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Abraham Avi Nisim, MD

Dr. Abraham Avi Nisim completed his general surgery residency from Cedars Sinai Medical Center in Los Angeles and subsequently trained in minimally invasive colon and rectal Surgery at University of California, Irvine. Dr. Nisim is multilingual with fluency in Spanish and Hebrew.

Born in Israel, Dr. Nisim resided in New York for several years where he commenced his general surgery residency before moving to California. He shifted with his family to Kern County to enjoy the small-town feel with the opportunity to explore the nearby coastal and mountain communities. Dr. Nisim offers patients various surgical options and strongly believes that postsurgical recovery and healing is supported through proper nutrition and physical and mental health.

On days off, Dr. Nisim spends time saltwater fishing and is active in his son’s sport teams.

Breast Cancer

  • Breast Cancer/Procedures

    Breast Cancer Procedures

    There is estimated to be 235,000 new cases of cancer diagnosed this year. Breast cancer is a disease in which the breast cells grow out of control, eventually forming a lump or mass. Each year the breast cancer survival is improving due to both the advancement in surgical techniques, improved tumor suppressing drugs and chemotherapy, as well as better targeted radiation methods. Early detection, like any disease, is vital to the survival rate of those patients affected by breast cancer. It is currently estimated that 1 in every 8 women in the U.S will develop breast cancer at some point during their lives. And while women of Caucasian decent are more likely to develop breast cancer, the mortality rate is higher among African American women. According to the latest published data from the National Cancer Institute, the 5 year breast cancer survival rate is now at almost 90%.

    Other symptoms of breast cancer are:

    • Sudden nipple discharge
    • Itchy, rash-like appearance on the nipple
    • Sudden swelling or redness
    • Change in the shape and or size of the breast
    • Dimpling of the skin on the breast
    • Persistent localized pain

    It important to remember that these symptoms can also be due to other health factors, but should also be examined by a breast specialist so that it can be properly diagnosed.

    There is NO ONE cause of breast cancer. Genetics, environmental factors, drug use, and other behavioral choices all play a role. The majority of women who develop breast cancer have no identifiable risk factors other than being a woman in the western hemisphere in the 21st century.

    Some women do have additional risks:

    • Caucasian and Jewish women have the highest incidence of breast cancer;
    • Women of color have a lower rate of breast cancer but a higher mortality;

    Women with a history of breast cancer have a lifelong increased risk of recurrence. Because of this increased risk, women who have been previous diagnosed with breast cancer must continue to be closely followed by their physician throughout the rest of their life. Typically speaking, being cancer free for longer than a five year duration is very encouraging, but does not mean that the cancer will never return. Some women with a history of breast cancer may even develop a recurrence or a completely separate cancer after more than 20 years of being cancer free. Knowing your risk and family history are vital components to detection and survival.

    Genetic Counseling
    About 5% to 10% of all breast cancers are thought to be hereditary, brought on by abnormal genes passed down from a parent. In some cases, those who carry such abnormalities may be given the wrong set of genetic instructions, leading to faulty cell growth. In essence, if there is an error in a gene, that same mistake will replicate and appear in all the cells that contain the same gene.

    Most inherited cases of breast cancer are associated with two abnormal genes; BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two). Therefore, any man or woman with a strong family history of breast or ovarian cancer should be tested for the presence of the BRCA 1 and BRCA 2 genes. Both of these genes are responsible for producing tumor suppressing proteins, which repair damaged DNA and ensures the proper functionality of the cells. If it is found that either of those two genes are mutated, DNA may not be repaired properly which can in turn lead to the development of cancer.

    While less than 10% of women with breast cancer are actual carriers of this gene, those that do have up to an 80% risk of being diagnosed with breast cancer during their lifetime. They also have an increased risk of developing ovarian, colon, pancreatic, and thyroid cancers, as well as melanoma. Awareness is key. Knowing your predisposition to developing breast cancer can ultimately save one's life.

