Our expert surgeons and physicians are specially trained to treat a variety of conditions with an array of cutting-edge treatments at our state-of-the-art facilities and partner hospitals.
Our surgeons provide service excellence by taking a holistic approach to a common disorder. By integrating evidence based medicine with best surgical practices, our surgeons offer high quality Hernia Care, tailored to each patient. By utilizing tension-free and minimally invasive techniques, our patients return to their activities of daily living soon and are left with a durable repair.
A hernia is a hole in the
abdominal wall, where tissue or organs can protrude through.
Abdominal hernias occur in areas of inherent weakness or where areas of weakness were created by previous surgery.
- Inguinal Hernia: The most common type of abdominal wall hernia. Occur in the region between your hip and pubic bone. May also be felt in the scrotum.
- Femoral: Present In the region where the blood vessels of the abdomen pass to the leg. Slightly lower than an inguinal hernia and toward the middle of the groin.
- Umbilical Hernia: Occur at the belly button. Sometimes referred to as, “outies,” they are indeed hernias and should be repaired.
- Incisional Hernia: Occur in old surgical sites anywhere in the abdominal and flank regions. Approximately 10% of patients who undergo abdominal surgical procedures can develop hernias in their old incision sites. This can even happen after laparoscopic surgery and more commonly after robotic surgery.
- Hiatal Hernia: Also known as a diaphragmatic hernia, occur within the abdomen, where the esophagus passes from the chest into abdomen. A common cause of Gastro-Esophageal Reflux Disease (GERD), can also cause obstructive complications associated with the stomach and other organs. They are broken up into 4 types
- Type I (sliding): Where the junction between the stomach and esophagus migrate into the chest as a single unit
- Type II: Where part of the stomach creeps past the junction of the stomach and esophagus and slides into the chest
- Type III: A combination of Type I and II, where a large part of the stomach along with the junction of the esophagus and stomach all slide into the chest.
- Type IV: Presence of organs or fat other than the stomach are slide into the chest
The biggest concern with this hernias is that anything within the abdomen can protrude through that and get stuck or “Incarcerate.” Incarceration of intestine, colon, fat or omentum and bladder are among the most common contents which can incarcerate. Once this occurs the blood supply to those organs may become compromised and “strangulate.” Strangulation, if not dealt with in a timely manner, can cause necrosis. In these situations acute surgical care and intervention is necessary. Organ removal and intensive resuscitation is often required.
Discomfort and a lump in the region of a hernia are the most common complaints patients have. The lump usually increases in size with exertion. Standing, coughing, sneezing or constipation often make symptoms more noticeable.
Rest and lying flat can ease symptoms and sometimes give patients the ability to push their hernia back in.
Hiatal hernias, however, are most commonly associated with reflux. They may also be noticed incidentally while working up patients for other diseases.
Depending on the type, size and location of the hernia and array of options may be offered. While laparoscopy and mesh offer the most durable repairs, open and primary techniques may be utilized and are sometimes more appropriate. While all hernias should be repaired in order to prevent long and short-term complications, only you and your surgeon can best identify what best suits you. Often performed in a same-day setting, the vast majority of patients can enjoy a rapid recovery and return to normal activities in a timely manner.
In some severe circumstances or in situations where recurrences have occurred, Abdominal Wall Reconstruction may be indicated. Separation of components or muscle advancement may be needed to bring the abdominal wall into a more natural contour in order to restore functional and structural integrity.
