The Gold Standard of Surgical Care


2050 Hall Johnson Road Suite 200 Grapevine, TX 76051

Surgical Procedures

Specializing in the following traditional surgical procedures and minimally invasive surgical procedures.

Traditional Surgeries and Procedures

Understand Your Condition


Hemorrhoids are a very common ailment that affects millions of Americans. They consist of enlarged blood vessels in and around the anus. Enlarged hemorrhoids are caused by a combination of factors, but are usually related to aging, heredity, chronic constipation or diarrhea, straining with bowel movements, pregnancy, and spending too much time (e.g. reading) on the toilet. Hemorrhoids become symptomatic when they bleed, prolapse or cause pain.

Many of the symptoms caused by enlarged hemorrhoids can be managed without surgery. If symptoms persist despite conservative management several surgical options exist. Small external hemorrhoids can be removed under local anesthesia in the office. Small bleeding internal hemorrhoids can be treated with a rubber band technique, also as an office procedure. Large or complex hemorrhoids may require more extensive surgery.

Hemorrhoidectomy involves the removal of the enlarged hemorrhoids around the anal opening. At that time an endoscope can be used to examine the rectum and the lower end of the colon to look for other sources of bleeding. In our practice we offer hemorrhoidectomy using the CO2 laser, Ligasure, Harmonic Scalpel, and conventional techniques. There is a 4 to 6 week recovery period, however most people can return to work after 1 to 2 weeks.

Anal Fissures

An anal fissure is a tear in the anal canal caused by hard stool or forceful diarrhea. Anal fissures fail to heal in some cases because of spasm in the anal sphincter muscle. Non-surgical treatment involves fiber, stool softeners and possibly nitroglycerine cream. Surgical treatment involves division of a small part of the anal sphincter which prevents spasm. Five percent of post operative patients will have less than complete control of gas. The non-surgical treatment is over 80% successful. Anal fissure surgery is an outpatient procedure and has approximately one week of down time.

Anal Abscess

An abscess forms near the anus or rectum when bacteria collects in an anal gland and leads to an infection. The treatment involves making an incision near the anus to drain the abscess. Antibiotics alone will not cure an abscess. A small superficial abscess can be drained in the office under local anesthesia. More complex infections need to be drained in the operating room.

Anal Fistula

Anal fistulas develop in 50% of patients after an anorectal abscess. Surgery is necessary to cure an anal fistula and involves joining the external and internal openings and making the tunnel into a groove that heals from within outward. This can be performed as an outpatient with a 1 to 2 week disability period.

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Anorectal Surgery - Post-Operative Instructions

A hernia is a hole in the abdominal wall through which a portion of the abdominal contents protrude. Hernias are classified as inguinal, umbilical, or ventral.

Inguinal Hernia

Inguinal hernias are located in the groin area. They can present as a tender lump with a pressure sensation while bending over, coughing, or straining. They are repaired through a 2 to 2 ½ inch incision below the hair line in the groin under local, spinal, or general anesthesia. The defect in the abdominal wall is closed or tightened around the spermatic cord and then reinforced with a flat piece of mesh. This is an outpatient procedure and patients typically return to work in 1 to 2 weeks and normal activity in 3 to 4 weeks.

Umbilical Hernias

Umbilical hernias occur through a weak area behind the belly-button. Repair and recovery are similar to the inguinal hernias. Mesh is usually required for repair.

Ventral Hernias

Ventral hernias can occur at any location on the abdominal surface. They usually occur in an area of previous surgery and are also calledincisional hernias. Scar tissue is never as strong as the original tissue and therefore all incisions are at some risk of breaking down. Often these hernias are massive in size and require a large piece of mesh to secure the repair. The hospitalization and recovery are longer than in the repair of smaller hernias.