    A discussion with one of Dr. Nisim can help you determine whether or not you should be tested for the mutation and what your treatment options are, should you be a carrier.

  • Sentinel Lymph Node Biopsy

    Sentinel Lymph Node Biopsy

    A sentinel lymph node biopsy is a surgical procedure used to determine if cancer has spread beyond a primary tumor into your lymphatic system. The sentinel lymph node is the first draining lymph node, typically in the underarm for breast cancer, where cancer cells may start to spread.

    During a sentinel node biopsy the surgeon utilizes two techniques to identify the appropriate lymph node to remove. On the morning of the procedure, the radiologist injects a special tracer in the breast which helps the surgeon identify the sentinel node during surgery. A blue dye is also typically injected in the breast to highlight the sentinel node. After the lymph node is removed, the pathologist can then examine the node to determine if any cancer cells have spread. Your surgeon may recommend additional surgery to remove the remaining lymph nodes if the sentinel node shows cancer cells.

  • Mastectomy


    Traditional mastectomy is the removal of the whole breast and usually some portion of the breast skin. Mastectomy is indicated if the involved area is too extensive for lumpectomy. A majority of the time this operation is followed by breast reconstruction at the same procedure.

    People that are more likely to have the procedure of a mastectomy are those that have large areas of breast cancer or those patients that wish to remove the entire breast because of the possibility of breast cancer recurring in the future (prophylactic mastectomies). Although this procedure is typically done on a cancerous breast, it is sometimes also done on the healthy breast to decrease the risk of breast cancer in the future. For women who carry the BRCA mutation or are known to be at high risk for breast cancer, this surgery is sometimes done bilaterally (on both breasts) to maximize cancer-prevention.

  • Nipple-Sparing Mastectomy

    Nipple-Sparing Mastectomy

    During a nipple-sparing mastectomy the surgeon preserves all of the skin of the breast, including the nipple and areola (the pigmented skin around the nipple). Just like the traditional mastectomy, nearly all of the contents of the breast are removed except for a thin layer of fat and blood vessels that are needed to keep the skin healthy. The major advantage of a nipple-sparing mastectomy is that it is usually combined with immediate breast reconstruction to produce a reconstructed breast that looks the same or better than the original breast–with skin and nipple intact.

  • Skin-Sparing Mastectomy

    Skin-Sparing Mastectomy

    A skin-sparing mastectomy is a technique that preserves as much of the patient’s breast skin as possible. During a skin-sparing mastectomy, the surgeon removes only the skin of the nipple, areola, and the original biopsy scar. Then the surgeon removes the breast tissue through the small opening that is created. The remaining pouch of skin provides the best shape and form to accommodate an implant or a reconstruction using your own tissue. Many women are not candidates for nipple-sparing mastectomy will choose this type of mastectomy in order to get the most realistic and pleasing results from immediate breast reconstruction.

  • Lumpectomy


    Lumpectomy (also referred to as breast-conserving surgery or partial mastectomy) is an operation performed in which the surgeon removes the tumor along with some normal breast tissue surrounding it. A lumpectomy may be performed with or without preoperative imaging localization. If the tumor is not palpable (meaning it can only be seen on breast imaging) then under imaging guidance a small wire is placed into the abnormal tissue to indicate the tissue that should be removed. The removed specimen is then imaged to confirm that it contains the abnormal area.

    Women who have this type of breast cancer surgery usually:

    • Have a single breast cancer less than five centimeters in diameter
    • Have enough tissue so that removing surrounding tissue would not leave a misshapen breast
    • Are medically able to undergo
  • Breast Reconstruction

    Breast Reconstruction

    Breast reconstruction following a mastectomy is typically achieved through various surgical techniques that restore the breast to near normal shape, appearance and feel. Performed by a plastic surgeon, breast reconstruction can be done at the same time as the mastectomy (“immediate”) or at a later date, known as “delayed” reconstruction. At the SGLA Breast Center, we take sincere pride in listening to our patients and learning what reconstructive option is the best choice for each patient's lifestyle. Our surgeons work closely with the most esteemed plastic surgeons in Los Angeles to provide the most comprehensive oncological care and physical outcome possible.

