Preparation for gallbladder surgery The gallbladder is a pear-shaped organ located below the liver in the upper right part of the abdomen. It serves as a reservoir for bile produced by the liver. The gallbladder itself does not produce bile. Preparation for abdominal hernia surgery This is a defect in the abdominal wall where it tears or enlarges. As a result, the intestines are no longer held securely inside the abdomen. Whenever you strain, you create an increase in pressure inside your stomach, and since your intestines always try to move towards areas of lower pressure, they protrude through the hernia. Preparation for hemorrhoid surgery Hemorrhoids are varicose veins, meaning venous congestion in the network of these three bundles. This causes the tissues of the hemorrhoidal veins to swell and stretch, which are then commonly called hemorrhoids. Preparation for anal fissure surgery An anal fissure is a tear in the surface layer of the anus and the beginning of the rectum. It can start at the skin of the anus and extend into the anal canal, within the rectum. Often, it is not visible because it is only inside the rectum. Most commonly, the fissure is located at the anus opposite the gluteal cleft, but it can also be found opposite the genitals, or on both sides. Preparation for tubal ligation Tubal ligation is a surgical procedure that sterilizes a woman. This operation prevents the egg and sperm from meeting and thus prevents pregnancy. After this procedure, it is no longer necessary to use other contraceptive methods. However, it does not protect you against sexually transmitted infections, and it is recommended that you use condoms if you have unprotected sex. Preparation for a colonoscopy Colonoscopy, the purpose of which is to visualize the entire surface of the mucous membrane lining the inside of the rectum and colon, naturally requires complete evacuation of the normal contents of the colon, leaving an empty and clean colon. For this reason, very careful and meticulous preparation is necessary. Operating guides

Tubal ligation What is tubal ligation? Tubal ligation is a surgical procedure that sterilizes a woman. This operation prevents the egg and sperm from meeting and thus prevents pregnancy. After this procedure, it is no longer necessary to use other contraceptive methods. However, it does not protect you against sexually transmitted infections, and it is recommended that you use condoms if you have unprotected sex. Efficiency Tubal ligation is 99.9% effective and IRREVERSIBLE: it should only be used when one is absolutely certain that one no longer wants children. Sterilization method Tubal ligation is most often performed laparoscopically. Small incisions of 5 mm to 1 cm are made in the navel and abdomen to allow the insertion of the laparoscope (a tube equipped with a camera) and other surgical instruments. Carbon dioxide gas is insufflated into the abdomen to allow visualization of the fallopian tubes; this gas is released into the body after the procedure. Benefits The advantages of this method in the postoperative period are: Pain reduction Reduction of the surgical wound The reduction in the length of hospital stays and convalescence. The procedure Filshie clips are used for tubal ligation. They reduce operating time and the risk of complications associated with other techniques. For example, cauterization with cut fallopian tubes carries a risk of accidental bowel burns. What do I need to know after the procedure? You can resume a normal diet the next day and hydrate yourself as much as possible. Gradually resume your regular activities over the first 2-3 days. Avoid lifting, pulling, or pushing heavy objects for approximately 3 weeks. You can shower two days after the operation, taking care to remove the dressings before showering. Afterwards, leave the wound uncovered without reapplying a dressing. The wound is covered with small adhesive strips called Steri-Strips. Leave them in place; they will come off on their own. If they haven't all come off after a week, remove them yourself in the shower. The stitches are dissolving and will disappear on their own in 7 to 14 days. Pain in the abdomen, shoulders, and neck may occur due to the gas insufflated into the abdominal cavity. This discomfort will disappear within 2-3 days following the procedure. Menstrual cramps are normal for the first 2-3 days. Your doctor will have prescribed a pain reliever for you. It should be noted that if the contraceptive pill was used as a method and had regulated menstrual cycles, menstrual irregularity and more painful periods may follow, this being secondary to the cessation of oral contraceptives. Tubal ligation does not cause weight gain. Once the fear of becoming pregnant is eliminated, the woman can feel more comfortable in her sexual relationships because the procedure has no effect on desire, performance, or sexual pleasure. Sexual relations can be resumed as soon as the wound has healed and is no longer sensitive (a delay of approximately two weeks). Your return to work is recommended after 4 weeks. It is recommended that you see your doctor every year for cervical cytology (screening for cervical cancer) and breast examination.