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Hernia - Discharge Instructions Following Surgery Laporoscopic Hernia Repair - Post-Operative Instructions
Peptic Ulcer Disease

With the development of medications which reduce the production of acid by the stomach, operations for ulcer disease are much less common. Surgery currently is most often used to treat the complications of ulcer disease, i.e., bleeding, perforation, or obstruction. The operations typically involve removal of the acid producing part of the stomach, with or without division of the vagus nerves. (The vagus nerves carry the messages from the brain which stimulate the stomach to secrete acid.) The five environmental factors which contribute to ulcer disease are stress, caffeine, tobacco, alcohol, and aspirin-like medications.

Cancer of the Stomach

Cancer of the stomach is treated by removal of the part of the stomach containing the cancer. Sometimes removal of the entire stomach is required. The small intestine is then connected to the esophagus or remnant of the stomach. New eating habits are necessary after most stomach operations.

Diverticular Disease

Diverticular disease is a product of the "American" diet. The American diet is very low in fiber and therefore causes the colon to develop small pockets off of the colon due to high pressures. The medical treatment of diverticulosis involves a high fiber diet, or bulk agents like Metamucil, and the avoidance of foods such as popcorn. Surgery is considered for the complications of diverticulitis, i.e.: chronic pain, bleeding, perforation, obstruction, or colon fistula formation.

Elective surgery involves removal of the diseased portion of the colon, typically without the need for a colostomy. Emergency surgery may require construction of a temporary colostomy. A colostomy is an opening on the lower abdomen to which a bag is connected to catch the stool (feces). The hospital stay is usually 4 to 7 days.

Colon and Rectal Cancer

Colectomy for colon and rectal cancer involves removing the cancerous part of the intestine and the adjacent lymph nodes. Colostomy is rarely required. For rectal cancers very near the anus a permanent colostomy may be necessary to ensure complete removal of the cancer. Depending on how advanced the cancer is, chemotherapy or radiation may be required. Colon surgery can be performed conventionally (open) through an incision on the abdomen, laparoscopically or with a robot-assisted technique. The hospital stay is usually 4 to 7 days.


Appendectomy involves the emergency removal of the appendix for inflammation, infection or rupture. The appendix is removed under general anesthesia through a small incision in the right lower abdomen. If the appendix has not started leaking infection a 1 to 2 night hospital stay is required and patients return to school or work after 7 to 10 days. If the appendix is ruptured a 3 to 5 day hospital stay is required for intravenous antibiotics.

Inflammatory Bowel Disease

There are two inflammatory diseases of the gastrointestinal tract, Crohn’s Disease and Ulcerative Colitis. These conditions are not completely understood but they both involve inflammation of the intestinal tract that is mediated by your immune system. Hereditary and environmental factors are thought to play a role in the severity of these diseases. Several medications have been developed to control the inflammation and sustain remission, although currently there is no known cure. Surgery is required when medications fail to control symptoms.

Crohn's Disease usually involves the distal end of the small intestine, but can be present at any location from the mouth to the anus. Surgery is indicated for bleeding, perforation, blockage, or fistula formation.

Ulcerative Colitis involves only the colon, rectum, and anus. Operative treatment is recommended for failure of medical therapy or because of the increased risk of cancer. Surgery involves removing the entire colon and rectum. A restorative proctocolectomy is a procedure that replaces the rectum with a pouch made from small bowel, which avoids the need for a permanent ileostomy. Some patients are not good candidates for this procedure and require a permanent ileostomy. Operations for inflammatory bowel disease require a 5 to 7 day hospital stay with 4 to 6 weeks of recovery.


Colonoscopy is the most effective method of finding and removing polyps from the colon. It is generally performed as an outpatient procedure and involves inspecting the lining of the colon with a long flexible instrument inserted through the anus. Laxatives must be taken the day before the procedure to clear the bowel of stool. The procedure is performed under light sedation and is generally well-tolerated and safe. You will need someone to drive you home from the procedure but recovery is rapid.

Because colon polyps and cancer are very common is it recommended that everyone undergo a screening colonoscopy beginning at age 50. Some who are at higher risk for colon or rectal cancer should start earlier. Family history of colorectal cancer, polyps and certain diseases can put you at higher risk for colorectal cancer. Colonoscopy can also be used to help evaluate new symptoms such as rectal bleeding, abdominal pain and unexplained changes in your bowels such as diarrhea or constipation.