    During a one-stage, immediate, breast reconstruction the implant is put in at the same time the mastectomy is done. After the breast surgeon removes the breast tissue, a plastic surgeon then places the new breast implant in place. Typically the implant is placed beneath the muscle on your chest wall and held in place by a special type of soft tissue graft. Two-stage reconstruction is done by first placing a short-term tissue expander beneath the muscle on your chest wall after the mastectomy is completed. The expander acts like a balloon-like sac that slowly expands to the desired size allowing the skin flaps to stretch. A two-stage reconstruction plan is usually decided upon when the surgeon believes that the mastectomy skin flaps will not be sufficient size to support a full-sized implant right away. Once in place, through a tiny valve under the skin, the surgeon will inject a salt-water solution at regular intervals to fill the expander over a period of time. After the skin over the breast area has stretched enough to the desired size breast, a second surgery will remove the expander and put in the permanent implant. If radiation therapy is needed, the final placement of the implant is delayed until radiation treatment is complete. Breast reconstruction can be done with:

    • Breast implants (filled with saline or silicone)
    • Natural tissue flaps (using skin, fat and sometimes muscle from your own body)
    • A combination of these methods

    There is no one best reconstruction method, and every individual’s needs will vary. A person's age, body size, medical conditions, and surgical history may also affect the types of breast reconstruction best suited to yield the most desirable results.

    It is our mission to provide expert diagnosis and surgical treatment for breast cancer and all other breast health issues. Having the correct diagnosis is a critical first step in providing the best treatment possible. Early detection is important, and we will determine the best screening regimen for you.

Colorectal Surgery

  • Fecal Incontinence

    Fecal Incontinence (Bowel Incontinence)

    What is Fecal Incontinence?
    Fecal incontinence, or bowel incontinence, is the inability to control bowel movements causing unexpected leaks from an individual’s rectum. This loss of control can range from an occasional leakage before being able to reach a restroom, to complete loss of bowl movements all together. Or, a person may not feel the urge to go to the toilet at all.

    What most people suffering from this condition fail to realize is there are many new effective treatment options available for fecal incontinence. Nearly 18 million Americans deal with this embarrassing condition, so don’t be ashamed to talk about it! Treatment is available that can drastically improve your quality of life.

    Why Does Fecal Incontinence Occur?
    When a person loses the ability to hold in their stool (continence), it is mainly due to damage of the rectal nerves or muscles that control your bowel movements. In order to maintain continence, the anus, rectum and nervous system all have to be working together. If the muscles on the wall of the anus and rectum are at all compromised, a person’s ability to hold in stool will in turn be affected. Continence also relies on the body’s ability to notice the presence of stool in the rectum, as well as the body’s ability to relax and store stool while using the bathroom. If any of these dexterities become weak or none compliant, incontinence is what ensues.

    What causes fecal incontinence?
    Age: As we grow older its natural for sphincter muscles to become weaker. In turn, older people often find themselves unable to contract the sphincter muscles tightly enough to hold in stool until they are able to reach a bathroom.

    Constant diarrhea: Conditions such as diarrhea can cause the muscles in the anus and in the intestines to stretch and become weak. Diarrhea can lead to bowel incontinence by overwhelming the rectum and anal sphincters with the volume of stool being passed, ultimately leading to leakage or complete incontinence.

    Crohn's disease: Patients who suffer from Colitis or Crohn’s disease most often than not aslo suffer from bowel incontinence. Because both conditions can cause severe and chronic diarrhea, the anal muscles often become weak and control eventual becomes compromised.

