General Surgery Procedures

Sometimes, the abdominal wall is weakened due to multiple previous surgeries resulting in the formation of complex hernias and/ or the return of a previously repaired hernia. In these cases, Dr. Heaton can use the tissues of the abdominal wall along with mesh(synthetic/biologic) to repair the abdominal wall. Abdominal wall reconstruction is a surgical procedure used to restore the structural and functional integrity of the abdominal muscles.

Abdominal wall reconstruction is most often performed on patients who have had unsuccessful hernia repair operations. The goal of abdominal wall reconstruction is to treat any open wounds in the abdominal wall, restructure the tissues, and reinforce the integrity of the muscles.

Abdominal wall reconstruction may be recommended for patients who experience the following:

  • Recurrent hernias
  • Incisional hernias
  • Infection that develops after a surgery
  • Wound that develops after a hernia repair

It is important to adhere to all postoperative instructions as well as schedule and attend all necessary follow-up appointments.


An appendectomy is surgery to remove the appendix. The appendix is a small, finger-shaped organ that branches off from the first part of the large intestine. The appendix is removed when it becomes swollen (inflamed) or infected. This condition is called appendicitis. An appendix that has a hole in it (perforated) can leak and infect the entire abdomen area. This can be life-threatening.

Appendectomy is done laparoscopic most of the time with 3 small incisions. But can also be performed with a right lower quadrant incision.

General anesthesia is used and You will be asleep and not feel any pain during the surgery. The surgeon makes a small cut in the lower right side of your belly area and removes the appendix. The appendix can also be removed using small surgical cuts and a camera. This is called a laparoscopic appendectomy. If the appendix broke open or a pocket of infection (abscess) formed, you may not require traditional surgical intervention and have a drainage tube place by a radiologist.

Intestinal obstruction is a significant mechanical impairment or complete arrest of the passage of contents through the intestine due to something that causes blockage of the bowel. Symptoms can include cramping pain, vomiting, obstipation, and lack of flatus. Diagnosis is clinical, confirmed by abdominal x-rays. Treatment is fluid resuscitation, nasogastric suction, and, in some cases of complete obstruction, surgery.

Mechanical obstruction is divided into obstruction of the small bowel (including the duodenum) and obstruction of the large bowel. Obstruction may be partial or complete. About 85% of partial small-bowel obstructions resolve with nonoperative treatment, whereas about 85% of complete small-bowel obstructions require surgery. Overall, the most common causes of mechanical obstruction are adhesions (scar tissue)

Patients with possible intestinal obstruction should be hospitalized. Treatment of acute intestinal obstruction must proceed simultaneously with diagnosis. A surgeon should always be involved.

PEG stands for percutaneous endoscopic gastrostomy, a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach. PEG allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and esophagus. Patients who have difficulty swallowing, problems with their appetite or an inability to take adequate nutrition through the mouth can benefit from this procedure. Specialized liquid nutrition, as well as fluids, are given through the PEG tube.

Dr. Heaton uses a lighted flexible scope called an endoscope to guide the creation of a small opening through the skin of the upper abdomen and directly into the stomach. This procedure allows the doctor to place and secure a feeding tube into the stomach. Patients generally receive an intravenous sedative and local anesthesia, and an antibiotic is given by vein prior to the procedure. Patients can usually go home the day of the procedure.

A dressing will be placed on the PEG site following the procedure. This dressing is usually removed after one or two days. After that you should clean the site once a day with diluted soap and water and keep the site dry between cleansings. No special dressing or covering is needed.

Complications can occur with the PEG placement. Possible complications include pain at the PEG site, leakage of stomach contents around the tube site, and dislodgment or malfunction of the tube. Possible complications include infection of the PEG site, aspiration (inhalation of gastric contents into the lungs), bleeding and perforation (an unwanted hole in the bowel wall).

PEG tubes can last for months or years. However, because they can break down or become clogged over extended periods of time, they might need to be replaced. Your doctor can easily remove or replace a tube without sedatives or anesthesia, although your doctor might opt to use sedation and endoscopy in some cases. Your doctor will remove the tube using firm traction and will either insert a new tube or let the opening close if no replacement is needed. PEG sites close quickly once the tube is removed, so accidental dislodgment requires immediate attention.

