General Surgery

Knowing someone important has its advantages. Knowing the owner of a cinema might get you a free ticket. Knowing the manager of a restaurant might get you a free meal. Affiliated with Johns Hopkins Medicine International, your surgeon and staff in general surgery will be the very important people that make sure your panama medical care is the very best possible experience. We have one goal; we want to be the first thing that enters your mind when you think about general surgery. We have found the very best surgeons and staff so that you not only receive the finest health care available, but you have the confidence that our expertise meets the high standards of Johns Hopkins Medicine International. Our general surgery team is committed to being the health care answer for Panamanians and health tourists alike.
The hospital is recognized as the first digital hospital in Latin America. By combining the doctor, the computer and advanced technology, digital hospitals are seen as a way to save lives and money. The advantages of such an environment are:

Virtual Doctor: Our digital technology enables doctors to visit their patients and other hospital staff members from wherever they are in the world. Doctors can log on to the hospital intranet from any computer in or out of the hospital, in order to view and analyze crystal-clear digital versions of their patient’s X-Rays, MRIs, CT scans, and other important information.

Mobile Videoconferencing Technology: This technology allows patients to communicate with their physicians making them feel as if the doctors are right in the room. Also, the videoconferencing allows Johns Hopkins’s doctors to have virtual presence in any surgery at the Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International.

The Computers on Wheels: are wireless laptops used primarily by nursing staff, but also by doctors in order to have an electronic patient record for vital signs, symptoms, medication, patient progress and other information, allowing attending staff to better utilize their time and make fewer errors.

Virtual Operating Rooms: This is the culmination of technology meets medicine. By having features like Computers on Wheels, Mobile Videoconferencing and Virtual Doctor we are able to equip the operating rooms like no other operating room in Latin America. The 20,000 doctor-strong network l has the ability to consult on your surgery, even while it is being performed.

A wide variety of services in general surgery

General surgery covers a wide range of surgical specialties where patients can consultations with and receive treatment from some of the best surgeons in all of Latin America.The surgeons in the Surgical Clinic represent some of the best and brightest minds in the world. Some of the disciplines that these surgeons represent in general surgery are:

Anesthesiology
Cardiothoracic Surgery (Heart & Chest Surgery)
Cosmetic Surgery
Neurosurgery
Pediatric Surgery
Urological Surgery
Vascular Surgery
Surgical Pathology

Prior to Surgery

Any necessary precautions prior to surgery will be outlined for you in the treatment plan. If you require pre-op therapy, you will receive the proper instructions. If you are a smoker, you may be asked to stop for a time prior to your surgery. You might also be asked to refrain from using vitamin E (in large does), aspirin or anti-inflammatory medicines since they can lead to increased bleeding during surgery.

The Procedure

There are several kinds of weight-reduction procedures: the gastric band, the gastric bypass and the gastric sleeve. The team at Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, will help select the best procedure for each patient.
In each of these procedures the size of the stomach is reduced significantly, creating a very small pouch at the top of the stomach. Then a segment of small intestine is attached to this pouch.
This procedure not only limits how much a person can eat at a time, but also redirects the food to bypass most of the stomach and the first section of the small intestine. This greatly limits the body's ability to absorb nutrients and calories.

After your surgery

Due to the increased use of laparoscopic surgery for bariatric procedures the recovery time is very rapid. After surgery, the patient is taking to recovery to wake from the anesthetic which usually takes 1-2 hours. After recovery, the patient will begin on a liquid diet before returning to semi-solid and then solid foods.

The long term post-op care consists largely of lifestyle changes. The patient will find it only possible to eat a few bites of food and will need to eat more times each day to compensate for the few calories consumed each meal. Follow-up visits to the patient’s family physician will follow periodically for the next year to monitor the patient’s progress.

Risks

Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity or where the intestine is connected (resulting in an infection called peritonitis), and a blood clot in the lung (pulmonary embolism). About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.

While there is always an element of risk, having an American-trained surgeon, a professional staff and a world-class hospital make your Panama bariatric surgery at Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, a safe and rewarding procedure.

