom that people experience with rib fractures is....

Pectus excavatum often referred to as either "sunken" or "funnel" chest is the most common congenital chest wall deformity affecting up to one in a thousand children. It results from excessive growth of the cartilage between the ribs and the breast bone (sternum) leading to a sunken (concave) appearance of the chest.

(Image source)

Although present at birth, this usually becomes much more obvious after a child undergoes a growth spurt in their early teens. Pectus excavatum can range from mild to quite severe with the moderate to severe cases involving compression of the heart and lungs. It may not cause any symptoms, however, children with pectus excavatum often report exercise intolerance (shortness of breath or tiring before peers in sports), chest pain, heart problems, and body image difficulties. The last issue deserves some attention as children often are reluctant to discuss how the appearance of their chest affects their self-esteem globally. There is a bias even within the medical community to dismiss the appearance component of pectus excavatum as merely "cosmetic", but I view the surgery to fix this congenital defect as corrective and support the idea that the impact of its appearance should be considered. I have seen patients emotionally transformed in ways that they and their families never expected.

Thanks in great part to the pioneering work of Dr. Donald Nuss (a now retired pediatric surgeon in Virginia), we have a well-proven minimally invasive option to correct pectus excavatum: the Nuss bar procedure. This involves ...

If you are scheduled to have surgery, it is normal to be concerned about pain you may experience after surgery.

The best time to talk about post-surgical pain is actually before your operation. Make sure you:

• Talk to your surgeon about your experience with different methods of pain control.
• Bring a current list of all your medicines and any drug allergies with you to your appointment.
• Be honest about your alcohol and drug use. If you are abusing alcohol or drugs, you may experience withdrawal from these substances making your postoperative recovery difficult. If you are a recovering from alcohol or drug abuse we can design a pain management plan to reduce the chance for relapse.
• Ask questions about the post-surgical pain: the severity, how long it will last, how it will be treated, what medications will be used, how they work, and their possible side effects.
• Discuss any concerns you have about taking pain medications.

Surgical pain is common and should be expected after your procedure. Luckily, modern pain medications and anesthesia can minimize surgical pain. While we cannot eliminate all pain, we want to make you as comfortable as possible. Our pain management goals are simple:

Have you ever noticed someone whose chest sinks inward in the front, kind of like a funnel? The first time I ever noticed this bony malformation was when I was in high school, and a friend of mine on the soccer team had one. It was called “pectus excavatum,” he told me.

In my thoracic surgery training, I was often called upon to evaluate patients with this chest wall abnormality. As a result, I began to delve deeper into some of the issues that may affect people with this type of defect.

Pectus excavatum is the most common chest wall deformity and results from abnormal development of the sternum and its attachments. Most patients are self conscious about the defect and usually focus on its appearance but because this is usually present for much of a person’s life, symptoms associated with it may not be totally obvious. Individuals affected generally get used to how they feel and try to overcome any limitations to the best of their abilities without even knowing that’s what they are doing. Most patients describe some chest discomfort, shortness of breath when exerting themselves, lack of endurance, or feeling embarrassed in social situations when their shirt is off. It is not uncommon to hear patients say that they have trouble keeping up with their friends during activities, or that they avoid any activities that would require them to take off their shirt in public-such as going to a pool.

Most physicians aren’t even aware that there is an effective treatment for pectus excavatum...

Come to the Northwest Women’s Show held this Friday, March 2 through Sunday, March 4 and visit the various Swedish and Minor & James booths. Come learn about Weight Loss Services, try your hand on the daVinci robot at the Robotics Surgery Program booth, visit Minor & James and ask skin-care questions or learn about the women’s health services available. Or, take a look inside the Swedish Mobile Mammography van and learn about mammograms and breast care.

(Make sure you take advantage of a $2 off coupon for admission to the show!)

We'll also have the hands-on daVinci robot device so you can test your hand skills on the robot and get an idea of what it would be like to be a robotic surgeon at Swedish - you can also meet our gynecological surgeons and ask any questions you have.