General and Gastrointestinal Surgery

The Center is in the capacity to treat problems of head and neck surgery (thyroids, parathyroids, tumors, etc), breast surgery (cancer and benign tumors), soft tissue tumors, gastrointestinal surgery, colon and rectum surgery, hemorrhoids, pancreatic, hepatic and biliary surgery, (liver, gallbladder and biliary ducts), suprarenal glands, spleen surgery, etc.

Gastroesopheageal Reflux Surgery

Gastroesophageal reflux occurs when the stomach contents (usually acid), refluxes to the esophagus causing injury to the esophageal wall. The patients present retro sternal pain (pain in the mid thorax), regurgitation, belching, difficulty to swallow, nausea and vomiting. Some of the complications of the esophageal reflux are shown below (See figure)

The most common cause is a decrease of the pressure of the lower esophageal sphincter. Patients with hiatal hernia have more complications due to reflux. Reflux complications range from esophagitis (inflammation), ulceration, narrowing, Barret’s esophagus (usually pre cancerous lesion that is preventable through medical and surgical treatment) to esophageal cancer. During the last years, laparoscopic surgeons have developed Laparoscopic Nissen Fundoplication to repairs the defect in the gastroesophageal union; reflux is eliminated and the described complications are prevented. This procedure has an index of 95% of satisfaction among treated patients. Generally, it lasts for 1 hour and patients are discharged after 24 hours. In the last 10 years, Dr. Chitrit has performed hundreds of procedures of gastroesopheageal reflux surgery in Panama including the exceptional cases of giant hiatal hernia where more than 50% of the stomach migrates towards the thorax of the patient, causing severe health problems. Actually, Dr. Chitrit is the surgeon with the most experience in this procedure in Hospital Punta Pacifica and probably in the country. For additional information visit our office and we will explain further.

Laparoscopic Biliary Surgery

The gallbladder is an organ located under the liver; it contains bile and plays an important role in food digestion. When calculi (stones) get lodged in its interior, there is pain after eating causing chronic discomforts. A biliary colic is the pain produced by a stone trying to pass through the gallbladder duct. If this condition is not treated adequately, acute cholecystitis, which is gallbladder infection, will occur and it is characterized by fever, general malaise and intense abdominal pain. Other complication feared are choledocholelithiasis (stones in the main duct) and pancreatitis, which in some cases, may be fatal. Removal of the gallbladder is one of the most common surgeries practiced by a General Surgeon.

This problem can be treated by Laparoscopic Cholecystectomy (See figure).

This surgery consists of removing the gallbladder through 4 small orifices on the abdomen (See figure):

And assisted by a television camera (See figure):

Generally, the patient is tolerating liquids 12 hours after surgery and is discharged 24 hours after. Recovery is extraordinarily better than with the open technique.

Abdominal Laparoscopic Surgery

Other procedures available are: 1) Laparoscopic exploration of the biliary ducts, 2) Laparoscopic appendectomy, 3) Excision of postoperative adhesions 4) Excision of oncologic intra abdominal masses, 5) Drainage of abscess and hepatic cysts, 6) Laparoscopic drainage of hepatic lacerations and biliary leaks, 7) Resection of malignant intestinal tumors, 8) Laparoscopic splenectomy, and 9) Excision of suprarenal and pancreatic tumors.

Watch the following video of the surgery:

• Aneurisma Arteria Esplenica - Esplenectomia Laparoscopica - Dr. Moises Chitrit

Laparoscopic Colon and Rectal Surgery

The large intestine or colon may harbor several diseases during a lifetime. It is estimated that 30% of the population over age 60 will suffer from colon diverticular disease, which consists of weak spots on the large intestine wall. These weak zones may burst and produce peritonitis and endanger the patient’s life. Sometimes a condition known as diverticulitis occurs which consists of inflammation of the diverticulum site probably caused by a micro perforation. Chronic diverticulitis leads to intestinal narrowing or to an anomalous connection (communication) with other organs causing fistulas. Diverticuli are adjacent to the blood vessels and may produce massive rectal bleeding that requires emergency surgery. On the other hand, Rectal and Colon Cancer is a frequent disease in our media which requires close monitoring after 40 years of age. In the past, colon surgery used to entail a long and painful incision in the mid abdomen, several days of hospitalization and a lengthy recovery. Today, with laparoscopic surgery, only 5 small incisions of less than 1 cm long and one 5 cm incision on the abdomen through which the tissue is withdrawn, are required to perform the same surgery with less pain, less invasion, less hospital stay and a faster recovery.

During the last 7 years our practice has stood out for being one of the most experienced in colon laparoscopic surgery in Panama with outstanding results both in benign diseases (diverticular disease and colon polyps) as well as colon and rectum cancer. Our rate of conversion to open surgery is less than 5% abreast the leading specialized foreign centers.

Laparoscopic Hernia Surgery

Inguinal hernias are a frequent ailment, mainly in men. Usuall, repair of the hernia is done through a conventional technique by a 4 inches incision in the inguinal region, repairing the defect and placing a Marlex mesh (polypropylene) on the site. Laparoscopic technique repairs the same defect without having to cut extensively, the hernia is closed in its original site and only 3 small incisions of 5 mm each need to be done. Recovery time is extremely short and there is less pain. Laparoscopic technique is ideal for patients with bad tissue, poor scarring, bilateral hernias (both can be repaired through the same 3 orifices), recurrent hernias (may be repaired over region that has not been treated surgically) and obese patients.

Another group of patients that benefit from laparoscopic technique are those with a ventral hernia that generally happens after previous abdominal surgery. The inside of the defect is excised, a mesh is placed over the defect and closure is accomplished with laparoscopic sutures without the discomfort of a long scar.

Trauma Surgery

Injuries do not distinguish between age, sex, sexual orientation, religion, etc. Accidents do not announce themselves and you need to be sure that people in charge of taking care of you have the necessary training and experience to guarantee favorable results. Dr. Chitrit has lead management of trauma patients since 1995 in Panama. He was trained in Cali, Colombia and in United States centerso. Dr. Chitrit has the necessary accreditation to be a trusted Trauma Surgeon with udated knowledge in the treatment of these patients. We offer services for auto, flip-over accidents, run-over accidents, large heights falls, penetrating wounds secondary to gunshot or piercing or cutting instruments, submersion injuries, burns, explosive injuries, etc.