Gastric Band Surgery

Millions of individuals in the United States and around the world are overweight or obese (severely overweight). When weight increases to an extreme level, it is called morbid obesity. Obesity is associated with diabetes, heart disease, high blood pressure, some types of cancer, and other medical problems. Bariatrics is the field of medicine that specializes in treating obesity. Gastric band surgery is the term for one type of operation to help promote weight loss. Gastric band surgical procedures are only considered for people with severe obesity and not for individuals with mild weight problems.

The Procedure
Gastric banding was only approved in the U.S. in 2001 this procedure has been used in Europe for a number of years. In this operation, a small band is placed around the upper part of the stomach, creating a small pouch. As with stomach stapling, the small size of the pouch means that you feel full sooner. However, the band can be adjusted in size by inflating or deflating the band; this allows the health professional to adjust the size of the opening between the pouch and the stomach.

After your surgery
This surgery usually involves a 2 to 4 day hospital stay. Most people can return to their normal activities within 3 to 5 weeks. The long term post-op care consists largely of lifestyle changes. The patient will find it only possible to eat a few bites of food and will need to eat more times each day to compensate for the few calories consumed each meal. Follow-up visits to the patient’s family physician will follow periodically for the next year to monitor the patient’s progress.

Risks

The most common risk in all surgeries for weight loss is an infection in the incision. A secondary concern for gastric banding is overeating which can cause the band to expand, minimizing its effectiveness. About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.

While there is always an element of risk, having an American-trained surgeon, a professional staff and a world-class hospital make your Panama gastric band surgery at Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, a safe and rewarding procedure.

Gastric Bypass Surgery
Millions of individuals in the United States and around the world are overweight or obese (severely overweight). When weight increases to an extreme level, it is called morbid obesity. Obesity is associated with diabetes, heart disease, high blood pressure, some types of cancer, and other medical problems. Bariatrics is the field of medicine that specializes in treating obesity. Gastric bypass surgery is the term for one type of operation to help promote weight loss. Gastric bypass surgical procedures are only considered for people with severe obesity and not for individuals with mild weight problems

The Procedure

In normal digestion, food passes through the stomach and enters the small intestine, where most of the nutrients and calories are absorbed. It then passes into the large intestine, and the remaining waste is eventually excreted. In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine.
This procedure can be done by making a large incision in the abdomen or by making a small incision and using small instruments and a camera to guide the surgery.

After your surgery

This surgery usually involves a 4- to 6-day hospital stay (2 to 3 days for a laparoscopic approach). Most people can return to their normal activities within 3 to 5 weeks. The long term post-op care consists largely of lifestyle changes. The patient will find it only possible to eat a few bites of food and will need to eat more times each day to compensate for the few calories consumed each meal. Follow-up visits to the patient’s family physician will follow periodically for the next year to monitor the patient’s progress.

Risks

Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity or where the intestine is connected resulting in an infection called peritonitis, and a blood clot in the lung pulmonary embolism. About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.

While there is always an element of risk, having an American-trained surgeon, a professional staff and a world-class hospital make your Panama gastric bypass surgery at Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, a safe and rewarding procedure.

Gastric Sleeve Surgery

The Procedure

This is the newest approach in bariatric surgery. It involves removing about two-thirds of the stomach with a stapling device. It can be done laparoscopically but is not reversible. It basically leaves a stomach tube instead of a stomach sack.

The incisions that the surgeons make nowadays are of no more than 0.4 inches the surgical trauma they produce is much lower and the post surgical pain much more tolerable. Through these incisions, the surgeon can reach the stomach and, using a special stapler, he makes a vertical suture to divide the stomach in two. One of the sections is shaped like a tube that goes from the esophagus to the intestine. The other one is separated and removed. The staples used are quite strong and stay in place very well.

After your surgery

This surgery usually involves a 3 to 4 day hospital stay including one day in Intensive Care. Because the procedure is laparoscopic and only includes seven small incisions, the recovery time is very short. The long term post-op care consists largely of lifestyle changes. The patient will find it only possible to eat a few bites of food and will need to eat more times each day to compensate for the few calories consumed each meal. Follow-up visits to the patient’s family physician will follow periodically for the next year to monitor the patient’s progress.

Risks

The most common risk in all surgeries for weight loss is an infection in the incision. A secondary concern for a gastric sleeve procedure is overeating which can cause the stomach to expand and reduce or eliminate the effectiveness of the procedure. About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.

