Q: Do we do laser surgery?
A: No. There really are no applications for laser in general surgery.
Q: Do we do laparoscopic surgery for inguinal hernias?
A: No.  Very good studies have shown that there is no benefit in doing laparoscopy over conventional open surgery for most hernias.
Q: Do we do laparoscopic surgery for ventral/incisional/umbilical hernias?       
A: We do, but only in very selected cases.
Q: Do we use mesh for inguinal hernias?
A: Yes, in a great majority of cases.
Q: Do we use mesh for ventral/incision/umbilical hernias?
A: We do, but only in very selected cases.
Q: Are incisional hernias always avoidable?
A: No.  There are many factors that may inhibit wound healing that are beyond our control.  For example, excess body weight is one of the most significant predisposing factors because the muscle layer under the abdomen stretches during weight gain and that makes it more prone to ripping even after we close it during surgery.  Smoking is another significant factor for incisional hernias.
Q: Do we do surgery for adhesions?
A: No, unless imaging studies show that the adhesions are causing a bowel obstruction. Pain alone is not an indication for surgery.
Q: Do we do surgery for delayed emptying of the gallbladder (also known as gallbladder dysmotility)?
A: No, unless we have proof that the gallbladder has formed sludge or stones.
Q: Do we do surgery for irritable bowel syndrome (IBS)?
A: No.  IBS tends to get worse with surgery.
Q: Do we do surgery based on reports of x-ray studies?
A: No.  We prefer to see the hard copies of the films or digital images as well as the report.
Q: Can we be absolutely sure that ulcerative colitis (UC) is present?
A: No, there is always the possibility that the pathological studies will reveal Crohn’s disease after surgery.  To be confident that the diagnosis is correct, we review all studies including the glass slides of the last colonoscopy.
Q: Can a patient with Crohn’s disease (CD) expect to be cured with surgery? 
A: No.   Crohn’s disease will always be present, but with surgery your symptoms may resolve. We recommend that every patient with Crohn’s disease continue taking medication.
Q: Does surgery trigger more inflammation in CD?
A: No.  In some patients CD is arrested with surgery while in others it is not. CD activity is inherent to the disease itself and is not generated by surgery.
Q: Do all patients with colon or rectal cancer need a colostomy?
A: No.  In fact, very few need a permanent colostomy and some will require only a temporary colostomy, usually for 8 to 12 weeks.
Q: Does an ileostomy or colostomy create a handicap?
A: Not at all.  Patients with “ostomies” can continue with their usual activities (sports, sexual, and work) although some dietary adjustments may be necessary.
Q: Can a patient work while receiving chemotherapy?
A: Yes, the great majority of patients do work and most have very minimal side affects.
Q: Do we operate on all patients with hemorrhoids?
A: No.  We do very few surgeries for hemorrhoids.  In fact, we treat the great majority of patients with hemorrhoids in the office with injections of sclerotherapy and it does not cause any discomfort.
Q: Do all patients with enterocutaneous fistulas require surgery?
A: Not all, but the great majority will require surgery if the fistula persists beyond three months after the last surgery.  In patients who have had numerous surgeries, a point may be reached where surgery is no longer advisable.  In order to decide whether surgery is even possible, we need to evaluate all operative reports and review recent studies of the gastrointestinal tract.
Q: Can all patients with fecal incontinence have successful surgical repair of their anal sphincter?
A: Unfortunately not.  The only component that can be repaired is the muscle, but the nerves that elicit muscular contractions are often damaged as well and there is no surgery available for them.
Q: Can all surgical wound infections be avoided?
A: Not really.  No matter how well we prepare the skin and even if we use antibiotics, incisions still can get infected.  This is particularly a problem with sebaceous and  pilonidal cysts because these cysts harbor bacteria under the skin that cannot be eliminated before surgery.
Q: Do patients diagnosed with cancer need surgery immediately?
A: Not really, most cancers have developed over a matter of years. A few more days or weeks if needed to optimize the treatment plan do not make any difference in terms of final outcomes. 

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