Femoral hernias are another type of groin hernia. It occurs lower in the groin than the more common inguinal hernia. Femoral hernias develop in the upper part of the thigh near the groin just below the inguinal ligament ( or the crease in your groin), where abdominal contents pass through a naturally occurring weakness called the femoral canal.

It is a relatively uncommon type of hernia, accounting for only 3% of all hernias. They occur approximately 10 times as frequently in women than men.

It is repaired in the same manner as the other inguinal hernias with mesh.

Details of Laparoscopic Cholecystectomy

Cholecystectomy, or surgical removal of the gallbladder, has been the treatment of choice because it is a generally safe and permanent cure for gallbladder stones. In the past there have been attempts at using medications to dissolve stones or methods of stone crushing techniques, such as shock wave lithotripsy. Unfortunately, these techniques haven’t been shown to work. Changes in diet or the use of vitamins has not been successful in dissolving gallstones.

Laparoscopic cholecystectomy is the standard technique for complete removal of the gallbladder that greatly reduces postoperative pain, hospitalization time, disability, and cost. During conventional cholecystectomy, the abdomen is opened by cutting a four to six inch incision in the upper abdominal muscle. After surgery, the patient often remains in the hospital on pain medications for two to five days, and may be off of work three to six weeks. There can be no strenuous exercise for at least six weeks. Laparoscopic techniques allow some patients to go home the same day and often return to work within a week.

Laparoscopic cholecystectomy is much less traumatic. Because the gallbladder is removed with the help of a one-half inch telescopic camera and instruments inserted through several tiny punctures, the procedure can be performed on an outpatient basis. Minimal narcotics are needed and the patient can return to work within a week and light activities in two to four weeks. No blood transfusions are necessary. Thus, the laparoscopic approach to cholecystectomy offers total permanent relief of gallbladder stone problems with minimal discomfort and disability, and at greatly reduced hospital cost.

Treatment Options

Preoperative Care: The patient arrives at the hospital the morning of the procedure on an empty stomach. No bowel preparation is necessary. Lab work has been done during an earlier office visit.

Laparoscopic Cholecystectomy: Under general anesthesia the abdomen is gently inflated with carbon dioxide gas. The expanded space allows room to perform the operation. A small 5mm incision is made in the lower portion of the umbilicus, so that a laparoscope (a thin telescope) can be inserted into the abdominal space. The laparoscope is attached to a video camera, allowing the surgical team to work together watching a magnified TV picture.

Two grasping forceps are then inserted into the right side of the abdomen through two small 5mm incisions. These forceps are used to position the gallbladder through the remainder of the procedure. Finally, a 11mm incision is made in the mid upper abdomen. A variety of manipulating and cutting instruments can be inserted through this site. The blood vessels to the gallbladder and the cystic duct that attaches the gallbladder to the bile duct are freed of surrounding tissues. A fine tube can be inserted into the bile duct, so that x-rays can identify additional stones that may have migrated from the gallbladder to the bile duct, if needed. Next, the cystic duct and blood vessels are closed with surgical clips and cut. The gallbladder is then separated from the liver, using electrocautery then placed in a bag and removed from the abdomen. The gallbladder, containing its stones, is now free in the abdomen. Sutures are used to close the abdominal wall incisions and a “skin glue” placed over the puncture sites. Then patient is then transferred to the recovery room.

It should be noted that it may occasionally be necessary to convert the laparoscopic cholecystectomy to an open cholecystectomy. The abdomen would be opened, for instance, if there were marked scarring or inflammation of the gallbladder or if there were technical difficulties with bleeding or proper positioning of the internal organs.

Postoperative Care: Discharge from the hospital may occur following recovery from anesthesia or the next day, depending on how the patient feels and on his home circumstances. Diet consists of starting with liquids and advance diet as tolerated. Removal of the gallbladder does not cause problems with digestion or bowel function. Thus, there are no dietary restrictions. Postoperative pain is described as a stretching soreness of the abdominal wall, occasional referred shoulder pain from the stretching of the diaphragm, and very localized discomfort at the skin puncture sites. A pain shot may be needed immediately after cholecystectomy. Then you will use oral pain medication for the next few days.

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Hemorrhoids are swollen veins around the anus. They may be inside the anus (internal hemorrhoids) or outside the anus (external hemorrhoids).