While there is always an element of risk, having an American-trained surgeon, a professional staff and a world-class hospital make your Panama gastric sleeve surgery at Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, a safe and rewarding procedure.

Laparoscopic Cholecystectomy
The gallbladder is a pear-shaped organ that sits beneath the liver in the right-upper abdomen. It is attached to the liver and its function is to store bile. These ducts carry bile from the liver to the gallbladder and intestine where the bile helps digest food. The gallbladder is not required to keep you alive, but when there are problems with it, it can seriously affect your quality of life. If you need a gallbladder surgery, also known as a laparoscopic cholecystectomy, it’s time to take advantage of Panama’s health tourism and have your surgery done at Hospital Punta Pacifica.

Why Laparoscopic Cholecystectomy?

Laparoscopic cholecystectomy and open abdominal cholecystectomy are the two methods for this surgery. Before the laparoscopic method, doctors used the open abdominal method. It required a 3 to 7 inch incision across the abdomen and up to a week in the hospital. With the advent of laparoscopic surgery, the gallbladder can be removed with only a series of small incisions and it is frequently done as outpatient surgery, meaning the patient can go home the same day. Recovery time is virtually eliminated and the risks are greatly reduced.

The Procedure

The patient receives general anesthesia. A small incision is made at the navel and a thin tube carrying the video camera is inserted. Your surgeon will then inflate your abdomen with carbon dioxide, a harmless gas, for easier viewing as well as to provide room for the surgery to be performed. Next, two needle-like instruments are inserted in other incisions in your abdomen; these instruments serve as tiny hands within the abdomen. They can be used to move the gallbladder and intestines around and generally assist the surgeon. Finally, several different instruments are inserted into a fourth incision to clip the gallbladder artery and bile duct, and to safely dissect and remove the gallbladder and stones. When the gallbladder has been disconnected, it is then removed through the navel incision. The entire procedure normally takes 30 to 60 minutes. The three puncture wounds require no stitches and may leave very slight blemishes. The navel incision is barely visible and will fade with time.

After your surgery

One of the main benefits of this procedure is the ease of recovery for the patient. Since there is no large incision, there is no incision pain. The patient is up and about the same day and in 90% of the cases, patients go home the same day. The remaining patients are usually discharged the next day. Within several days, normal activities can be resumed because the recovery time is so quick. And the best news is no 7 inch scar to keep you out of your bathing suit and off the beach!

Risks

Because of the relatively safe nature of a laparoscopic cholecystectomy, the side effects are rare and usually minor. In about 5 to 10% of cases, the gallbladder cannot be safely removed by laparoscopy and an open abdominal cholecystectomy is then immediately performed. Nausea and vomiting are both possibilities and may occur after the surgery. Injury to the bile ducts, blood vessels, or intestine can also occur, requiring corrective surgery.

While there is always an element of risk, having an American-trained surgeon, a professional staff and a world-class hospital make your Panama laparoscopic cholecystectomy at Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, a safe and rewarding procedure.

Laparoscopic Colectomy
Laparoscopic colectomy 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. While this specialized procedure cannot be performed on all patients who need colon surgery, anyone who qualifies for a laparoscopic colectomy will want to make the journey to Panama and have their procedure at Hospital Punta Pacifica.

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 Jell-O (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

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.

The Procedure

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 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.

After your surgery

Laparoscopic colectomy is done as an overnight stay in one third of patients. Patients can resume light daily activity immediately. Most patients after laparoscopic surgery will experience a sharp shoulder pain that resolves after 2-24 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. Patients are permitted to chew gum. 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.

Risks

Risks of both open and laparoscopic colectomy 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

Surgery always has an element of risk. We have attempted to minimize that risk by having an American-trained surgeon, a professional staff and a world-class hospital ready for your Panama laparoscopic colon surgery. At Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, we want your visit to be a safe and rewarding procedure.

