General Surgery

General surgery includes a variety of surgical procedures to treat a broad range of health problems and diseases. Most procedures can be done either laparoscopically or robotically. In this way, surgery is performed through one or more small incisions.

Dr. Fernandez is committed to treating a comprehensive array of surgical issues. Listed below are the common procedures performed by Dr. Fernandez.

 

Common General Surgery procedures include:

General Surgery Doctor

Laparoscopic or Robotic Cholecystectomy (gallbladder removal)

What is a laparoscopic or robotic cholecystectomy?

It is a minimally invasive procedure, generally performed with three small incisions, for removal of a malfunctioning or diseased gallbladder. The surgery is performed on an outpatient basis and offers a quick recovery.

What kind of symptoms do you expect from gallbladder disease?

Many patients experience upper or upper-right abdominal pain which radiates to the upper back or right shoulder. Other symptoms include diarrhea, abdominal bloating or nausea and vomiting after eating something spicy or greasy.

What can I expect after surgery?

Small incisions allow for a much quicker recovery than traditional open surgery. Post-operative pain is minimal. Patients begin to feel much better after a few days and can usually return to regular activity within a week or two.

What can I eat after my surgery/Is there a special diet?

It is recommended that patients avoid overindulging in greasy or spicy foods within the first two weeks after surgery. To allow your body time to adjust to begin without a gallbladder, these foods should gradually be incorporated.

Are there are any post-surgical restrictions?

Generally, after two to three days, you may gradually resume normal activities. Patients may begin light aerobics two weeks after surgery. Patients may only lift up to 10 pounds or six weeks following surgery.

Ventral/Umbilical Hernia Repair

What is a ventral hernia?

A ventral hernia is a defect in the abdominal wall. (A ventral hernia at the umbilicus – belly button – is called an umbilical hernia.) The hernia can cause problems including incarceration in which intestine can be trapped in the sac of the hernia. This may cause a blockage or compromise the viability of the intestine and may also cause pain in the area of the hernia or along the distribution of the nerve that innervates the hernia. A patient may be born with the weakness or defect through the abdominal wall or the defect may be caused by a previous operation.

How is it repaired?

There are many ways to repair a hernia. Oftentimes, the hernia can be repaired laparoscopically or robotically and the hernia defect is sewed closed. A piece of mesh is used to reinforce the abdominal wall.

What kind of symptoms do you expect from a ventral hernia?

Patients may experience pain, nausea, and vomiting. Patients may also have a bulge at the hernia site which gives the abdomen an irregular-looking appearance.

What can I expect after surgery?

Patients generally experience discomfort and feel tension in the abdominal wall. Typically, the tenderness subsides two weeks after surgery.

What can I eat after my surgery/Is there a special diet?

You should be able to eat whatever you want to following surgery.

Are there are any post-surgical restrictions?

I recommend that patients avoid strenuous activity for the first two weeks following surgery to allow their discomfort to subside and the mesh to integrate into their abdominal wall. Patients may only lift up to 10 pounds or six weeks following surgery.

Inguinal Hernia Repair

What is an inguinal hernia?

An inguinal hernia is a defect in the inguinal region (groin) of the abdominal wall. This type of hernia may be caused by strenuous activity in which the abdominal wall gets weakened or ruptures due to the pressure generated in this area. It may also be related to a weakness or defect that a patient is born with.

How is it fixed?

Typically, the robotic approach is used repair an initial or recurrent inguinal hernia. This includes placement of a piece of mesh to underlay the area of the abdominal wall defect. For larger inguinal hernias, the fascial edges may be sewn together to allow the mesh to cover all groin defects.

What kind of symptoms do you expect from an inguinal hernia?

Many patients experience a bulge in the groin. If there is an obstructive pattern where the intestine get locked in the groin, nausea, vomiting, and pressure may be experienced.

What can I expect after surgery?

When performed robotically, only three small incisions are required which allows for a much quicker recovery time than traditional open surgery. Minimal discomfort is experienced. Males can expect some swelling in the scrotum. This swelling subsides within a few days following surgery. Most patients are able to return to regular activity within a week or two.