Often hemorrhoids do not cause problems. But if hemorrhoids bleed a lot, cause pain, or become swollen, hard, and painful, surgery can remove them.

Hemorrhoid surgery can be done in your healthcare provider’s office or in the hospital operating room. In most cases, you can go home the same day. The type of surgery you have depends on your symptoms and the location and size of the hemorrhoid.

Before the surgery, your doctor will numb the area so you can stay awake, but not feel anything. For some types of surgery, you may be given general anesthesia. This means you will be given medicine in your vein that puts you to sleep and keeps you pain-free during surgery.

Hemorrhoid surgery will involve:
– Using a knife (scalpel) to remove hemorrhoids; you may or may not have stitches

After the Procedure You will go home the same day after your surgery. Be sure you arrange to have someone drive you home. You may have a lot of pain after surgery as the area tightens and relaxes. You will be given medicines to relieve pain. Buy and over the counter stool softener to begin while you are on pain medications.

Follow instructions on how to care for yourself at home.
– after bowel movements take sitz baths or shower to clean the area

Most people do very well after hemorrhoid surgery. You should recover fully in a few weeks, depending on how involved the surgery was. You will need to continue with diet and lifestyle changes to help prevent the hemorrhoids from coming back.

A hernia is a condition in which tissue or an organ, usually fatty tissue, but possibly even part of the intestine, protrudes through an opening of the abdominal wall. When it occurs in the part of the groin area known as the inguinal canal, it is called an inguinal hernia. The inguinal canal is the passageway between the abdomen and the reproductive organs. The abdominal wall in this area has an opening to allow blood vessels to reach the testicles. This opening may not close properly or completely after birth or may enlarge during life. There are other factors, however, that can occur later in life to make this area prone to a hernia, including chronic cough, chronic constipation, smoking, pregnancy, heavy lifting, and certain medical conditions.

Although some inguinal hernias do not manifest symptoms, others may involve pain and/or a heavy sensation in the groin area. The tissue that is protruding through the abdominal wall can create a visible bulge. This bulge may become more obvious when the person is bending over, coughing, or otherwise straining. In some cases, the hernia may become trapped in the opening of the abdominal wall “incarcerated Hernia”. This can be extremely serious if blood flow to the tissues of the bowels is cut off and may become “Strangulated”.

Surgery is often necessary to treat a hernia. During inguinal hernia surgery Dr. Heaton returns the protruding tissue or organ back into the abdominal cavity and repairs the hole in the abdominal wall. Fortunately, advanced technology has made it possible for us to treat hernias in a minimally invasive manner that he uses at times when indicated. Laparoscopic surgery may eliminate the need for the single incision associated with traditional open hernia surgery. However, will involve three small incisions. Laparoscopy is usually reserved for bilateral inguinal hernia repairs or recurrent (previous) open inguinal hernia repairs. During your consultation Dr. Heaton will determine if you are a candidate for this procedure or if your condition requires a more traditional open surgical approach.

About the procedure
Open Surgery
Your surgeon will find the hernia and separate it from the tissues around it. Then your surgeon will remove the hernia sac or push the intestines back into your abdomen. Your surgeon will close your weakened abdominal muscles with stitches. Often a piece of mesh is also sewn into place to strengthen your abdominal wall. This repairs the weakness in the wall of your abdomen.
A laparoscopic hernia repair procedure uses a laparoscope with a camera that transmits images from your abdomen to a viewing screen to guide the surgeon in using the surgical instruments to make the repair. A harmless gas (carbon dioxide) is gently placed between the layers of your abdominal wall to separate layers and inflate it and provide enough room for Dr. Heaton to work. Three or four one quarter inch incisions are usually necessary for placement of the laparoscope and surgical instruments. The hernia is then repaired from behind the abdominal wall and includes the placement of a small piece of surgical mesh over the hernia defect which is then secured in place. This operation is usually performed with a short general anesthesia.

If you need frequent intravenous (IV) medicines or blood draws or both your healthcare provider may order a port for you. A port is a small medical device that allows providers easy, reliable access to administer medicine to a patient directly into the veins. A port is a small medical device that is inserted beneath the skin usually in the upper chest. It sits just below the collar bone. It is about 1/2″ thick and about the size of a quarter. You can feel its raised center under your skin. A flexible piece of tubing (catheter) is connected to it. The catheter is tunneled under the skin to an area near the neck where it enters a vein.