Laparoscopic Nissen Fundoplication
That burning from your stomach into your throat. It won’t go away; even the prescription from your family doctor doesn’t eliminate it all. There is hope; a laparoscopic Nissen fundoplication is the surgical treatment for gastroesophageal reflux disease or GERD. Patients who suffer from GERD experience a burning sensation as acid flows back from the stomach to the esophagus. During the procedure, the valve between the esophagus and stomach is strengthened. You want that kind of relief and you know where to get it. A friend of yours enjoyed his Panama medical tourism trip so much that you’re ready to come for your laparoscopic Nissen fundoplication and the surgeons and staff at Hospital Punta Pacifica are ready to help.

Prior to Surgery

The Procedure

To perform laparoscopic Nissen fundoplication, your surgeon will make four to five small incisions and insert tube-like instruments through them. Your abdomen will be filled with gas to aid the surgeon in viewing the abdominal cavity and giving him or her room to operate. A video camera, inserted through one of the tubes, will display images on a monitor located in the operating room. Other instruments for holding and cutting will be placed through the other incisions. With this method, your surgeon will be able to work inside your abdomen without making the larger, traditional incision. Your surgeon will wrap the upper portion of your stomach around the lower portion of your esophagus and secure it.

After your surgery

After the surgery, you will go to the recovery unit where the nursing staff will monitor your recovery. After you have recovered, you will be taken to your room. Most patients can expect to spend one night in the hospital, but it varies depending upon the patient.

Risks

As with any surgery, there is a risk of a reaction to anesthesia, excessive bleeding, and infection. There is also a risk of dysphagia, trouble swallowing, recurrence of GERD, injury to the espophagus, and splenic injury.

Surgery always has an element of risk. We have attempted to minimize that risk by having an American-trained surgeon, a professional staff and a world-class hospital ready for your Panama laparoscopic Nissen fundoplication. At Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, we want your visit to be a safe and rewarding procedure.

Laparoscopic Splenectomy
Laparoscopic splenectomy is the surgical removal of the spleen. It differs from the traditional 'open' technique in that the procedure is performed through small incisions. This usually allows a much faster recovery and is significantly less painful. Panama’s health tourism provides a unique opportunity to combine your laparoscopic splenectomy at Hospital Punta Pacifica with a relaxing recovery in the beautiful country of Panama.

The Procedure

The purpose of a laparoscopic splenectomy is to remove the spleen without making the traditional large incision. You will be given general anesthesia and your surgeon may choose to operate with you lying flat on your back or turned onto your right side depending on his or her preference. Several small incisions are made into the abdomen; one is used for the laparoscope which sends images to a monitor. The other incisions are used for clamps or tools that can manipulate tissue in the abdomen. Carbon dioxide gas is used to inflate the abdominal cavity to allow room to see and to work. The spleen is then freed from surrounding tissue and the blood vessels to the stomach and spleen are visualized, tied off and divided. Once the spleen is freed from the abdominal cavity, it is placed in a special surgical plastic bag and removed through one of the small abdominal incisions. If the spleen is too large to be removed in one piece, it will be broken into small pieces in the bag and removed. At the end of the surgery, the abdomen is deflated, the incisions are closed with suture, the skin is cleaned and the incisions are covered with steri-strips.

After your surgery

Immediately after your laparoscopic splenectomy, you will go to the recovery room where the staff will monitor your blood pressure, pulse, and respirations until you are fully awake. After you have recovered sufficiently, you will be moved to your room for the night. Many people only require one night in the hospital but it’s possible that your stay will be longer if needed. Resumption of normal activities should be discussed with your surgeon but you should be able to return to most things after your follow-up visit in one to two weeks.

Risks

Laparoscopic Splenectomy is a safe procedure. As with any other surgical procedure however, complications may occur such as bleeding and infection. The risk of surgery is also related to the disease process for which the laparoscopic splenectomy is being performed. Your surgeon will discuss any risks with you prior to your laparoscopic splenectomy.

Surgery always has an element of risk. We have attempted to minimize that risk by having an American-trained surgeon, a professional staff and a world-class hospital ready for your Panama laparoscopic splenectomy. At Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, we want your visit to be a safe and rewarding procedure.

Ventral Hernia Surgery
An incisional or ventral hernia can develop in the abdominal wall around a previous incision. It usually arises in the abdominal wall where a previous surgical incision was made. This results in a bulge or a tear in the area where the abdominal muscles have weakened. Ventral hernias can increase in size with time. Laparoscopic ventral hernia surgery can be successful in correcting your hernia and using Panama’s health tourism to combine your surgery and a tropical recovery is a very smart idea!