What can I eat after my surgery/Is there a special diet?

There is no special diet to follow after surgery.

Are there are any post-surgical restrictions?

Activity levels can be gradually increased, according to the patient’s pain level. Patients may only lift up to 10 pounds or six weeks following surgery.

Abdominal Wall Reconstruction Large, complex abdominal hernia repair

If you have this type of hernia, you may have been told that it cannot be repaired or it is difficult to repair. Generally, the repair of such a complex abdominal hernia is performed open. However, Dr. Fernandez is amongst the few surgeons in the country who specialize in the robotic repair of complex abdominal hernias. The robotic approach prevents the need for a large open incision and prevents an up-to-one-week inpatient stay in the hospital. When performed robotically, most patients are discharged after only one or two nights in the hospital. Generally, patients require far less pain medicine than when the surgery is performed open.

What is a complex abdominal hernia?

A complex abdominal hernia involves larger, sometimes multiple, defects in the abdominal wall. These are often a result of previous operations. The defects may also be present at birth and grow larger as a patient ages and becomes more obese. Many patients have gone through multiple attempts at repair of these hernias and have had multiple recurrences. These types of repairs can be very complex due to the scarring and the need to remove previously placed mesh. Occasionally, these hernias may be associated with obstruction secondary to incarcerated intestine and sometimes these hernias can be associated with infection and possible fistula.

What kind of symptoms do you expect from a large complex hernia?

Patients may experience pain, nausea and vomiting. If they have an obstruction from their intestines being incarcerated, many patients will also have a large bulge which can be unsightly and make the abdomen appear irregular.

What can I expect after surgery?

These procedures are more complex than the average robotic ventral hernia repair and involve the use of muscle flaps to cover the hernia defect. Due to the greater extent of the dissection, a drain is placed to capture any fluid which internally builds up. The drain is only temporary is typically left in for two weeks. The level of discomfort patients experience is very similar to a traditional ventral hernia repair and requires a two- to three-week recovery period. As patients experience less discomfort, they may gradually increase their activity level. Patients must wear an abdominal binder to give support to the abdominal repair and to allow for compression to lessen the amount of fluid that builds up underneath the flaps.

What can I eat after my surgery/Is there a special diet?

Patients do not need to follow a special diet. After the anesthesia wears off and a patient begins weaning off the pain medicine, their appetite should return to normal.

Are there are any post-surgical restrictions?

Patients are restricted to light activities and should not lift anything greater than 20 pounds for approximately six weeks following surgery.

Surgery for Gastroesophageal Reflux Disease (GERD)

What is GERD?

Patients with GERD will have reflux of food and other contents in their alimentary track from their stomach to their esophagus. The gastric acids come back into the esophagus and cause erosive damage to the esophageal lining. GERD can be caused by a defect in the sphincter between the esophagus and the stomach which is the lower esophageal sphincter. It can also be caused by a hiatal hernia which is a defect in the diaphragm that allows the esophagus to come into the abdomen.

What is the treatment for reflux?

Normally, the treatment for reflux involves antacid therapy. For patients who have a severe case of acid reflux which is unreceptive to medication, as well as patients who have a significant hiatal hernia, surgical intervention is recommended. If a patient requires surgery, generally the repair is done laparoscopically or robotically. The damaged lower esophageal sphincter is repaired by creating a stomach wrap and the diaphragmatic defect is repaired with suture or mesh.

What kind of symptoms do you expect from GERD?

Many patients will experience severe heartburn. They may also experience difficulty swallowing solids or liquids and have burning sensations in their chest. If severe enough, some patients may have reflux all the way into their throat with some of the contents going from their esophagus into their lungs. This can cause aspiration pneumonia.

What can I eat after my surgery/Is there a special diet?

Patients are required to eat softer foods and avoid pulpy foods. To avoid getting foods stuck in the repair, patients should chew their food very well.

Are there are any post-surgical restrictions?

In addition to the special diet, patients are restricted to light activities and should not lift anything greater than 20 pounds for approximately six weeks following surgery.