The center of the port is made of a tough, self-sealing, rubber-like material that can be punctured through the chest skin with a special needle many times. After each puncture, it will reseal instantly.

It is commonly inserted as a day surgery procedure in a hospital or in a clinic by a surgeon. Many patients prefer the outpatient setting because the cost is generally less than in a hospital setting.

Once ready for the port placement, Dr. Heaton will inject a local anesthetic under your skin in the chest area. You will only feel it for a few seconds and then the skin will be numb.

Under the guidance of fluoroscopy (real-time x-ray images viewed on a monitor), Dr. Heaton will insert a small tube (called a catheter) into the vein in your neck or under the collar bone. A small pocket, into which the port will be placed is formed under your chest skin approximately 2-3 inches below your collarbone. After that, the tubing is connected to the port is tunneled under the chest skin so that it enters the neck or subclavian vein (under the collar bone).

When no longer needed, the port can be removed in the hospital or in the outpatient setting in a similar fashion.

A minimally invasive approach to surgery, laparoscopic procedures afford patients the benefit of smaller incisions, less pain, fewer heart, lung and wound complications and shortened hospital stay.

Dr. Bren Heaton has extensive experience using laparoscopic techniques for a variety of conditions. He is at the forefront of minimally invasive patient care, research, and education. Techniques in Minimally Invasive surgery have become the gold standard of a general surgery practice, and can be employed in everything from gallbladder removal to Hernia surgery.

Benefits of Laparoscopic Surgery

Many surgeries that were once performed as open surgeries (using longer incisions of the abdominal wall) can now be performed using minimally invasive laparoscopic procedures. Your physician will determine if this approach is best for you.

Laparoscopic Surgery can have significant benefits over traditional surgery. These may include:

  • Reduced hospital stays
  • Fewer wound infections
  • Less pain
  • Faster recovery time
  • Less surgical trauma
  • Improved outcomes
  • Much smaller scars

There are four parathyroid glands, which are located on the underside of the thyroid. These glands produce parathyroid hormone (PTH), which regulates the amount of calcium in the blood. This is their ONLY job. The most common parathyroid problem is hyperparathyroidism, a condition in which the gland produces too much PTH. This is often the result of a parathyroid adenoma, a benign condition.

Cancerous growths in the parathyroid glands are extremely rare. Idaho Surgical provides exceptional treatment for parathyroid disease including these adenomas. Patients in the Treasure Valley area can expect exceptional, compassionate care from our team.

When a parathyroid gland develops into an adenoma, it grows at an abnormal rate. In turn, this results in production of an abnormal amount of PTH. Therefore, one of the main symptoms of parathyroid cancer is a result of massive amount of PTH in the blood – well beyond even “excessive” Levels. Extremely high levels of calcium in the blood are the result, leading to possible kidney stones, gallstones, constipation, depression and osteoporosis.

Risk factors:
Parathyroid disease can be usually associated with an inherited defect, so people with a family history of the disease are more at risk. Most cases are random events found as the result of a routine blood test showing a higher than normal calcium level. Contact our office if you believe you are at risk for this disease, and we can schedule a diagnostic exam.

Parathyroid adenoma is a slowly developing disease that responds well to treatment, especially if it is caught early on. Surgery is the most common and effective treatment. Usually the parathyroid gland containing the adenoma is removed through a small incision in the neck, leaving the other healthy glands in place with intraoperative PTH testing and the use of the electronic breathing tube monitor (NIM tube) He can identify if the adenoma was indeed in the specimen removed and can locate the nerve to the vocal cord/cords.

Post Operative:
Much like thyroid surgery , recovery from parathyroid surgery is similar. After a parathyroidectomy, the patient stays in hospital overnight to check calcium and PTH labs the next morning and to assure that there will be minimal swelling. The incision usually heals in a week or so, and most patients are able to return to their regular activities a few days/weeks after the procedure. Some patients may or may not also be prescribed a calcium supplement pills to maintain normal calcium levels while the remaining glands recover. Our team works closely with patients in the days, weeks, and months after surgery to monitor their recovery and help if any complications arise with the close help of the endocrinologists.