The Procedure

A surgeon uses special instruments, small incisions, and a videoscope to perform the laparoscopic ventral hernia surgery. A small incision is made in the abdominal wall in a location chosen too minimize the risk of running into organs or scar tissue from prior operations. Surgeons make as few other tiny incisions as is feasible, depending on how much scar tissue there is and how well they can see.

A laparoscope (a tiny telescope with a television camera attached) is inserted through a small hollow tube. The laparoscope and TV camera allow the surgeon to view the hernia from the inside.
Other small incisions will be made for placement of other instruments to remove any scar tissue, and to insert a surgical mesh into the abdomen. This mesh is fixed under the hernia defect to the strong tissues of the abdominal wall. The surgeon will use mesh to reinforce the weakened area of the abdominal wall. This will help prevent the hernia from recurring.

After your surgery

Patients usually go home within 24 hours after laparoscopic repair, as opposed to a longer hospital stay after open repair, and report less pain and quicker return to normal activity.

Risks

Many of the common risks are prevalent with laparoscopic ventral hernia surgery: excessive bleeding, infection and if the surgery is in the abdominal region, there is a possibility injury to surrounding organs. Although laparoscopic ventral hernia surgery has a 10% possibility of recurrence, it is much lower than the 20% to 40% possibility with traditional methods.

While there is always an element of risk, having an American-trained surgeon, a professional staff and a world-class hospital make your Panama laparoscopic ventral hernia surgery at Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, a safe and rewarding procedure.

Parotidectomy
Living with facial tumors can not only be physically uncomfortable but psychologically uncomfortable as well. Parotidectomy is the removal of the parotid gland, a salivary gland near the ear. The parotid gland is the largest of the salivary glands. There are two parotid glands, one on each side of the face, just below and to the front of the ear. A duct through which saliva is secreted runs from each gland to the inside of the cheek. Having your Panama Parotidectomy will not only benefit your health but will change your appearance as well.

The Procedure

During surgery, two different areas of the parotid gland are identified: the superficial lobe and the deep lobe. Superficial parotidectomy removes just the superficial lobe, while total parotidectomy removes both lobes. Extreme care is taken to protect the Parotid duct as well as identifying and avoid damaging the facial nerve.

The patient is first placed under general anesthesia to ensure that no pain is experienced and that all muscles remain relaxed. An incision is made directly to the front or back of the ear and down the jaw line. The skin is folded back to expose the parotid gland. The various facial nerves are identified and protected during the surgery so as to avoid permanent facial paralysis or numbness. A superficial or total parotidectomy is then performed, depending on the type and location of the tumor. If the tumor has spread to involve the facial nerve, the operation is expanded to include parts of the bone behind the ear (mastoid) to remove as much tumor as possible. Before the incision is closed, a drain is inserted into the area to collect any leaking saliva, if a superficial parotidectomy was performed. The procedure typically takes from two to five hours to complete, depending on the extent of surgery and the skill of the surgeon.

After your surgery

After surgery, the patient will remain in the hospital for one to three days. The incision site will be watched closely for signs of infection and heavy bleeding (hemorrhage). The incision site should be kept clean and dry until it is completely healed. If the patient has difficulty smiling, winking, or drinking fluids, the physician should be contacted immediately. These are signs of facial nerve damage.

Risks

There are a number of complications that are associated with parotidectomy. Facial nerve paralysis after minor surgery should be minimal. After major surgery, a graft is attempted to restore nerve function to facial muscles. Salivary fistulas can occur when saliva collects in the incision site or drains through the incision. Recurrence of cancer is the single most important consideration for patients who have undergone parotidectomy. Long-term survival rates are largely dependent on the tumor type and the stage of tumor development at the time of the operation.

Other risks include hematoma, or the collection of blood under the skin and infection. The most common long-term complication of parotidectomy is redness and sweating in the cheek, known as Frey's syndrome. Rarely, paralysis may extend throughout all the branches of the facial nervous system.

While there is always an element of risk, having an American-trained surgeon, a professional staff and a world-class hospital make your Panama parotidectomy at Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, a safe and rewarding procedure.