Thyroid Resection

The thyroid gland is important in the regulation of metabolism. Thyroid resection involves removal of part or all of the thyroid gland for benign or malignant disease. After thyroid surgery a hospital stay of 1 to 2 night is necessary. Thyroid hormone pills may be required post operatively.

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Thydroidectomy - Discharge Instructions Following Surgery

Atherosclerosis or hardened arteries is a term to describe the buildup of cholesterol and fat on the inner wall of an artery. This decreases the blood supply to the parts of the body "down stream" from that point. Atherosclerosis can occur in any artery in the body. Risk factors include family history, smoking, elevated cholesterol, high blood pressure, diabetes, obesity and stress.


An Arteriogram is a diagnostic test to look for the location and extent of blockage in the arteries. This is essential to determine what type of treatment will be used. It is typically performed as an outpatient procedure under local anesthesia and with intravenous sedation. A tiny needle is inserted in the artery and a liquid (dye) is injected into the blood stream while x-rays are taken. The recovery from an arteriogram is usually no more than one day.

Angioplasty (balloon surgery) with stent placement

An angioplasty involves dilating a narrowed artery with a cigar shaped balloon. Frequently, a small wire basket called a stent is inserted at the balloon site to keep the artery open. The procedure is identical to an arteriogram and the patient typically goes home the same day. Local anesthesia and intravenous sedation are commonly used. The recovery time is usually one day. The benefits of a successful angioplasty are usually apparent immediately.

Carotid Surgery

The carotid arteries are located in the neck and may become clogged or narrowed by atherosclerosis. The restriction of blood flow to the brain may greatly increase the risk of a stroke. Carotidendarterectomy is a procedure in which the artery is opened and the cholesterol buildup is removed. The hospitalization is usually one to two days and the recovery is approximately two weeks.

Colon cancer, including rectal cancer, is one of the leading causes of cancer-related death in the United States. Fortunately your risk of developing colon cancer can be reduced by screening tests, such as having a colonoscopy.

This is an endoscopic procedure in which a flexible camera (the colonoscope) examines your colon while you are under sedation. The day before the exam you will be on a liquid diet and drink a solution that clears the stool from your colon. Precancerous growths (polyps) can be removed if discovered during the colonoscopy.

People at average risk for colon cancer should start screening no later than age 50. If you are at increased risk for colon cancer because of your personal or family history, screening should begin at a younger age. Speak with your doctor about when you should begin colon cancer screening.

Minimally Invasive Procedures

Minimally Invasive Procedures

Utilizing the da Vinci Surgical System, a surgical robot is used to perform laparoscopic surgeries. The surgeon controls robotic arms which eliminate tremors and allows very precise dissection and suturing of tissues. Utilizing the da Vinci Surgical System, a surgical robot is used to perform laparoscopic surgeries. The surgeon controls robotic arms which eliminate tremors and allows very precise dissection and suturing of tissues. It also gives the surgeon also a high-definition 3-D view of the abdomen. Our surgeons can perform several procedures, including gallbladder, hernia repairs and colon and rectal surgeries with this technology. It also gives the surgeon also a high-definition 3-D view of the abdomen. Our surgeons can perform several procedures, including gallbladder, hernia repairs and colon and rectal surgeries with this technology.

Laparoscopy is the use of a viewing tube called a laparoscope to see the inside of the abdomen and pelvis. It can be performed to diagnose and surgically treat conditions of the abdomen. Through a small incision in the abdominal cavity the instruments can be inserted to perform the various steps in the procedure. The abdominal cavity is distended and made visible by the instillation of absorbable gas (generally carbon dioxide). Most patients receive general anesthesia during the procedure.

The advantages of laparoscopy include a shortened post-operative period and less pain during recovery. After the procedure, many patients experience temporary bloating and discomfort related to retained gas.

Today, the use of laparoscopy has been extended to surgical procedures involving the appendix, colon, repair of abdominal wall and hiatal hernias, and more. The procedure has come full circle from one of diagnosis to what is now known as "minimally invasive" surgery.