Prescribed medications
Continue to take all your usual medications in their usual doses. If you normally take any medications for blood pressure or heart problems in the morning, these can be taken with a small sip of water on the morning of your surgery.

Coumadin (Please confirm these instructions with your surgeon)

If you take Coumadin (a type of blood thinner), we will frequently suggest that you discontinue this medication 5 days prior to your operation. Only discontinue this following the specific instructions of your doctor.

Plavix (Please confirm these instructions with your surgeon)

This medication should be discontinued one week prior to surgery. Please check with your doctor for specific instructions.

Other medications
Due to the risk of increased bleeding, you should stop any of the following medications at least 10 days prior to surgery:

  • Aspirin
  • Plavix
  • Bufferin ®
  • Excedrin ®
  • Advil ®
  • Motrin ®
  • Ticlid ®
  • Naproxen
  • VIOXX ®
  • Voltaren ®
  • Ibuprofen
Any other medications not listed, please discuss with your surgeon. It is okay to take Tylenol.

Removal of a pilonidal cyst is a procedure for draining or removing a cyst near the tailbone.

If acutely infected this procedure may be done to open and drain an infected pilonidal cyst prior to surgical excision. A pilonidal cyst is a saclike structure under the skin. It usually happens in the crease just above the buttocks, near the tailbone. Most of the time it contains hair. It can become infected and cause a recurrent abscess. If infected it usually needs to be drained prior to surgical excision (removal) of the cyst.

What happens after the procedure?
The procedure is outpatient and you will go home afterword. Keep the area as clean as possible. It will be closed with multiple layers of dissolvable sutures with an outer layer of it was closed with stitches, the stitches may stay in as long as 2 to 3 weeks.

The wound will need 1 to 2 months to heal. In some cases it may take multiple weeks to months to heal.

Skin lesion removal is a procedure to remove the lesion. A skin lesion is an area of the skin that is different than the surrounding skin. This can be a lump, sore, or an area of skin that is not normal. It may also be a skin cancer.

Which procedure you have depends on the location, size, and type of lesion. It can be done in the clinic procedure room or in the operating room depending on size and location of the lesion. The removed lesion is then sent to the Pathologist where it is examined under a microscope.

You will receive some type of numbing medicine (anesthetic) before the procedure In the skin and area of excision. You will have dissolvable stiches and can shower the next day. We will follow up with you in 2-3 weeks, but feel free to call with any questions or concerns at any time.

Some reasons to remove a skin lesion include:

  • To make a diagnosis
  • To improve the cosmetic appearance
  • To relieve symptoms (if a lesion is tender or prone to being bumped)
  • To remove an inflamed or frequently infected lesion

Core muscle injury, often misleadingly called a “sports hernia,” is a condition that mainly affects athletes who play soccer, hockey, football, and rugby, and who run track. It is more common in males than females. A full 94% of these injuries occur gradually from unknown causes; the other 6% are caused by a specific traumatic incident

Stress from repetitive twisting, kicking, and turning at high speeds is a likely cause of injury.

Athletic pubalgia and sports hernia, but this injury does not fit the common definition of a “hernia,” where an organ or soft tissue protrudes outside its normal cavity. There is no defect in the abdominal wall or herniation of the abdominal contents with a sports hernia. Injury occurs in the form of tears and weakening in the deep layers of the abdominal wall.

Repetitive hip and pelvic motions typical in sports can cause injury to the lower abdominal area. Imbalances between the hip and abdominal muscles can, over time, cause overuse and injury. Weakness and lack of conditioning in the abdominals also might contribute to the injury. Ironically, aggressive and unsafe abdominal exercise programs can also cause or aggravate a core muscle injury. A core muscle injury usually occurs where the abdominal muscles attach in your pelvis. There is no protrusion of organs, but there are tears in tendons and muscles, such as those surrounding the hip. This makes the term “hernia” a misnomer, as the term hernia means when organs from your abdomen come out through spaces, such as the inguinal canal. Nerve irritation can also occur, contributing to the uncomfortable symptoms.

Chronic groin pain is a hallmark symptom of core muscle injury. It occurs in 5% to 18% of athletes, and varies with the sport being played. Sharp groin pain with exertion is also a typical symptom. Pain often occurs exclusively with intense sprinting, kicking, twisting, or “cutting,” and subsides rapidly with rest. Significant training and competition time can be lost due to related chronic groin pain.