At Vein Treatment and Access Care, you will be consulting with board certified vascular surgeons from Highland Park Surgical Associates. These people are not only experts in performing the multiple types venous corrective procedures, but also in providing the lasting care that may be required. The degree to which we may recommend (or not recommend) a procedure is guided by the severity of the situation and the patient’s overall health. In fact, the many of our patients do not require any type of procedure, only the correct conservative care and continued monitoring. Varicose veins alone, in the absence of complications, demand nothing more than a pair of good compression stockings and the willingness to use them regularly. The decision to proceed further should be based on the presence of persistent symptoms. This decision should be patient-driven and doctor-guided, not doctor-driven. Remember this, whether you choose to work with us or any other group. On the other hand, once a patient manifests skin damage, our focus shifts to wound healing and our level of fervor in recommending a specific therapy increases. We do this in order to avoid the complications and health risks of a chronic wound, the time lost from work and other meaningful activities, and the risk of infection. Our reputation is for providing the most up-to-date care in the most appropriate manner for each patient we encounter. We do not strive to perform the greatest number of procedures in central Jersey. We make sure you understand the expected benefits, alternatives, and risks to any intervention we undertake and encourage you to ask questions if you feel anything is left unclear or unanswered. Your health, safety, and comfort are always our first and foremost priorities; and this we will never compromise. Please understand that if we feel you are not an appropriate candidate for a certain procedure, we won’t do it, even if it means losing your business to dr. X’s vein shop. Although we make our living treating varicose veins, it might surprise you to know that some of our most gratifying results have occurred after providing charity care to indigent patients with neglected and advanced venous disease. You can always count on our honest opinion and know that we will treat you as we would our own family member. We look forward to knowing you.
Hemodialysis Access
Many patients may require hemodialysis to remove fluid and toxins from the body which accumulate when the kidneys are not functioning normally. In order for this to be performed we must be able to deliver a continuous flow of blood from the patient to the dialysis machine and back to the patient during a dialysis treatment. In general, patients undergo hemodialysis three times per week. The most efficient and safest way of providing blood flow is by creating an access in the arm through a surgical procedure. The two major types of these are the arteriovenous fistula (AV fistula) and the AV graft.
Hemodialysis Access
Gastroesophageal Reflux Disease or GERD affects nearly 1 in 3 people throughout their lifetime. The majority of people suffering from GERD manage this disease ineffectively with medications like proton pump inhibitors. Increasingly these medications are being found to have drastic side-effects and may even stop working. Along with your gastroenterologist, primary care or ENT physician we work closely to coordinating the care of patients suffering from GERD. In some circumstances, a large hiatal hernia is associated with GERD. At Highland Park Surgical Associates we have the ability to both repair these hernias and address your reflux symptoms.
- Heartburn
- Regurgitation
- Asthma
- Cough
- Hoarseness
- Dental Erosion
- Sore throat
- Change in voice
- Chest Pain
- Esophaageal Cancer
- Barrett’s Esophagus (Pre-cancerous changes to the esophagus)
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Stricture and Dysphagia
- Narrowing and Trouble swallowing
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Esophagitis
- inflammation, irritation or swelling of the esophagus
- A Nissen Fundoplication is the gold standard treatment for GERD. This procedure involves wrapping the stomach around the lower esophagus and reinforcing the lower esophageal sphincter
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Medical therapy: Although good for initial treatment of symptoms medications do not treat the cause of the disease and does not prevent reflux. They can also have dramatic side-effects and lead to dependency
- Cardiac Arrhythmias
- Vitamin B12 deficiency
- Low Magnesium levels
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Medications
- Antacids
- H2 blockers
- Proton-pump Inhibitors
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Diet and Lifestyle-A good initial way to treat your symptoms, also doesn’t treat the cause. Changes to diet and lifestyle can help with mild disease.
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Diet-
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Many foods can decrease the LES to prevent Reflux. These include:
- Caffeine
- Fats
- Chocolate
- Others:
Everyone handles food differently and different triggers may set off reflux. Keeping a journal may assist identify your trigger.
- Do not lie down within 3 hours of a large meal
- Lying down with an incompetent Lower Esophageal sphincter can force food into the esophagus causing GERD.
- Acid production is at it peaks within the first 3 hours of eating a meal.