    Excessive staining or constipation: Constipation is one of the more common causes of fecal incontinence. The type of constipation that is most likely to lead to fecal incontinence occurs when people are unable to relax their sphincter and pelvic floor muscles when trying to push out a bowel movement. Unknowingly while straining, the individual can mistakenly squeezing these muscles instead of relaxing them making it difficult for stool to pass. When stool becomes hardened in the rectum the looser, watery stool must move around the drier mass and often leaks from the anus.

    Neurological Conditions: Many neurological diseases, such as Alzheimer's, that affect the nervous system may also cause fecal incontinence. Because bowel control relies so heavily on the bodies nervous system to notice the presence of stool, patients who suffer from these (and other) neurological disorders are often unable to hold in their stool.

    Radiation treatment: The anal sphincter muscles won’t open and close properly if the nerves that control them are damaged. Likewise, if the nerves that sense stool in the rectum are damaged, a person may not feel the urge to go. Both types of nerve damage can lead to fecal incontinence, and both these types of nerve damage can occur while undergoing radiation therapy.

    Trauma or damage done during pervious anal surgery - Injury to one or both of the sphincter muscles can cause fecal incontinence. If these muscles, called the external and internal anal sphincter muscles, are damaged or weakened, they may not be strong enough to keep the anus closed and prevent stool from leaking.

    Vaginal delivery – Obstetrical injuries are the number one cause of fecal incontinence and result in about 60 percent of all cases. During childbirth or anal surgery injury to one or both of the sphincter muscles can often occur. The risk becomes greater if forceps are used during the birthing process or if an episiotomy (a cut made to the vagina to help deliver the baby) is performed. Some woman experience incontinence directly following child birth, while others aren’t affected until years later.

    What are the symptoms of fecal incontinence?
    Symptoms of fecal incontinence can vary to include:

    • Staining or completely soiling your underwear
    • Not being able to reach the bathroom in time
    • Not feeling the urge to use the bathroom
    • Complete loss of bowel control
    • Diagnosis of Fecal Incontinence

    Diagnoses of fecal incontinence is most often based off of a health care providers evaluation of a patient’s medical history, an in office physical exam, and other related blood or imaging test results.

    Patients are often asked to log their bowel movements as well. How frequent is your incontinence? Was it liquid or solid stool? Were you able to sense the need to go? How heavy of an impact does is it having on your day to day life? Do you need to wear a pad? In doing all of that, your physician will be able to better evaluate the severity of your condition, as well as implement the proper course of treatment.

    A physical examination can also assist in confirming the severity as well as the cause(s) of a patient’s incontinence. This may include a visual exam of the anus, a physical finger exam of the anus, and or an anoscopy, or a look at the anal canal with a small scope.

    Further diagnostic testing may also be required to confirm the exact cause of a patient’s incontinence. One of the most common examinations performed is anal ultrasound. During this test, the ultrasound machine takes multiple pictures which can uncover damaged or abnormal function of the anal muscles.

    Diagnostic tests may include:

    • Blood tests
    • Colonoscopy
    • Electromyography (EMG) - Tests the nerve function in the muscles around the anus by using tiny needle electrodes.
    • Rectal or pelvic ultrasound
    • Stool culture
    • Test of anal sphincter tone (anal manometry) – This is used to evaluate the rectal sensation, strength and response by utilizing a catheter and a balloon to study the
    • nerves and muscles of the anus and rectum.
    • X-ray procedure using a special dye to evaluate how well the sphincter contracts (balloon sphincterogram)
    • Treatment & Prevention Options

    Treatment for fecal incontinence can vary. Sometimes, for less severe cases, a simple change in diet and nutrition is all that is needed. For patients suffering from more severe incontinence, treatment can include biofeedback, surgery, or the latest and most favorable procedure, electoral nerve stimulation or InterStim Therapy.

    Injection treatment - This procedure entails injections of a thick gel, called Solesta, into the anal sphincter to bulk up the lining of the rectum. By added density, fecal matter is less likely to slip out due to muscle weakness.

