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					Diverticulitis - Mark Fusco MD                                                                           Page 1 of 2




            Diverticulitis

            DEFINITIONS
            Diverticulosis: The state of
            having sac-like protrusions
            of the inner most part of
            the colonic wall through
            the colonic muscular
            layers.

            Diverticulitis: Inflammation
            of one or more diverticula

            Diverticular bleeding:
            Colon bleeding due to
            divertucula

            WHO IS AT RISK?
            Diverticulosis if very common in western society. It is less common in African and
            Asian populations.

            The chance of getting diverticulosis increases as you get older.

            In general roughly 50% of the population has diverticulosis by the time they turn 70
            years of age.




            HOW DO DIVERTICULA FORM?
            Diverticula form when the pressure inside the colon is high enough to push the inner
            lining of the colon through the muscular layer of the colon to form the sac like
            protrusions. The strength or weakness of the wall of the colon is an important factor in
            who develops diverticula. It is also thought that as people age a gradual weakening of the
            colon leads to the higher rates of diverticulosis in older people.

            The main reason people will have excess pressures in the colon leading to diverticula is
            an inadequate amount of fecal bulk. With decreasing amount of bulk there is a decrease in
            bowel diameter which increases the pressure in the bowel. Decrease bulk results from
            inadequate ingestion of dietary fiber. A diet rich in dietary fiber or supplemented with
            commercially available fiber preparations, is thought to prevent the formation of
            diverticula.
            DIVERTICULITIS
            Diverticulitis develops in approximately twenty five percent of people with
            diverticulosis. It occurs in the sigimoid colon over 90% of the time. This accounts for
            the fact that most patients have left lower quadrant abdominal pain. It is also true,




file://D:\My Documents\Web page\Work site\TMP6hjhdwrcb3.htm                                               3/26/2006
Diverticulitis - Mark Fusco MD                                                                          Page 2 of 2



            however, that as many as ten percent of patients have no abdominal pain at all. Most
            of these patients will have urinary symptoms.
            Diverticulitis occurs when a
            diverticula is filled with
            inspisated stool that eventually
            erodes through the colon leading
            to micro (or macro) perforation.




            TREATMENT
            The main initial treatment for diverticulitis is bowl rest, intravenous hydration, and
            antibiotics. This will work in the majority of patients. If this does not work surgery is
            required. The risk of surgery during an acute attack of diverticulitis is higher than
            elective surgery. It is also true that having surgery during an acute attack increases
            the likelihood a temporary colostomy would be required. For this reason the usual
            approach to diverticulitis is to try to resolve the attack without surgery and then try
            to predict who is most at risk for having additional attacks. These patients can then
            have surgery to prevent future attacks. Elective sigmoid resection can be done at a
            much lower risk, without a colostomy, and often using a laparoscopic approach.

             ADDITIONAL INFORMATION
             National Digestive Disease Clearing House
             General Overview from iVillage
             American College of Colon and Rectal Surgeons Practice Parameters for Diverticulitis
Not meant as a substitute for consultation with your doctor. Please read disclaimer.




file://D:\My Documents\Web page\Work site\TMP6hjhdwrcb3.htm                                              3/26/2006
Laparoscopic colectomy - Mark Fusco MD                                                             Page 1 of 3




      Laparoscopic Colectomy

      Laparoscopic colon surgery is a technique whereby the
      colon can be removed using several small incisions.
      Traditionally, removal of the colon has been accomplished
      using one larger incision. The use of smaller incisions
      leads to less pain after surgery, less time in the hospital,
      and a quicker return to work and full activity. This
      specialized procedure cannot be performed on all patients
      who need colon surgery.

      Prior To Surgery
      Depending on your age and medical condition you may be required to undergo
      preoperative testing. This may include blood work, x-rays, and an electrocardiogram.
      The office will arrange this and give you instructions when you schedule your surgery.
      Patients will also be given a prescription for pain medication. It is recommended that
      you fill this prescription prior to the day of surgery.

      On the day prior to surgery - Drink only clear liquids.
      Clear liquids includes:
      · Water
      · Apple juice
      · Tea or coffee
      · Soda
      · White grape juice
      · Gatorade
      · Chicken or Beef broth
      · Plain Jello (no added fruit)

      The day prior to surgery you will be required to take a regimen to clean out your
      colon. You also must take several antibiotic pills. This regimen is designed to decrease
      the likelihood of getting an infection so it is very important you follow the instructions
      for the bowel prep: (Click here to get instructions on taking the bowel prep.)

      It is very important that you do not eat or drink anything after
      midnight the night prior to surgery. This includes coffee, water, mints, gum,
      candies. You may ingest only a small sip of water with your morning medications.

      Dr. Fusco's office staff will advise you when to arrive at the hospital. Since the
      procedures scheduled prior to yours may be longer or shorter than anticipated, we ask
      that you remain available prior to your arrival time so that you can be contacted and
      informed of any changes in your surgery time.