Cholecystectomy: Surgical Guide Document.pdf À quoi sert la vésicule biliaire? La vésicule biliaire est un organe en forme de poire qui se situe sous le foie dans la partie supérieure droite de l’abdomen. Elle sert de réservoir de bile produite par le foie. La vésicule biliaire ne produit pas de bile. Quand on mange, un signal hormonal est envoyé à la vésicule afin de secréter la bile stockée. Celle-ci est libérée dans l’intestin afin de commencer la digestion des aliments que nous venons de manger. Indications de faire l'ablation de la vésicule biliaire (cholécystectomie): – Colique hépatique – Cholécystite aiguë – Suite à une jaunisse (cholangite) sur un calcul biliaire – Suite à une pancréatite sur calcul biliaire – Polype de la vésicule biliaire Opération : Lors de l’intervention, après insufflation de la cavités abdominale avec un gaz (CO2), la vésicule est détachée du foie à l’aide de l’électrocoagulation, uncourant électrique qui brûle les tissus adhérents entre le foie et la vésicule. Les deux structures principales que le chirurgien doit repérer sont le canal cystique (qui lie la vésicule biliaire à la voie biliaire principale) et l’artère cystiquequi nourrit la vésicule biliaire. Le canal cystique est fermé à l’aide d’un ou plusieurs clips afin d’éviter une fuite biliaire à travers le moignon cystique. Il estimportant que la voie biliaire principale ne soit pas blessée lors de l’intervention. Une fois la vésicule biliaire détachée de ces structures, elle est retirée par lacicatrice de 10 mm au niveau de l’ombilic. Les suites opératoire: Les symptômes normaux en post-opératoire comprennent: Un ballonnement abdominal pendant 2 semaines en régression constante. Une douleur de l’épaule (24-48h) suite à l’accumulation du gaz (CO2) insufflé lors de l’intervention). Des nausées et vomissements (24-48h) peuvent être présents. Une rétention urinaire peut être présente dans les premières heures après l’intervention. Un sondage temporairepeut être nécessaire. Induration et douleur au niveau des cicatrices surtout au niveau de la cicatrice sous l’ombilic. Les plaies restentdures pendant plusieurs semaines. Douleur dans l’hypochondre droit en régression Souvent la douleur sera exacerbée par des mouvements brusques. Conséquences de ne plus avoir de vésicule biliaire : Chez la majorité des patients, il n'y a aucune conséquence après la chirurgie. On peut reprendre une alimentation normale sans craindre d'avoir des douleurs, même si vous mangez des aliments gras. 10 à 15% des patients souffriront de diarrhée parfois accompagnée de ballonnement, mauvaise digestion ou de douleur épigastrique . Dans la majorité des cas les symptômes disparaissent dans les semaines suivant la chirurgie. Si le symptômes persistent, une poudre (cholestyramine) à prendre avant les repas aide à résoudre les diarrhées. Symptômes anormaux: Douleur abdominale postopératoire qui ne régresse pas ou qui augmente. Fièvre persistante. Jaunisse. Incapacité à s’alimenter suite à des nausées et vomissements. Ballonnements en augmentation. Si vous avez l'un des symptômes ci-dessus, veuillez immédiatement contacter votre infirmière ou vous présenter à l'urgence.

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Hernia What is a hernia? A hernia is a protrusion of the peritoneal sac through a natural opening, which may contain internal organs. This protrusion forms a more or less large, visible bulge that is usually reducible, meaning it can shrink or disappear without straining. A consequence of muscle weakness, a hernia occurs through the abdominal wall, always in specific locations corresponding to particular areas of the anatomy. What is an inguinal hernia? Very common in the groin crease, a hernia protrudes through the abdominal wall via the inguinal canal, which normally carries the spermatic cord in men and the round ligament (suspensory ligament of the uterus) in women. Men are ten times more likely to develop an inguinal hernia than women. An inguinal hernia can be congenital or acquired (resulting from a weakening of the abdominal muscle wall). It is called an inguinal hernia when the hernial sac remains confined to and above the groin, and an inguinoscrotal hernia when it extends into the scrotum. The contents of the hernial sac most often contain either omentum (fatty apron of the stomach) or intestine. What is the treatment for a hernia? The goal of modern treatment should prioritize techniques that allow for maximum post-operative comfort, a short recovery period, and a low rate of recurrence or complication. The choice of surgical technique takes into account the following factors: the patient's age, the size of the hernia, whether it is a primary or recurrent hernia, whether it is bilateral, and the anesthetic risk. 90% of procedures are performed on an outpatient basis, either under local, general, or spinal anesthesia (puncture of the back with administration of a local anesthetic). Treatment involves closing or reducing the diameter of the inguinal opening through which the hernia protruded using sutures, while bringing the muscles together. Often, it is necessary to insert a non-absorbable tissue prosthesis to cover the weak opening in the hernia area. This "mesh" is gradually filled with scar tissue and, after a few weeks, forms a very strong additional muscular layer.

