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General Surgery

General Surgery Specialty

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Especialidad de General Surgery

Complaints of the abdominal wall:  hernias or abdominal wall defects generally identified as “masses” which alter following strenuous activity and respiratory movements. These appear in the groin, in the umbilical region, or at times as evisceral abdominal hernias occurring after abdominal surgery, or related to previous scar tissue. Nowadays they can be rectified via out- patient surgery or with a minimal hospital stay, under local anesthesia, and repaired by installing a mesh made of a biocompatible material, to prevent reoccurrence.

Benign biliary disease: Lithiasis or “stones” in the gallbladder causing cramps, pain and discomfort after meals. These disorders are treated by laparoscopic or minimally invasive surgery, in which scars are non-existent or almost invisible, and for which the patient is admitted for a short stay only. Other diseases related to gallstones and pancreatitis, choledocholithiasis and associated jaundice can also be treated.

Thyroid problems: The thyroid is a gland in the neck that regulates the body’s basal metabolism. It is operated on in the event of the following three situations:

  • Firstly, if there is excess growth causing a goiter, permeating the neck that causes discomfort, difficulty in breathing, swallowing, or voice disorders, and even significant aesthetic changes.
  • Secondly, when it overproduces the thyroid hormone which is not controllable with medicines.
  • And thirdly, when delimited nodules or defined growths are present, causing doubts as to their possible cancerous nature, or in pre-diagnosed tumorous diseases.

These cases are usually studied and diagnosed by an Endocrinologist who will refer the patient to the surgeon.

Morbid obesity: Extreme obesity is currently considered the cause of multiple disorders, and conventional treatments are often unable to control it. Within the field of general surgery, procedures are designed to effectively control this serious problem. Treatments offered are stomach reduction techniques that prevent overindulgence and bypass procedures which restrict the absorption of food. Such techniques must be individualized according to the needs of the patient, and in many cases procedures can be combined. Currently they can be performed on patients with less morbidity using laparoscopic techniques.

Hiatal hernias or gastroesophageal reflux disease: Heartburn or burning after meals is very common in this field, resulting from the improper closure of the sphincter that connects esophagus and stomach. The acid content of the stomach flows back into the esophagus causing damage and very unpleasant symptoms. When this defect appears, it can be operated on by performing a fundoplication, which is a kind of “tie knot” around the esophagus made with part of the stomach. This can be done today by laparoscopic or minimally invasive surgery producing less pain and minimising postoperative discomfort.

Anorectal disorders: Includes haemorrhoids, anal fissures, and abscesses resulting from acute perianal suppuration, and fistulas in its chronic form. These are very common disorders. Nowadays, there are effective treatments which involve virtually no hospital stay and with rapid patient recovery. There are other more complex disorders such as rectoceles, incontinence of varying degrees or uncontrollable constipation, these are grouped as secondary diseases; disorders of the pelvic floor, which should be studied and treated carefully.

Skin lesions requiring removal: Many skin and superficial injuries can be effectively treated by a general surgeon. They include sebaceous cysts located in various areas, axillary or inguinal hidroadenitis, lipomas of varying size, ingrown toenails, dermatofibromas, and other benign or unusual growths. They can also deal with the diagnosis and treatment of malignant lesions by carrying out a biopsy, or completely removing them, with direct closure, or by performing surgical skin moulding /plasty or grafts. Pilonidal sinus or sacrococcygeal dermoid cysts are also treated by a general surgeon.

Varicose veins:  

Prominent varicose veins of the lower limbs resulting from weakness of the deep veins are assessed at a surgical consultation. Nowadays, the treatment must be individualized, so as to ensure that selective removal is only applied to damaged venous paths. Similarly, current treatments provide rapid recovery for patients through the use of minimally invasive surgery.

Digestive tract conditions:  

This covers a wide range of disorders requiring initially treatment with medicines but which may need surgical intervention when therapeutic options are exhausted. Also included are complicated gastroduodenal ulcers- very symptomatic in recurrent diverticulitis, and inflammatory diseases such as ulcerative colitis and advanced uncontrollable Crohn’s disease.

Cancers of the digestive tract and the biliopancreatic system:   

This vast group includes major disorders such as esophageal cancers, gastric and liver cancers, whether primary or metastasised from others, biliopancreatic cancers, and most importantly, due to their frequency, tumours of the colon and rectum. To cure patients, many of these tumors require a surgical treatment in conjunction with radiotherapy and chemotherapy.