Laparoscopic cholecystectomy is the operation to remove the gallbladder. It is performed under general anesthesia and is often an outpatient operation. A laparoscope is placed through a tiny cut made near the navel. The surgeon can then see the gallbladder on a video monitor and the surgery is performed with tools inserted in two or three other small cuts made in the abdomen. The gallbladder is then taken out through one of the incisions.

Laparoscopic Cholecystectomy is usually an out patient procedure and has a 1 - 2 week recovery period. Time off work depends on the job duties but usually ranges from a couple of days to 2 weeks.

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Laparoscopic Cholecystectomy - Discharge Instructions Following Surgery

The appendix is removed in cases of infection, or if the appendix may contain an abnormal polyp or tumor. In cases of infection it is often an emergency procedure and performed laparoscopically. Recovery time is usually 1-2 weeks, although certain situations such as a ruptured appendix can involve a longer recovery and may require a larger incision.

This includes any hernia of the abdominal wall including inguinal, femoral, ventral, umbilical, incisional, and lumbar.

Our surgeons perform all types of hernia repairs, including open, laparoscopic and robotic. Most repairs utilize mesh to decrease the risk of hernia recurrence. Smaller hernias are often repaired as an outpatient procedure, and larger hernia surgeries require a short hospital stay. There are many types of hernias and different options for repair. Your surgeon will discuss the relative risks and benefits of these operations with you at your consultation. They will also discuss the expected recovery time based on your type of hernia.

A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Treatment of large para-esophageal hernias causing symptoms requires surgery. During surgery, the stomach is pulled down into the abdomen, the esophageal hiatus is made smaller, and the esophagus is attached firmly to the diaphragm. This procedure restores the normal anatomy.

Since sliding hiatal hernias rarely cause problems themselves but rather contribute to acid reflux, the treatment for patients with hiatal hernias is usually the same as for the associated GERD (Gastroesophageal reflux disease), the condition wherein stomach contents regurgitate or back up (reflux) into the esophagus. If the GERD is severe, complicated, or unresponsive to reasonable doses of medications, surgery often is performed. At the time of surgery, the hiatal hernia is eliminated in a manner similar to the repair of para-esophageal hernias. However, in addition, part of the upper stomach is wrapped around the lower sphincter to augment the pressure at the sphincter and further prevent acid reflux.

In some patients suffering from GERD, the lining that is in the esophagus is replaced by an abnormal epithelium. This condition is called Barrett’s condition and has been linked to esophageal cancer and must be monitored carefully. A new endoscopic treatment of GERD and Barrett's is being developed.

Surgical Associates of the Mid-Cities offers both laparoscopic and traditional surgery on hernias. The technique that is chosen depends on the patient’s desire and physiology.

Click for more information on LINX and Nissen / Toupet Fundoplication

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Post Surgery Hiatal Hernia Diet

Colon and rectal operations are performed for a variety of conditions including cancer, large polyps, diverticulitis, and rectal prolapse. Most non-emergent operations can be performed with minimally invasive techniques, including both traditional laparoscopic and robotic surgeries. This allows for shorter hospital stays, quicker recovery and reduced risk of wound infections.

The spleen is an organ located in the upper left portion of the abdomen, behind the stomach. Its functions are to filter blood, remove bacteria, make blood, and store blood. Laparoscopic Splenectomy is the removal of the spleen with the use of a laparoscope.

The advantages of a laparoscopic splenectomy include having only three or four tiny scars instead of one large abdominal scar, shorter hospital stay, less pain, shorter recovery time and quicker return to daily activities, including work. After surgery most patients go home in 1-2 days.

An adrenalectomy is the removal of one adrenal gland (unilateral adrenalectomy), the removal of both adrenal glands (bilateral adrenalectomy), or partial removal of one or both adrenal glands. Compared to traditional open surgery, Laparoscopic adrenalectomy has a faster recovery time of generally 1-2 weeks rather than 1-2 months, which is the normal amount for an open adrenalectomy. The patient often leaves the hospital 1or 2 days after the surgery.

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