Anal fissure COMMENT ELLE SE DÉVELOPPE La fissure anale est une déchirure de la couche de surface de l’anus et du début du rectum, qui peut débuter au niveau de la peau de l’anus et se prolonger jusqu’à l’intérieur du canal anal, dans le rectum. Souvent, on ne la voie pas, car elle est seulement à l’intérieur du rectum. Le plus souvent, la fissure se trouve au niveau de l’anus vis-à-vis le pli inter-fessier, mais elle peut aussi se trouver vis-à-vis les organes génitaux, ou des deux cotés. Au moment où la déchirure survient, on peut ne PAS ressentir de douleur immédiatement. Elle survient à la suite d’un étirement trop grand ou d’une pression trop grande au niveau de l’anus, soit par de la constipation, une selle de gros calibre, une diarrhée ou après avoir soulevé une charge trop lourde etc. Une fois la première couche déchirée et ouverte (muqueuse), un muscle d’envergure qui se retrouve tout juste en dessous est exposé, il s’agit du sphincter interne. Ce muscle important sert à la continence, mais on ne le contrôle pas, il agit de façon autonome. Ce muscle est bien utile, mais réagit très mal à une fissure. En effet, il se spasme, c’est-à-dire qu’il se contracte au maximum sans qu’on ait de contrôle sur lui. C’est ce spasme qui est à l’origine de la douleur importante et de la chronicité de la fissure anale. En effet, ce muscle est de 8 cm de hauteur au niveau du rectum et lorsqu’il est spasmé, il occasionne une douleur vive. Les vaisseaux sanguins comprimés dans ce muscles en contraction constante sont écrasés et ne peuvent plus apporter l’oxygène et les nutriments nécessaires à la guérison de la fissure. Les tissus re-déchirent donc à chaque fois que l’anus est écarté, lors de chaque selle entre autre. LES SYMPTÔMES Ils sont typiques et sont tout simplement des manifestation du spasme du sphincter interne. La douleur est le symptôme principal. Elle se présente au passage de la selle principalement, mais peut se prolonger jusqu’à des heures après la selle, ceci même si les selles sont de consistance normale. Les saignements rouge clair sur le papier de toilette, sur la selle ou dans la toilette représente un des symptômes initiaux de la fissure anale. Avec le temps, la fissure devient cicatricielle et saigne plus rarement. Une boule de chair se forme lentement vis-à-vis la fissure, sur le rebord de l’anus. Cette accumulation de chair, qu'on appelle une pseudo-marisque, est souvent confondue avec une hémorroïde douloureuse, mais il n’en est point. Il s’agit simplement d’une conséquence d’une fissure qui est juste vis-à-vis et qui tente tant bien que mal de guérir, mais qui se re déchire à chaque selle. Le prurit (ça pique) est aussi une manifestation fréquente de la fissure anale, ceci causé par le passage de matières infectées sur une plaie ouverte. D’autres symptômes peuvent être présents comme le fait d’avoir des selles effilées comme un crayon, avoir des écoulements de l’anus ainsi que des irritations de la peau autour de l’anus. LE TRAITEMENT Puisque le spasme (hypertonicité) du sphincter anal interne est le coupable, tous les traitements de la fissure anale sont basés sur le relâchement de ce sphincter, afin de permettre à votre propre corps de guérir la fissure. Le contrôle de la consistance des selles : Il s’agit de la recommandation la plus importante, car si la diarrhée ou la constipation persistent, il y aura des récidives de fissure anale. Plusieurs agents aident à un meilleur contrôle de la consistance des selles, comme les suppléments de fibres, qui aident autant les patients qui ont de la diarrhée que ceux qui ont de la constipation. Les émollients peuvent aussi aider à ramollir les selles dans le cas de constipation. Les traitements topiques: D’abord, aucun onguent contenant des corticostéroïde n’a démontré une efficacité quelconque dans le traitement d’une fissure anale, même que ces crèmes peuvent empirer le problème de fissure et créer une dermite cutanée secondaire. Les onguents qui relâchent le muscle lisse (le sphincter interne spasmé), comme les inhibiteurs calciques ou les dérivés nitrés font parti de la première approche de traitement. Lorsque appliqué adéquatement et de bonne compliance au traitement, les taux de guérison s’élèvent jusqu’à 70%. La compliance au traitement est difficile puisque le traitement est long. De plus, certains patients acquièrent une résistance au médicament qui n’exerce plus aucun effet. La toxine botulique: Comme en esthétique, cette toxine est utilisée en injection dans le muscle sphincter interne afin de le relaxer temporairement et ainsi, permettre la cicatrisation de la fissure. Elle constitue une alternative efficace aux agents topiques et peut guérir une fissure anale chez plus de 80% à 90% des patients. Une deuxième injection 6 semaines après la première peut être nécessaire. Les complications sont rares, mais comprennent l’incontinence fécale (moins de 1%), qui est temporaire, mais invalidante. Le traitement chirurgical: La sphinctérotomie latérale interne chirurgicale: Il s’agit du traitement de référence lors de situations réfractaires aux traitements non-chirurgicaux. La cicatrisation de la fissure est obtenue durablement dans plus de 95 % des cas. Toutefois, l’incontinence fécale induite par le geste irréversible de section sphinctérienne est la principale limite de la méthode. En effet, des troubles de la continence sont observés dans 5 % à 30 % des cas après chirurgie. Dre Doyon vous évaluera et selon la présentation de votre pathologie, identifiera avec vous la meilleure approche de traitement. En tout temps, si vous avez des questions, inquiétude ou que vous présentez une persistance ou récidive des symptômes décrits plus haut, prenez rendez-vous avec Dre Doyon, elle saura résoudre votre problème. dépliant post-op sphinctérotomie_francais .pdf