Linx
Lower esophageal sphincter augmentation device Stops GERD at the source Returns the Lower esophageal sphincter toward normal conditions. Allows the body to work in a more natural state Advantage Keeps the stomach in a natural state Reduces gas and bloating Preserves your ability to belch and vomit Same day procedure and home on a normal diet
- Dependence of medications for GERD
- Suffering from GERD while on medications
- Quality of life affected by GERD
- Difficulty sleeping
- Inability to tolerate certain foods
- Daily activities affected by GERD
- Concerns about the long-term side effects of medications
- Concerned about the long term risks of the complications of GERD itself
General Surgery
Gallstones and the diseases which are caused by them, are the most common general surgical problem, the surgeons of Highland Park Surgical Associates treat. While not all gall stones cause problems, those that do should undergo prompt surgical evaluation.
Gall stones most commonly form from precipitation of cholesterol in bile. Bile is created and drains into a pipe or duct which passes from the liver into the gut. When we are in a fasting state the body closes the gate on pipe and bile backs up and is stored in the Gall Bladder. In the Gall bladder the bile sits and concentrates while awaiting stimulation from a meal. During this time the cholesterol precipitates out.
As this cholesterol precipitates out, fine stones begin to aggregate. Just like an oyster forms a pearl these stones will increase in size.
When the gut recognizes a meal, a hormone signals the pipe to open and Gall Bladder to contract. With this contraction, anything in the gall bladder will try to move through the ducts and into the gut. If stones are in the gall bladder they can block the ducts and cause an array related diseases.
Cholecystitis and Colic
When the stones get caught between the gall bladder and the bile duct the gall bladder will swell causing colicky pain. If left untreated or the stone doesn’t allow passage of the stored bile through the ducts, infection can set in causing cholecysitis.
Prompt surgical intervention is required along with antibiotics and IV fluids,
Laparoscopic Cholecystectomy is the most common general surgical procedure performed by our HPSA surgeons and is always performed safely
Cholangitis and Choledocholithiasis
When the stones pass beyond the gall bladder and its duct and get caught in the main bile duct a more life-threatening process can occur. Often associated with jaundice which is the yellowing of the skin and eyes, the stone can block the entire livers drainage system and make a patient very ill very quickly. Once accompanied by fever and pain the patient needs prompt drainage by a gastroenterologist or sometimes interventional radiologist. Once the patient improves, the gall bladder is then removed, most commonly by laparoscopy.
Gall Stone Pancreatitis
If the stone makes it beyond the two previously mentioned points it may still obstruct further downstream and block the duct which drains the pancreas and joins the bile duct. If this occurs, inflammation and infection of the pancreas may occur as well. Pancreatitis is the most severe consequence associated with gall stone disease. Treated similarly to choledocholithiasis, once the patient recovers from his/her pancreatitis, the gall bladder is removed. In this situation is highly recommended to remove the gall bladder prior to the patients discharge from the hospital. Occasionally abscesses or cysts are accompanied by the inflamed pancreas and these may need to be addressed by open surgical techniques, which your HPSA surgeons are adept at performing.
From simple pain to systemic infection your Highland Park Surgical Associates pride themselves on their abilities to recognize and treat the many different aspects of Gall Stone disease. If you or a family member is suffering please do not hesitate to call us in consultation. We would be happy to answer your questions and guide you.
Acute Care Surgery revolves around the specialized treatment of specific surgical diseases and the surrounding consequences induced on the body by those diseases. Often worsened by pre-existing conditions, the care given to patients suffering from these processes starts by trying to improve the state the body is in prior to embarking on the surgical procedure. Sometimes interval procedures may be required in order to complete the task at hand.
1. Gall Stones and Gall Bladder Disease
2. Appendicitis
The appendix is an organ which projects from the first portion of your colon or large intestine. When it becomes inflamed it can cause infection, peritonitis and abscesses. When this occurs it needs to be removed and an appendectomy is performed.
Appendicitis can be simple or complex. If simple appendicitis is recognized an appendectomy is performed and patient’s typically go home within 48 hours. If complex, patients may remain hospitalized and go on antibiotics while awaiting return of bowel function. Sepsis can set in and prolonged recovery may ensue.
