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Treatments

Conditions Treated

 

Colorectal Cancer

One of leading causes of cancer death, is often treatable with surgery.  It is critical that a patient be seen promptly and get a “gameplan” started.  Our initial visit is often spent answering numerous questions followed by obtaining required scans and labs.  Following this we discuss our findings with the patient and family and offer our advice based on the NCCN (National Comprehensive Cancer Network) guidelines.

I like to draw pictures use diagrams and even videos to explain what options are available.  Most patients are candidates for minimally invasive surgery which will allow for faster recovery.  Some patients unfortunately are not surgical candidates and need referrals to oncologist for chemotherapy.

There are many different styles of surgeons.  I always admired my mentors that spent time with the patient and did their best to ensure that they understood the plan.  No matter how long it takes, we want you and your family to feel comfortable.

 

Diverticulitis

A very common and often, in my opinion, over-treated condition.  We are very conservative in our approach in accordance with the latest ASCRS practice parameters.  Many surgeons will inappropriately operate for mild diverticulitis.  Our clinic will discuss with you the cause and treatment options.  The majority of patients referred for surgical resection are successfully managed non-operatively.

 

Hemorrhoids

Whether it is itching, bleeding, or pain, there are numerous options available.  Most of the time something as simple as 2 teaspoons of Benefiter or Metamucil clear can alleviate your symptoms.  It is important to be seen for “hemorrhoids” as many patients with advanced cancers were told “you just have hemorrhoids.” 

If fiber and diet changes do not help with symptoms, we offer numerous office based and surgery based treatments.  We distinguish our selves from other general surgery clinics by treating you non-operatively and surgically and will do our best to prevent recurrences. Please do not hesitate to contact our office.

In addition, if you had a hemorrhoid surgery and are having complications.  We offer anal reconstruction surgeries, medical relief, and evaluation to help improve your quality of life.

 

Anal Fissures

A common cause of pain with bowel movements, anal fissures can significantly affect your quality of life.  Often misdiagnosed as “hemorrhoids” patients suffer for months trying numerous ineffective therapies.  We offer medial and surgical relief of these procedures. 

 

Inflammatory Bowel Disease (Crohns Disease and Ulcerative Colitis)

As one of the busiest IBD surgeons in the state, we offer numerous options for a complex patient.  Whether it is medical management of ulcerative colitis to robotic ileocectomties to j-pouch creation, we will work with you and your gastroenterologist to maximize your chance at success. 

We distinguish ourselves from several clinics in the area by our results and our understanding of this complex disease.  Where some surgeons simply operate, we understand the complexities of IBD medical therapy.  We will contact gastroenterology and discuss our recommendations regarding medical therapy.  We feel comfortable handling many of the immunosuppressant agents used in this patient population.

While not unique to the IBD patients, many of these patients are younger in age.  We specialize in these patients and receive numerous referrals from pediatric doctors.  In addition, we understand the unique challenges presented such as increased concerns over cosmetic outcomes, return to work/school, etc.  Please do not hesitate to discuss this at your office visit. 

 

Rectal Abscess

Recently seen in an emergency room or primary care provider’s office and had a rectal abscess drained?  Surprisingly this is a very common problem related to anal glands.  We offer same day or next day appointments to assist with this.  Do not go the emergency room, call our office and get seen.

 

Fistula in Ano

Unfortunately, 50% of the time rectal abscess will turn into a fistula.  This will present as recurring abscesses and drainage.  This can only be corrected with surgical therapy.  We receive many referrals from other surgeons as they simply have not had the training to manage these.  We manage these on nearly a daily basis in the clinic and operating room. We offer the most effective therapies available, including fistulotomy, LIFT procedure, Endorectal advancement flap, ACell application, and seton placement.  Please do not hesitate to contact our office for details. 

 

Constipation

Many patients deal with constipation that can be addressed with simply laxatives or diet changes.  Some require prescription laxatives, physical therapy, and surgery.  Patients usually present to our office after years of struggling with the condition.  We offer evaluation and treatment for a wide cause of constipation associated etiologies. 

 

Rectal Prolapse

Pelvic floor dysfunction including rectal prolapse requires attention and a team approach.  We are fortunate to have partnered with many urologist and gynecologist in the area.  Rectal prolapse can cause significant issues with bleeding, pressure, constipation, and the inability to live a normal life.  We offer minimally invasive techniques. 

 

Fecal Incontinence

A socially unacceptable topic of conversation, is very common affecting the majority of Americans as they age.  It can also be secondary to hemorrhoid surgery, colon surgery, and child birth.  In the past we had limited options.  Now we have medical and surgical techniques that allow for dramatic improvement in quality of life.  You do not have to live with incontinence anymore!

 

Hernias and General Surgery

We offer both open and minimally invasive hernia repair.  Often times the hernias we repair are simple, but we also specialize in complex hernias with associated enterocutanous fistulas.  Robotic repair of a hernia is a new and exciting field that allows for the advantages of open repair with the improved recovery of laparoscopy. 

Our clinic is pleased to treat and evaluate patients with gallbladder problems or other general surgery issues.  We cover general surgery call and are board certified in general surgery.  In addition, we used to be on the faculty of OU and instructed surgery residents on proper technique. 