With complete peace of mind A unique service that includes: Telephone or virtual access to a nurse or medical assistant during clinic opening hours. Post-operative follow-up for 1 year. Top-notch, personalized medical monitoring. Make an appointment COST 1 Payment by the employer/insurer If the cost of your procedure is covered, in whole or in part, by your employer or private insurance, please inform us in advance so that we can finalize the payment arrangements before the procedure. 2 Tax credit and tax deduction Health expenses may qualify for a tax credit for the portion that exceeds 3% of your annual income. 3 How do I determine the cost of my procedure? Before scheduling any surgery, an initial consultation with the surgeon is required. This consultation aims to establish or confirm the condition for which surgery would be necessary. Its purpose is also to determine if you are a candidate for surgery in an environment like ours. During your consultation, after a thorough examination and diagnosis, a treatment plan will be explained to you. You will then be able to obtain a detailed quote regarding the price of the surgical procedure. 4 What is included in the cost of the procedure? The costs associated with a surgical procedure include the costs related to anesthesia, surgery, implants used (if applicable) and post-surgical follow-up for one year. 5 Are there any funding options available? Funding for your surgery is possible through companies like Medicard or Crédit Médical, by submitting a funding request to one of these partners. You need to visit their website to submit your application. Let's work together Please note that no consultation request is required to book an appointment with the surgeon privately. However, whether you have already submitted a consultation request or not, an initial consultation with the surgeon is necessary and mandatory. Make an appointment

Exceptional care for each patient Biography of Dr. Doyon Dr. Caroline Doyon, surgeon She holds a Doctorate in General Surgery from the University of Montreal. She holds a Master's degree in Biomedical Sciences, as well as a Master's degree in Molecular Biology. She specializes in benign anorectal pathologies. She also specializes in the endoscopic management of colonic polyps. She made a notable contribution to medical education, particularly as a member of the resident training committee and as a speaker at medical conferences. She is certified by the Royal College of Surgeons of Canada and the American Society for Gastrointestinal Endoscopy. Since September 2017, she has been juggling her career between remote regions and the private sector, thus offering an alternative to the public system. She has treated more than 5,000 patients with anorectal pathologies since 2017. She works as a speaker, trainer, columnist and panelist, contributing to the education of both doctors and the general public. She is the author of an online training course for family physicians on hemorrhoidal and venous diseases, in collaboration with the FMOQ. It favours a patient-centred approach, promoting the establishment of a relationship of trust and patient satisfaction. Treatments that stand out From the initial consultation to the final follow-up, Dr. Doyon's approach offers personalized attention to each patient. She takes the time to listen, focusing on each patient's unique goals. Her empathetic nature creates a safe and trusting environment, easing anxieties and fostering open communication. In today's world, where access to quality care within a reasonable timeframe can be difficult, Dr. Doyon stands out as a beacon of unwavering dedication and compassion. She consistently goes above and beyond, ensuring her patients receive the highest quality of care at every stage of their surgical journey. Dr. Doyon's exceptional patient care is not simply a job, but a sincere mission to make a difference in the lives of those she treats.