      When patients bathe the night prior to surgery they should thoroughly cleanse the
      umbilicus (belly button).




file://D:\My Documents\Web page\Work site\TMP7e46hwrdhb.htm                                         3/26/2006
Laparoscopic colectomy - Mark Fusco MD                                                              Page 2 of 3



      Incisions
      Right sided colon removal requires                Left sided colon removal requires a 1/2
      a 1/2 inch incision near the                      inch incision near the umbilicus to place
      umbilicus to place the camera.                    the camera. Instruments are placed
      Instruments are placed through                    through two 1/4 inch incision and the
      three 1/4 inch incision and the                   colon is extracted using an incision
      colon is extracted using an incision              about three inches long.
      about three inches long.




      Conduct of the operation
      Using the inserted instruments the attachments and blood supply of the colon is
      divided and the colon is mobilized. The colon is extracted and the remaining ends of
      the colon are reattached. The incisions are closed with absorbable sutures. Steri strips
      (butterfly stitches) are placed. These remain on the wounds until they peel off on their
      own, usually in two weeks. The wounds are covered with Band-Aids. These Band-Aids
      can be removed the day after surgery. Patients are allowed to bathe normally the day
      following surgery.

      Recovery
      The surgery is done as an overnight stay in one third of patients. For those patients
      who are not ready for discharge the morning after surgery, the average length of stay
      is 3.5 days. Patients can resume light daily activity immediately. Most patients after
      laparoscopic surgery will experience a sharp shoulder pain that resolves after 2-4
      hours. It is important that patients get out of bed and go for a walk as soon as
      possible (the night of surgery), to improve lung function and decrease the risk of
      abnormal blood clots. The average patient will require 1-2 weeks recovery before
      resuming more vigorous activity. There is no forced limitation of activity, instead
      patients are asked to advance their activity as tolerated. This applies to the
      resumption of work, sports, and sexual activity.

      Patients are allowed nothing by mouth (NPO) the night after surgery. The morning
      after surgery they are given a clear liquid diet. Patients stay on a clear liquid diet till
      they have a bowel movement which normally occurs approximately 3-5 days after
      surgery.

      Patients are seen in the office 5 to 9 days after surgery for a postoperative check, but
      patients are encouraged to contact the office sooner than this if they have any
      questions or problems. Dr. Fusco requests you contact the office for any of the
      following:

            Nausea or vomiting that persists for greater then 24 hours after surgery -
            nausea shortly after surgery is commonly due to general anesthesia and usually




file://D:\My Documents\Web page\Work site\TMP7e46hwrdhb.htm                                          3/26/2006
Laparoscopic colectomy - Mark Fusco MD                                                           Page 3 of 3



            resolves within this time period.
            Temperature greater than 101.5 degrees - Temperature elevations less than
            this are very common after surgery and usually have little significance.
            Pain that is not relieved by the oral pain medication prescribed.
            Inability to pass urine.
            Any questions or concerns.
            Patients experiencing any difficulty breathing, chest pain, change in level of
            consciousness, or loss of vision or strength should promptly call 911 for
            transport to the nearest emergency department.

      Success Rate
      Any patient who undergoes laparoscopic colon surgery may need to be converted to
      the open surgery. The risk of this varies significantly depending on the location of the
      colon that needs to be removed, the size of the abnormality to be removed and a
      variety of patient factors. (previous surgery, medical condition, weight) Dr. Fusco can
      estimate the likelihood of completing the surgery laparoscopically during the
      preoperative consultation.

      Risks
      Risks of both open and laparoscopic colon removal include:
      · Conversion to open procedure.
      · Injury to nearby structures: including intestines, spleen, and the tube that brings
      urine from the kidney to the bladder~ 2%
      · Bleeding
      · Infection in the wound
      · Deep infection within the abdomen
      · Leakage from the connection of the colon (Anastomotic leak). ~ 2 %

      Additional information
      Laparoscopy.com - Slide show of actual intraoperative images explaining the conduct
      of surgery. (Images may be to graphic for some viewers)
      Society of Laparoendoscopic Surgeons - general information on laparoscopic
      Colectomy
      SAGES - Society of American Gastrointestinal and Endoscopic Surgeons
      New York Times article reviewing laparoscopic colon surgery study
      New England Journal of Medicine article - showing equal cure rate for laparoscopic
      colectomy
  Not meant as a substitute for consultation with your doctor. Please read disclaimer.




file://D:\My Documents\Web page\Work site\TMP7e46hwrdhb.htm                                       3/26/2006
Colectomy - Mark Fusco MD                                                                         Page 1 of 2




     Colectomy (Open)

     Colectomy involves removal of all or part of the colon. This is used to treat a variety
     of conditions including diverticulitis, polyps, colon bleeding, inflammatory disease, and
     cancer. In most instances this surgery does not require a colostomy (ostomy
     bag).