 

Procedures Offered

 

Laparoscopic Procedures 

The use of a laparoscope allows a surgeon to perform a surgery through small holes.  Once thought to be experimental it is now standard for many different surgeries.  Many surgeons will perform gallbladder, appendix, and hernia surgeries using this techniques.  Our clinic specializes in these and many other procedures.  In particular, we are one of the few places in western Oklahoma that offers complex colorectal laparoscopic surgeries such as:

  • Laparoscopic Ventral Hernia Repair
  • Laparoscopic Colon Surgery
  • Laparoscopic Ostomy Creation
  • Laparoscopic Ostomy Reversal
  • Laparoscopic Rectopexy (for rectal prolapse)
  • Laparoscopic Incisional Hernia Repair

When looking for a surgeon, you want someone that is highly trained.   As a general surgery resident, I had the opportunity to watch several laparoscopic colon surgeries and perform a few.  My additional year of training in colorectal surgery, provided me with the opportunity to perform over a hundred colon surgeries using a laparoscope.  This training along with academic and private practice experience allows our clinic to shorten recover times and hospital stays, improve cosmetic outcomes, and most importantly improve lymph node harvests ( an important marker of a good “cancer surgery”). 

 

Robotic Surgery

Certain areas of the body are difficult to approach using conventional minimal invasive techniques.  In addition by using advanced technology we can improve where laparoscopy fails.  Indeed there were two recent publications in JAMA that questioned whether we should be doing laparoscopic rectal resections at all.  Advanced technology such as the DaVinci Robot provide increased visibility and manipulation compared to laparoscopic surgery.

Our expertise in robotic rectal surgery is unmatched in the OKC Metro area.  We have performed more colorectal cases than any surgeon in the metro area.  We are the only clinic that is listed on the DaVinci site which requires a minimum number of procedures to be performed. 

The robot has allowed us to perform numerous surgeries with smaller or hidden scars. Perhaps, my favorite part is when we see a patient the afternoon following a morning surgery and they have little to no pain and want to go home.  Compared to the week long hospital stays I saw during residency, it is amazing. 

We are happy to offer the following robotic procedures:

  • Robotic Colon Surgery
  • Robotic Rectal Surgery
  • Robotic Ostomy Reversal
  • Robotic Rectopexy (for rectal prolapse)
  • Robotic Ventral Hernia Repair
  • Robotic Incisional Hernia Repair
  • Robotic J Pouch Creation or IleoAnal Anastomosis

 

Colon and Rectal Surgery

Some surgeons will approach a difficult case with the mindset, “can I do this procedure laparoscopically?”  We look and ask ourselves, “why can’t we do this using minimally invasive techniques?”  This mindset is crucial in pushing yourself to providing the best care for your patients in minimizing recovery, hospital stay, costs, etc.  Unfortunately, not every patient is a candidate for minimally invasive techniques like robotic or laparoscopic surgery. In this case we, will perform an open procedure. 

Several studies have been produced showing that surgical technique is the most important predictor of cancer survival in rectal cancer.  It is critical that your surgeon be specially trained in performing rectal surgery. 

We utilize many innovative technologies and techniques such as an Applied Wound Protectors, separate closing trays, pre-operative complex carbohydrate drinks, and Covidien staplers. 

 

Trans-Anal Minimally Invasive Surgery (TAMIS)

Rectal cancer regardless of the stage and the age of the patient has significant morbidity. Some patients are candidates for a procedure that provides NO scars and short recovery compared to the alternative of a temporary or permanent ostomy.  Using the Applied Medical TAMIS platform we are able to remove rectal cancer from inside the rectum leaving the patient without scars.   Followup is key and we provide this for the life of the patient. 

 

Hemorrhoidal Banding

Hemorrhoids are often misunderstood by physicians and patients.  Often presenting as painless bleeding, it can be irritating to the patient.  Most are hesitant to search for treatment.  Banding offers an office based procedure with minimal discomfort and complications.  It can be repeated as needed and is well tolerated.  Surprisingly, most surgeons in the metro area do not provide this service and are quick to take the patient to the operating room.  Rather than take off 2 to 4 weeks of work, banding allows you to go back the same day. 

 

Anorectal Procedures

We offer treatments for numerous anorectal conditions including:

  • Anal Fissures
  • Hemorrhoids
  • Condylomas (office and surgery procedures)
  • Incontinence
  • Pilonidal Disease including flap closure
  • Repair of Rectovaginal Fistulas

Many can be seen the same day if needed.  Please call the office and explain the need for urgent consultation.

 

Colonoscopies

One of the few procedures that can remove pre-cancerous tissue before it is a problem.  We offer both screening and diagnostic procedures.  In addition, we specialize in removing large polyps that often times are referred for colectomies.  We utilize anesthesia to maximize patient comfort and safety.  We work with you to find the best prep agent for you.  Please do not hesitate to contact our office with any questions so we can set you at ease. 

 

General Surgery

While we focus our attention on colorectal surgery.  Our clinic does offer numerous general surgery procedures.  Indeed may of our colorectal patients require our general surgery services at some point.  Below are a list of procedures we routinely perform.

  • Laparoscopic Cholecystectomies (Removal of the Gallbladder)
  • Laparoscopic Appendectomies
  • Port placements and removals
  • Hernia Repair
  • Emergency General Surgery