Hemorrhoid Hemorrhoids, a reminder: We have three, sometimes four hemorrhoidal bundles or venous networks inside the entrance to the rectum. We also have three bundles outside the anus, right at the exit. Hemorrhoids are varicose veins, that is, venous congestion in the network of these three bundles. This causes the tissues of the hemorrhoidal veins to swell and stretch, which are then commonly called hemorrhoids. When one or more bundles inside the anus are swollen, they can: Stretching and expanding until they protrude from the anus during bowel movements and/or when exerting oneself; this is called a prolapse. Causing bright red bleeding in the toilet at the time of defecation, due to weakened and swollen veins. Internal hemorrhoids do not usually cause any pain, but rather discomfort, a feeling of heaviness in the rectum. Note that this is not the same condition as external hemorrhoids, which, when swollen at the opening of the anus, can be very painful. Treatment of hemorrhoidal disease: What does hemorrhoid ligation involve as a treatment for hemorrhoids? First, the various corticosteroid-based creams available on the market offer no advantage in the treatment of internal hemorrhoids. The effective technique for treating symptomatic internal hemorrhoids is hemorrhoidal ligation. The procedure involves aspirating the hemorrhoidal vein into what is called the ligator, then ejecting an elastic band at the base of the hemorrhoidal varices. This leads to strangulation of the vein, therefore its drying out, which after 4 to 5 days will atrophy and create scarring of the tissues. This healing process includes tissues that are now stronger, and this helps prevent the vein from stretching again. By acting in this way, we significantly reduce the risk of symptom recurrence. Hemorrhoidectomy is a surgical procedure aimed at permanently removing hemorrhoidal tissue (internal and external) when it is large or resistant to less invasive treatments. The procedure is performed under general or regional anesthesia, with the main consequence being post-operative pain managed by medication, but with a high long-term satisfaction rate. For more details on post-operative care, see the PDF guide opposite. Document.pdf

Endoscopy The main role of endoscopy is to allow the doctor to directly visualize the inside of hollow organs (such as the digestive tract) using a flexible tube equipped with a camera, in order to diagnose pathologies (ulcers, inflammations, polyps, cancer), take biopsies for analysis, remove abnormalities (polyps, foreign bodies), control bleeding and monitor the effectiveness of treatments, thus acting as both a diagnostic and therapeutic tool. Diagnostic functions Detailed observation: Check the condition of the mucous membranes (irritations, inflammation, ulcers). Anomaly detection: Identify tumors, polyps, hernias. Investigating causes: Finding the origin of bleeding, pain, swallowing problems or bowel movement disorders. Staging assessment: Determining the extent of a cancer. Therapeutic functions (Interventional endoscopy) Biopsy: Taking tissue samples for analysis. Removal of abnormalities: Removing polyps ( polypectomy ) or other masses. Controlling bleeding: Stopping a hemorrhage. Unblocking: Clearing an obstruction. Treatment monitoring: Checking the effectiveness of a treatment, particularly for cancer or the eradication of bacteria such as H. pylori. Common types of endoscopies Gastroscopy or upper digestive endoscopy : Exploration of the esophagus, stomach and duodenum (beginning of the small intestine) via the mouth. Colonoscopy or lower digestive endoscopy : Exploration of the rectum and colon via the anus. Long colonoscopy Document.pdf INTRODUCTION: It is used to visualize the entire large intestine (colon and terminal ileum) to diagnose, screen for, and treat abnormalities, particularly precancerous polyps and colorectal cancer. Its role is therefore diagnostic (identifying bleeding, pain, inflammatory diseases), preventive (removing polyps), and therapeutic (biopsies, coagulation of lesions). Main roles Colorectal cancer screening: Identifying and removing polyps before they become cancerous. Diagnosis: Investigate the cause of symptoms (bleeding, diarrhea, constipation, abdominal pain). Disease monitoring: Monitoring chronic inflammatory diseases such as Crohn's disease or ulcerative colitis. Treatment: Removing polyps (polypectomy) or performing biopsies (tissue sampling). Features Complete exploration: Unlike other examinations, it allows us to see all the way to the end of the small intestine (ileum). Interventional: It goes beyond observation to directly treat abnormalities. Preparation required: Requires rigorous bowel cleansing for optimal visualization.

Areas of expertise Consultation Make an appointment Abdominal pain Anal pain Rectal bleeding Constipation or diarrhea Weight loss Skin abscess and infection Biliary colic Fecal incontinence Surgery Make an appointment Abdominal wall hernia repair Hemorrhoid treatment Treatment of anal fissure Gallbladder removal Removal of skin lesions (moles, cysts, lipomas) Treatment of pilonidal sinus Desire for sterility (male and female) Treatment of anal fistula Endoscopy Make an appointment Colonoscopy Gastroscopy Ileoscopy Polypectomy Follow-up of family history Anemia Digestive cancer monitoring pre-operative of obesity surgery

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