Peritonitis
Inflammation of the abdominal cavity. Typically due to a perforation of intestine, or intestinal compromise.Condition whereby a portion or
3. Bowel Obstruction
Introduction
Bowel Obstruction is the interruption of normal intestinal flow. This stoppage can be due to a mechanical or functional reason. Mechanical bowel obstruction is most often due to scar tissue from previous abdominal or pelvic surgery. This scar tissue can cause a kinking of the bowel resulting in obstruction. The gastrointestinal tract produces several liters of fluid per day and when the intestines are obstructed, this fluid along with swallowed air begins to back up in the system. This combination is often accompanied by abdominal distension, severe pain and vomiting. Flatulence and bowel movements often cease and patients typically present to their physician with a myriad of symptoms related to obstruction.
Other causes of mechanical obstruction can also be due to an incarcerated hernia, inflammatory bowel diseases, cancer, previous radiation or swallowing a foreign body. Also, as previously stated, bowel obstruction can also be due to a functional cause. This is often called ileus or paralysis of the intestines. Ileus, is typically a secondary manifestation of some other disease process going on in the body. Ileus results in cessation of normal function and flow of the entire gastrointestinal tract. It commonly occurs post surgical procedure, but can be the result of pancreatitis, gastroenteritis or colitis, ischemia or trauma, as well as medical conditions and medications.
Diagnosis and Treatment
Prompt diagnosis and treatment are the cornerstones to good outcomes and something, Highland Park Surgical Associates are adept at. If you have any of the above stated symptoms, you should contact your physician or seek prompt medical attention at an acute care or emergency medical facility.
Massive dehydration, electrolyte imbalance and even perforation can occur These may result in prolonged hospitalization, permanent organ damage and even sometimes death. Typically, the first steps in treatment include resuscitation with IV fluids, decompression, occasionally antibiotics and even sometimes surgery.
Surgical Intervention
Used only as a last resort, is only necessary approximately 20-30% of the time. While surgical intervention can occasionally be performed laparoscopically and involve simple cutting of scar tissue, it can also be more involved; requiring exploratory surgery, partial removal of intestines, prolonged ICU care and sequelae.
Bowel obstruction, although primarily a disorder of the digestive system is a complex process ultimately involving multiple organ systems. Highland Park Surgical Associates are fortunate to have an available surgeon 24 hours a day, 7 days a week to help manage patients suffering from this problem. Their combined experience in managing this disorder has gained them an unparalleled reputation which will assure you appropriate care.
4. Incarcerated Hernia
5. Peritonitis
6. Lower Extremity Wounds
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With our aging population, it has become increasingly important to focus as much on the non-surgical disease processes our geriatric and ailing patients have, as it is to focus on the surgical diseases themselves. As a patient of Highland Park Surgical Associates you will be comforted to find the goal of their care is to guide you through the preoperative, operative and postoperative process with ease and understanding.
As a Surgical Critical Care Fellow, Dr. Tutela, began his experience and developed a focus towards Acute, Geriatric and Palliative Surgical Care. He is published in this area and continues provide the attention needed to coordinate the task required to care for these patients.
As Vascular Surgeons, Dr.’s Curtiss and Rosen are established and adept at treating patients with organ failure. These patients, much like our Geriatric population have a myriad of medical conditions which need individualized attention and care.
With their combined experiences, Highland Park Surgical Associates provide the excellence in care which their patients require. Along with your Primary Care and Medical Specialists, HPSA efficiently organizes the risk stratification and medical optimization you will need prior to surgery. Once effectively prepared you will then then be safely taken through your procedure and onto recovery. Post-procedure, your HPSA surgeon effectively communicates with care coordinators and social workers to assist with the rehabilitation required to get you through the full recovery process.
Highland Park Surgical Associates, understands the importance and role of your family during this process and they make it a point to be available to communicate your care during this process, should you desire.
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Vascular Surgery
- Fistula and Graft
- Catheter
- Revision and Repair of non-functioning access
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Peripheral Artery Disease
- Carotid Stenosis
- Lower Extremity
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Peripheral Venous Disease
- Venous stasis
- DVT