    Artificial bowel sphincter – During this surgical procedure an artificial sphincter is placed around the rectal sphincter. Consisting of three parts (a cuff, a pressure-regulating balloon, and a pump) the cuff stays inflated to maintain continence. Once you have a bowel movement the cuff will deflate the balloon which will automatically re-inflate in 10 minutes.

    Biofeedback: Biofeedback is an effective non-surgical treatment option that helps the body learn through reinforcement. Bio-feedback training is usually done in conjunction with at home bowel training exercise (such as Kegel’s) and works to increase the body’s awareness of a biological response, like having to go to the bathroom, so a person and relearn and improve their voluntary control.

    Medication: For less severe cases a physician may recommend medication to treat fecal incontinence. Medications may include: Anti-diarrheal medication that helps bulk up stool, such as Imodium® and Pepto-Bismol®. Or for those suffering from constipation they may recommend laxatives such as milk of magnesia, or stool softeners such as Colace and Dulcolax.

    Sacral nerve stimulationor Interstim Implantation is a surgical procedure that is FDA approved for the treatment of fecal incontinence. The treatment form is highly affective and is most often used when conservative therapy doesn’t relieve a patient’s incontinence. This treatment targets the 3rd sacral nerve root, which controls bowel and bladder continence. Done in two stages by a colorectal surgeon, this procedure is normally performed in an out-patient setting. During the first stage, your surgeon will place a thin, flexible wire, called a test lead, near your tailbone, which will send mild electrical pulses to the nerves that control your bowel continence. Your ability to control your bowels with the “test lead” will be tracked over the next two weeks, and adjustments are made to the electrical pulses if needed. If Interstim has proved effective during the trial state, then the flexible wire or lead will be implanted under your skin permanently. Interstim therapy has been shown to improve quality of life, and reduce the frequency and severity of fecal incontinence episodes in the majority of patients who receive the permanent implant.

    We pride ourselves on staying at the forefront of innovative, personalized care. By utilizing the latest technology, Dr. Nisim is able to provide patients with a wide-verity cutting edge treatment options specifically tailored to every individual’s needs and personal preferences.

    (Bowel Incontinence)
  • THD Treatment

    THD Treatment

    Advanced & Non-Invasive Hemorrhoid Treatment
    It is estimated that 50% of Americans will, at some point in their lives, suffer from hemorrhoids. Thanks to vast improvements and modernizations of hemorrhoid removal procedures, our skilled surgeons at miVIP Surgery Center are proud to offer a new non-invasive procedure to efficiently and quickly remove painful hemorrhoids. Our staff of dedicated medical professionals are comprised of the most prominent industry experts. Specializing in cutting-edge robotic and minimally invasive techniques, Dr. Nasseri and Dr. Barnajian have unparalleled expertise in the field of hemorrhoid treatment. As one of the top hemorrhoids doctors in Southern California, they offer the most advanced procedures for the treatment of hemorrhoids, utilizing the latest technologies and surgical modalities available.

    Our THD procedures:

    • Are minimally -invasive and can be completed in our state-of-the-art out patient facility
    • Use Doppler technology to locate the source of potential hemorrhoids
    • Are significantly less painful than traditional hemorrhoid removal treatments

    The advanced technology we use allows our patients to return home from their procedure on the same day. We would be happy to discuss the THD procedure and explain its benefits to you or your loved ones. To find out more about our various treatment options or to schedule a consultation, please call our office at your earliest convenience.

  • Colon Cancer Treatment

    Colon Cancer Treatment

    Providing Compassionate Medical Care in Your Time of Need
    Whether you or a loved one has recently been diagnosed with colon or rectal cancer, or if you are searching for a treatment center to address concerns with your colon, our team of colorectal specialist offer competent and reputable medical advice. We are pioneers in the field of colon cancer treatment and feature the latest treatment methods available on the market.