     PRIOR TO SURGERY
     Depending on your age and medical condition you may be required to undergo
     preoperative testing. This may include blood work, x-rays, and an electrocardiogram.
     The office will arrange this and give you instructions when you schedule your surgery.
     Patients will also be given a prescription for pain medication. It is recommended that
     you fill this prescription prior to the day of surgery.

     On the day prior to surgery - Drink only clear liquids.
     Clear liquids includes:
     · Water
     · Apple juice
     · Tea or coffee
     · Soda
     · White grape juice
     · Gatorade
     · Chicken or Beef broth
     · Plain Jello (no added fruit)

     The day prior to surgery you may be required to take a regimen to clean out your
     colon. You also must take several antibiotic pills. This regimen is designed to decrease
     the likelihood of getting an infection so it is very important you follow the instructions
     for the bowel prep: (Click here to get instructions on taking the bowel prep.)

     It is very important that you do not eat or drink anything after midnight the
     night prior to surgery. This includes coffee, water, mints, gum, candies. You may
     ingest only a small sip of water with your morning medications.

     Dr. Fusco's office staff will advise you when to arrive at the hospital. Since the
     procedures scheduled prior to yours may be longer or shorter than anticipated, we ask
     that you remain available prior to your arrival time so that you can be contacted and
     informed of any changes in your surgery time.

     When patients bathe the night prior to surgery they should thoroughly cleanse the
     umbilicus (belly button).


     Incisions
     Usually in the middle part of the belly running in an up and down orientation, the size
     and exact location depend on a variety of factors including location of colon to be
     removed, previous surgery, patient size.




file://D:\My Documents\Web page\Work site\TMP7viqswre3v.htm                                        3/26/2006
Colectomy - Mark Fusco MD                                                                        Page 2 of 2



     Conduct of the operation
     After entering and exploring the abdomen, the attachments and blood supply of the
     colon are divided and the colon is mobilized. The colon is removed and the remaining
     ends of the colon are reattached. The incisions are closed with staples. These staples
     are removed 6-10 days after surgery. The wounds are covered with a gauze dressing
     that can be removed the day after surgery. Patients are allowed to bathe normally the
     day following surgery.
     Recovery
     The surgery is done as an inpatient. The average patient stays in the hospital 5 to 10
     days. It is important that patients get out of bed and go for a walk as soon as possible
     (the night of surgery). This improves lung function and decreases the risk of abnormal
     blood clots. Patients are asked not to resume vigorous activity or heavy lifting for 4 to
     6 weeks after surgery. This applies to the resumption of work, sports, and sexual
     activity.

     Patients are allowed nothing by mouth (NPO) the night after surgery. Patients are
     premitted to chew gum. Patients stay NPO till they have evidence of bowel function.
     They are then given a clear liquid diet and advanced to regular food as tolerated.

     Patients are seen in the office 10 to 14 days after surgery for a postoperative check,
     but patients are encouraged to contact the office sooner than this if they have any
     questions or problems. Dr. Fusco requests you contact the office for any of the
     following:

           Nausea or vomiting that persists for greater then 24 hours after surgery -
           nausea shortly after surgery is commonly due to general anesthesia and usually
           resolves within this time period.
           Temperature greater than 101.5 degrees - Temperature elevations less than
           this are very common after surgery and usually have little significance.
           Pain that is not relieved by the oral pain medication prescribed.
           Inability to pass urine.
           Any questions or concerns.
           Patients experiencing any difficulty breathing, chest pain, change in level of
           consciousness, or loss of vision or strength should promptly call 911 for
           transport to the nearest emergency department.



     SUCCESS RATE
     Highly dependent on the problem being treated.


     RISKS
     Risks of both open and laparoscopic colon removal include:
     · Injury to nearby structures: including intestines, spleen, and the tube that brings
     urine from the kidney to the bladder~ 2%
     · Bleeding
     · Infection in the wound
     · Deep infection within the abdomen
     · Leakage from the connection of the colon (Anastomotic leak). ~ 2 %


  Not meant as a substitute for consultation with your doctor. Please read disclaimer.




file://D:\My Documents\Web page\Work site\TMP7viqswre3v.htm                                       3/26/2006
Contact / Find us - Mark Fusco MD                                                                    Page 1 of 1




Dr. Fusco's office can be reached Monday to Friday
between 8:30am and 5pm at:
                       321- 725-4500 ext 420
If after hours assistance is needed call this number to be
connected to the answering service who in turn will page Dr.
Fusco or his coverage physician.

We are located at: 1130 S. Hickory Street
                   Melbourne, Florida 32901




Questions about Billing:         Surgery_Billing@mima.com




All issues related to weight loss surgery and
the Lap-Band are handled through Life Shape
Advanced Bariatrics Center of Florida


Please note: No patient information can be transmitted via this E-mail link due to confidentiality
issues and federal government HIPPA regulations.




file://D:\My Documents\Web page\Work site\TMPc15jhwrjhs.htm                                           3/26/2006

				
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