Conditions & procedures
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General surgery
Hernia Disease
A hernia is a weakness in the abdominal wall or diaphragm through which tissue can protrude. Common sites include the groin (inguinal/femoral), umbilicus, prior surgical scars (incisional), and the esophageal hiatus. Symptoms range from a painless bulge to discomfort with standing or lifting; some hernias remain quiet for years. Treatment is not one operation for everyone: selected small asymptomatic defects may be observed, while symptomatic, enlarging, or high-risk hernias are usually repaired. Open, laparoscopic, robotic, and balloonless TEP techniques each have a place when matched to anatomy, laterality, prior surgery, and overall health.
Open English hub →Pilonidal Disease
Pilonidal sinus disease affects the natal cleft, often in young adults, with pain, swelling, or chronic drainage. Acute abscess needs drainage first; definitive excision is planned when inflammation settles unless anatomy demands otherwise. Options include primary closure, lay-open healing, and flap techniques selected by cleft depth, pits, prior failed surgery, and lifestyle. Hygiene and hair management reduce flares but do not replace definitive planning for recurrent disease. Wound-care discipline after surgery strongly influences recurrence and healing time.
Open English hub →Spleen Disease
The spleen filters blood and helps fight encapsulated bacteria. Splenectomy is considered for selected hematologic disease, trauma, or tumors after team review. The most critical patient education after splenectomy is vaccination and infection awareness.
Open English hub →Soft Tissue Masses
A soft, mobile lump in the neck, shoulder, back, or abdomen is often a lipoma or skin cyst. Not every swelling is the same: rapid growth, deep location, fixation, or recurrent infection needs evaluation. This section explains lipomas, epidermoid/pilar cysts, examination and imaging steps, and principles of surgical excision in plain language.
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Hepatobiliary
Gallbladder Disease
I do not treat gallstones, acute cholecystitis, bile-duct stones, polyps, and gallbladder cancer as one diagnosis with one operation. Biliary colic after fatty meals differs from fever-associated cholecystitis or jaundice from duct obstruction. I start with clear ultrasound; MRCP or ERCP enters when I suspect duct stones or complications. For most symptomatic stone disease I plan laparoscopic cholecystectomy; I reserve robotic assistance for selected anatomy. I manage polyps by size, growth, and imaging features — not by fear alone.
Open English hub →Liver Disease
I characterize first — not every liver lesion needs resection. **Primary expertise here is hepatology/gastroenterology; surgical evaluation enters for selected complications or masses.** Hydatid disease, simple cysts, hemangioma, FNH/adenoma, primary and secondary tumors, cirrhosis, and variceal bleeding each follow different pathways. An incidental lesion on ultrasound is a starting point, not an automatic surgical booking.
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Oncologic surgery
Colon Cancer
Colon cancer often starts as an adenomatous polyp; colonoscopy both prevents and catches it early. The question I hear most often is whether rectal bleeding is “just hemorrhoids” — often it is not, and endoscopy settles it regardless of age. I do not discuss a one-size-fits-all plan before staging and MMR/MSI results are back. For localized disease I plan open, laparoscopic, or robotic colectomy with proper lymph-node clearance; when nodes or pathology warrant it, we add chemotherapy at tumor board.
Open English hub →Rectal Cancer
I do not finalize rectal decisions without pelvic MRI and a clear sphincter-distance discussion. Rectal cancer is not colon cancer moved lower. The question I hear most is whether radiation before surgery is mandatory; it depends on stage and tumor height. I offer TNT by stage and location, not automatically to everyone. Watch-and-wait is discussed only with disciplined follow-up. dMMR/MSI-H may open immunotherapy options. Bowel, sexual, and urinary function belong in the same conversation as cancer clearance.
Open English hub →Stomach (Gastric) Cancer
Early gastric cancer can feel like ordinary indigestion — the question I hear most is how long to keep taking acid medicine alone. I do not lock perioperative sequencing before staging laparoscopy and peritoneal cytology when indicated. Gastric cancer care starts with accurate staging; many locally advanced tumors receive chemotherapy around the time of surgery. Gastrectomy includes the appropriate lymph nodes. Symptoms that persist or worsen need endoscopy. Biomarkers guide systemic therapy especially in advanced disease: HER2, PD-L1, and CLDN18.2 mainly shape metastatic drug choice, while MSI/MMR can matter earlier. Laparoscopic or robotic gastrectomy is considered only when the same cancer operation can be done safely.