Dr. Bren Heaton at Idaho Surgical provides exceptional thyroid cancer treatment for patients in the Treasure Valley. He provides aggressive treatment to remove and eradicate the cancer while helping patients become fully informed about the symptoms, risk factors, and treatment options for this disease.

The first symptom of thyroid cancer is often the growth of nodules, or lumps of tissue, in the thyroid. If there are nodules, the thyroid may become enlarged and eventually cause pain in the neck and changes in the voice, swallowing and/or breathing. Although nodules are common and are usually benign, they can also be a symptom of thyroid cancer and should be monitored. Idaho Surgical provides quick, relatively painless diagnostic exams to determine whether nodules are pre-cancerous.

Risk Factors:
While anyone can develop nodules in the thyroid, the growths are more common in people who had radiation therapy in childhood. Individuals with a family history of thyroid problems are also more likely to develop thyroid cancer.

An ultrasound examination may be performed to detect nodules, their size, and whether they are solid or filled with fluid. A fine-needle biopsy may be performed to collect cells from the nodule(s) as well to determine whether they are cancerous.

Treatment – Thyroid Removal:
It may be necessary to remove all or part of the thyroid if a patient is diagnosed with thyroid cancer Dr. Bren Heaton has been known to and has been providing top-notch care for patients needing a thyroidectomy. To begin the procedure, general anesthesia is administered, using a breathing tube to electronically monitor the vocal cords during surgery. Next, He makes a small incision in the neck (collar incision) along a crease in the skin so that the scar is less noticeable. He then removes part of the thyroid or the entire gland, depending on how much cancerous tissue there is. There is always a risk of temporarily and/or chronically damaging the vocal cords changing pitch and sound of voice, and damage to the parathyroid glands. When the surgery is complete, he sutures the incision closed, you wake up, the breathing tube is removed and you’re admitted to the hospital overnight for observation.

After a thyroidectomy, the patient stays in hospital overnight to check labs the next morning and to assure that there will be minimal swelling. The incision usually heals in a week or so, and most patients are able to Return to their regular activities a few days/weeks after the procedure. Radiation therapy may be necessary to treat the surrounding tissue. Some patients may or may not also be prescribed thyroid hormone pills to maintain normal thyroid function. Our team works closely with patients in the days, weeks, and months after surgery to monitor their recovery and help if any complications arise with the close help of the endocrinologists.

The largest gland in the neck, the thyroid serves to regulate the body’s metabolism. Parathyroid glands are typically located right next to the thyroid gland and control how much calcium is in the blood and in the bones. It is relatively common for nodules to form in the thyroid gland. Although any nodule should immediately be investigated, most nodules found in the thyroid gland are benign. Cancerous nodules, when diagnosed early, have a very high cure rate if properly treated. Cancer of the parathyroid glands is extremely rare. An Adenoma of a parathyroid gland is discussed below.

A ventral hernia is a sac (pouch) formed from the inner lining of your belly (abdomen) that pushes through a hole in the abdominal wall. Ventral hernias often occur at the site of an old surgical cut (incision). This type of ventral hernia is also called incisional hernia.

Surgical Treatment for Hernias
Ventral hernia repair is surgery to repair a ventral hernia. You will probably receive general anesthesia (asleep and pain-free) for this surgery. If your hernia is small, you may receive a spinal or epidural block and medicine to relax you. You will be awake, but pain-free. Your surgeon will make a surgical cut in your abdomen.

Your surgeon will find the hernia and separate it from the tissues around it. Then your surgeon will gently push the contents of the abdomen back into the abdomen. The surgeon will only cut the intestines if they have been damaged.

Strong stitches will be used to repair the hole or weak spot caused by the hernia. Your surgeon may also lay a piece of mesh under the weak area to make it stronger. Mesh helps prevent the hernia coming back.

Your surgeon may use a laparoscope to repair the hernia. This is a thin, lighted tube with a camera that lets the surgeon see inside your belly. The surgeon inserts the laparoscope through a small cut in your belly and inserts the instruments through other small cuts. This type of procedure often heals faster and with less pain and scarring. Not all hernias can be repaired with laparoscopic surgery.


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