 

If a patient needs to undergo surgery, the whole cost of the intervention is handled as a single process, from the preoperative to postoperative consultation, until final discharge.

 

The consultants in General Surgery and Digestive Diseases assess and follow the progress of all patients suffering from any of the above listed disorders, either because they need to be treated in Spain, or because they have been treated in their own country and wish to continue their follow up treatment with us.

 

Emergency and Digestive General Surgery.

Due to their severity, this group of disorders generally requires urgent action. They are dealt with in hospital by urgent or delayed surgery, occasionally by observation, and in a smaller percentage of cases by conservative treatment. These patients are often referred to us by accident and emergency departments or by their general practitioners at the health centre where they have their first consultation. This condition can be classified as follows, depending on how the symptoms make their appearance:

Abdominal pain or suspected acute abdominal pain

This section include disorders typically treated urgently by the general surgeon such as:

a) acute appendicitis, b) acute cholecystitis, c) perforated hollow viscera, d) intestinal obstruction of the small intestine generally through strangulation (volvulus or flange) or colonic obstruction often caused by malignant neoplasty, e) intestinal ischemia, either thrombotic or embolic, or f) blunt force  abdominal trauma occurring after  an accident  or from open wounds  from knife or firearm attack.

A very diverse group of conditions, commonly needing rapid diagnosis and treatment are the following:

Acute appendicitis

Acute cholecystitis

Perforated hollow viscera

Uncontrollable gastrointestinal bleeding

Intestinal obstruction by neoplasty, strangulation

Embolic or thrombotic intestinal ischemia

Blunt force abdominal trauma or penetrating abdominal wound.

Acute/subacute abdominal pain, suspected of requiring surgery.

These symptoms are usually handled by the general surgeon urgently, as they often indicate underlying conditions which will require surgical treatment.

Includes:  a) obstructive jaundice, whether of a benign or malignant nature, and acute gallstone pancreatitis to be assessed for surgical or instrumental solution. b) Acute or subacute symptoms of abdominal pain with constipation, fever or rectal bleeding, which may be indicative of acute diverticulitis, either uncomplicated  – requiring medical treatment, or complicated requiring surgery, or a colonic neoplasia requiring diagnosis, study and treatment. c) Symptoms of vomiting with proven digestive intolerance, Stomach retention syndrome, showing stenosis with gastric ulcer or neoplasty. d) Similarly all dysphagias of an esophageal origin should be diagnosed urgently, as there is always an underlying organic or functional disorder.

Benign or malignant obstructive jaundice

Acute gallstone pancreatitis

Acute diverticulitis

Subocclusion or rectal bleeding associated with colon cancer

Benign duodenal stenosis or dysphagia,  and vomiting associated with gastric or esophageal cancer

Abdominal pain and hernial tumours:

Complicated hernia conditions are also included, plus previously reducible tumours that become trapped causing strangulation or intestinal obstruction.

Hernias, whether inguinal, femoral, umbilical, crural or laparoscopic, resulting from any of the above should be treated immediately.

Irreducible inguinal hernia

Irreducible umbilical hernia

 Disabling anal or perianal pain:

Frequently this section includes a disabling group of disorders generally not diagnosed properly and which previously have been badly treated.

We are referring to perianal abscesses, with or without underlying chronic fistulas, irreducible thrombosed haemorrhoids or very disabling anal fissures.

Perianal abscesses

Prolapsed or thrombosed haemorrhoids

Painful  superficial inflammatory  eruptions in various locations:

These are abscesses, usually produced by infected skin cysts, normally treated with local anesthesia and drainage. Sometimes they are underlying symptoms of more important problems such as complicated lymphadenopathy, deep infections in the muscles or of attached structures such as teeth.

– Skin abscesses

Affecting lower limbs as a consequence of vascular disease:

Such as acute or chronic arterial or venous disorders,  including chronic ulcers on lower limbs in connection with chronic ischemia usually atherosclerotic, diabetic foot as a side effect of venous insufficiency and acute ischemia, either thrombotic or embolic.

Ischemic ulcers of the lower limbs

Varicose ulcers of the lower limbs

Diabetic foot

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