Open English hub →Pancreatic Cancer
The Whipple name scares everyone; resectability depends on vessel involvement, not the procedure label. I review contrast imaging before promising surgery. Jaundice with weight loss needs prompt work-up — do not assume gallstones alone. Pancreatic adenocarcinoma requires tumor-board input and an honest resectability discussion. Whipple and distal pancreatectomy are offered only when oncologically and medically appropriate. Nutrition, biliary drainage, and performance status are optimized before any large resection.
Open English hub →Esophageal Cancer
Solid-food sticking is not ‘nothing’ — I send patients to endoscopy without months of delay. Esophageal cancer care is multimodal: accurate staging, chemoradiation or perioperative therapy when indicated, and esophagectomy in selected patients. Histology (adenocarcinoma vs squamous), location, and nodal status shape whether neoadjuvant therapy precedes surgery. Open, laparoscopic, and robotic approaches can achieve the same oncologic goals when expertise and anatomy allow. Postoperative nutrition and pulmonary care dominate recovery as much as the incision size.
Open English hub →Breast Disease
Not every breast lump is cancer — but I do not guess when something is new or changing. Triple assessment (exam, imaging, pathology) prevents both missed cancers and unnecessary mastectomy from fear alone. Tumor biology (ER/PR/HER2/Ki-67) shapes chemotherapy, endocrine therapy, and anti-HER2 options. I offer BRCA1/2 testing to newly diagnosed patients ≤65; above 65 the decision is individualized. Neoadjuvant therapy can reshape breast and axillary plans — the first sketch is not always the final map.
Open English hub →Molecular Testing in Cancer
Molecular and biomarker tests describe tumor or hereditary features that guide targeted drugs, immunotherapy, surgical sequencing, and family screening. Examples include MMR/MSI, RAS/BRAF, HER2, PD-L1, NTRK fusions, and CLDN18.2 protein expression — not all are “mutations.” Somatic tumor testing answers treatment questions; germline testing answers family-risk questions — mixing them confuses patients. A positive targetable result does not erase stage, fitness, or surgical judgment. Ordering panels without a clinical question wastes time and can delay necessary care.
Open English hub →Hereditary Cancers
Most cancers are sporadic. Lynch, BRCA1/2, FAP, CDH1, Li-Fraumeni, Peutz–Jeghers, and selected other germline conditions can raise risk for the patient and relatives. This hub is not a genetics clinic: it answers common surgical-patient questions and links to molecular testing. Tumor (somatic) results are not the same as germline results — confusing them causes unnecessary fear or missed cascade testing.
Open English hub →GIST and Neuroendocrine Tumors
Gastrointestinal stromal tumors (GIST) and neuroendocrine tumors (NET) need pathology, mutation or grade data, and organ-specific planning. They are not managed with a generic gastric-adenocarcinoma checklist. Selected small, low-risk gastric GIST may be surveilled; PDGFRA D842V changes tyrosine-kinase expectations including imatinib resistance. NET versus neuroendocrine carcinoma (NEC) separation is critical — biology and urgency differ. Surgery, TKIs, somatostatin analogs, and peptide-receptor therapies enter only after the report answers the right questions.
Open English hub →Peritoneal Metastasis, CRS & HIPEC
Cytoreductive surgery (CRS) and HIPEC are related but separate. CRS aims to remove visible peritoneal disease; HIPEC adds heated intraperitoneal chemotherapy in selected protocols afterward. HIPEC is not standard for all peritoneal disease and is not an automatic add-on to every CRS. In colorectal peritoneal metastases, PRODIGE-7 showed no overall-survival benefit for oxaliplatin HIPEC — this must be discussed honestly. PCI score, primary tumor type, fitness, and likelihood of complete cytoreduction decide candidacy. If you are not a candidate, saying so clearly is better than the wrong large operation.
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Upper GI
Robotic surgery
Emergency surgery
Acute Abdomen
Acute abdomen covers life-threatening causes of abdominal pain: perforation, ischemia, obstruction, appendicitis, cholecystitis, and more. Pain location, onset (sudden versus gradual), and associated symptoms such as vomiting, fever, or collapse guide urgency. Some causes need emergency surgery within hours; others start with fluids, antibiotics, and imaging. The danger is delay — waiting for painkillers to “prove” seriousness can cost bowel. Hospital evaluation with labs, imaging, and surgical review is the safe default when pain is severe, progressive, or paired with systemic signs.
Open English hub →Appendicitis
Appendicitis is a common surgical emergency caused by inflammation of the appendix. Pain often begins near the umbilicus and migrates to the right lower quadrant, with anorexia, nausea, or low-grade fever — but atypical locations and presentations are frequent. Clinical judgment plus ultrasound or CT guides timing of laparoscopic appendectomy. Perforation and abscess change antibiotics, drainage decisions, and sometimes operative strategy. Pathology after removal occasionally reveals unexpected findings; histology is not a formality. Most uncomplicated cases recover quickly after keyhole surgery.
Open English hub →Bowel Obstruction & Adhesions
Bowel obstruction presents with vomiting, bloating, crampy or continuous pain, and inability to pass gas or stool. Adhesions after prior surgery, hernia incarceration, and tumor are common causes. Some adhesive small-bowel obstructions can be observed safely with fluids and nasogastric decompression when there is no strangulation. Hernia incarceration, peritonitis, closed-loop signs, or ischemic features push toward prompt surgery. CT helps define the transition point and ischemia clues — but clinical decline overrides a “reassuring” early scan. Home waiting with progressive vomiting and distension is unsafe.
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Proctology
Anal Fistula
An anal fistula is an abnormal track between the anal canal and perianal skin, often after an abscess. Start with classification: simple low fistulas may heal with fistulotomy in suitable patients; complex sphincter-involving tracks need sphincter-sparing strategies such as seton drainage, LIFT, or advancement flap. Crohn’s-related fistulas need coordinated medical therapy. Selected newer techniques (plug, fibrin glue, laser, VAAFT) sit outside that core evidence ladder — discuss limits openly. Recurrence is real in complex disease — staged care and continence protection outrank speed of “one-shot cure” marketing.
Open English hub →Anal Fissure
An anal fissure is a tear in the anoderm that causes severe pain with bowel movements, often with bright red blood on the paper. Acute fissures frequently heal with soft stools, fiber, fluids, and topical agents that reduce sphincter spasm. Chronic fissures may need Botox (chemical sphincterotomy concept) or, in selected failures, lateral internal sphincterotomy (LIS). Continence risk is discussed before any sphincter-dividing surgery. Crohn’s disease and infection can mimic fissures — the diagnosis should be confirmed, not assumed forever as “constipation tear.”
Open English hub →Hemorrhoids
Internal and external hemorrhoids cause bleeding, prolapse, itching, and discomfort. Care is stepwise: dietary measures and office procedures first; excisional hemorrhoidectomy when conservative care fails for advanced symptomatic disease. Energy devices such as LigaSure assist excisional hemorrhoidectomy — they are not a separate treatment paradigm. Stapled hemorrhoidopexy is not a routine first-line surgical option for every patient. Bright rectal bleeding with anemia or change in bowel habit still needs proper examination and often colonoscopy.
Open English hub →Anal Abscess
An anal (anorectal) abscess presents with escalating perianal pain, swelling, and sometimes fever. Source control by drainage is the primary treatment; antibiotics support selected patients but seldom replace incision and drainage of a mature collection. Diabetes and immunosuppression raise complication risk and need closer pathways. After drainage, persistent discharge may signal an evolving fistula track that needs later definitive care. Early evaluation shortens suffering and reduces deeper soft-tissue infection.
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Endocrine surgery
Colorectal support
Stoma Living Guide
Ileostomy and colostomy care cover pouch changes, skin protection, diet, fluid–sodium balance, travel, and sport. Skills are teachable: most leaks and irritation improve with fit, contour, and timing rather than brand loyalty alone. High-output ileostomy needs personalized rehydration — “just drink lots of plain water” is not always correct and can worsen sodium loss. Temporary stoma closure timing depends on healing, oncology, and sphincter status — not a fixed calendar date. Education continues after surgery with stoma nursing in the same clinical language.
Open English hub →Diverticular Disease & Diverticulitis
Diverticulosis is common with aging; diverticulitis is inflammation of a diverticulum — this hub is separate from IBD (Crohn’s / ulcerative colitis). CT guides severity and separates mild from complicated disease (abscess, perforation, fistula, obstruction). Uncomplicated mild attacks may not need automatic antibiotics in selected patients. Elective resection is driven by complications, quality of life, immunosuppression, and preference — not attack count alone. Colonoscopy timing after inflammation depends on whether a recent high-quality exam already exists. Emergency surgery remains necessary for selected free perforations and unstable patients.
Open English hub →Colonoscopy
Colonoscopy uses a flexible camera to inspect the colon lining. It serves **screening** (catching polyps early), **diagnosis** (bleeding, stool change, anemia), and **therapy** (polypectomy, biopsy, stent, decompression, bleeding control) — often combined in one visit. Bowel prep quality determines whether small polyps are missed.
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