    We provide the following for our colon cancer patients:

    • Specialty trained physicians who consistently deliver superior outcomes
    • The latest in minimally invasive surgery and robotics to minimize pain and discomfort
    • A VIP treatment through high-quality care, patient advocacy, and personalized care every step of the way

    What Is Colorectal Cancer?
    Colorectal cancer, cancer that begins in either the colon or the rectum, is the 2nd most common cancer in the United States. Colon cancer affects the large intestine of the digestive tract (the colon), while rectal cancer is located in the last several inches of the colon. When discussed together, these conditions are referred to as colorectal cancers.

    Colorectal cancer often forms slowly, over the course of several years, when a polyp (non-cancerous growth) becomes present on the lining of the rectum or colon. What’s most astonishing is the fact that this disease is thought of to be preventable, yet has the 2nd highest rate of incidence. This is why colonoscopy is such an important tool in the prevention of colorectal cancer. By using screening colonoscopies, a physician can detect pre-malignant polyps and remove them before the cells become cancerous.

    Adenomatous polyps are what develop into cancerous tumors and are seen as a pre-cancerous condition. And while inflammatory polyps are generally benign, it is still important for your doctor to monitor. If the tumor were to continue to grow into the wall of the colon or rectum, it can potentially get into the lumph vessels or blood and metastasize, spreading to other areas of the body.

    Who is at risk?
    Although colorectal cancer can occur at any age, it affects most individuals over the age of 40. Often referred to as the “silent” disease, patients often present no symptoms until the cancer is advanced. However, if this type of cancer is found early, the cure rate is 80% or better, making regular screenings a vital competent to your routine health exams. Anyone may develop colorectal cancer, but there are a few factors that may increase your risk for the disease

    Other risk factors include:

    • Family history of colorectal cancer or polyps
    • African American descent
    • Obesity
    • Smoking/Alcohol Abuse
    • Personal history of polyps
    • Personal history of cancers of other organs especially uterus, ovaries, or breast
    • Inflammatory bowel disease (IBD) including ulcerative colitis (UC) or Crohn’s disease (CD)

    If someone in your family has been diagnosed with colon cancer, you’ll want to start the screening process for both colon and rectal cancer 10 years before the age that he/she was diagnosed. For other individuals, colon cancer and rectal cancer screenings should begin at age 50.

    What are the symptoms of colorectal cancer?
    Early cancers and polyps do not generally cause any symptoms, which is why screening (colonoscopy) is so important in preventing this disease. When symptoms do develop, the most common symptoms are rectal bleeding and changes in bowel habits such as constipation or diarrhea. Some patients with more advanced forms of the disease may also experience abdominal pain, weakness or fatigue, nausea, vomiting, or sudden weight loss.

    Colonoscopy is the best tool for screening and preventing colorectal cancer. With early detection and removal of pre-cancerous polyps colorectal cancer can be prevented all together. If at the type of colonoscopy polyps are found, the chance of future cancer does increase. Therefore, it is recommended that a patient then has routine colonoscopies every 3 – 5 years instead of every 10. Like most all cancer related diseases, early detection is key! Do not put off getting your colonoscopy. If you notice any change in your bowel habits, have experienced sudden and unexpected weight loss, and/or experience rectal bleeding, make an appointment for a private consultation with one of our renowned colorectal specialist in our office.

    When should you be screened for colorectal cancer?
    All individuals who are at an ‘average risk’ should have a screening colonoscopy beginning at the age 50, every 10 years to follow if no cancers or polyps are found.
    Individuals of African Americans decent have a higher risk of colorectal cancer and are recommended to begin screenings at the age of 45, and then every 10 years to follow if nothing is found.

    People with a family history of colorectal cancer, or polyps, suggests they have a higher risk of developing colorectal cancer. Individuals with a strong family history of other known genetically mutated cancers such as breast, ovarian or uterine cancer, are also at a great risk and should have a colonoscopy at age 40, or 10 years before the youngest diagnosed relative.

    Polyps detected at the time of colonoscopy may put you at a higher risk for developing cancer. If you have had a polyp detected on colonoscopy you should have repeat colonoscopies every 3 to 5 years to screen for new growths.

    Inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis puts individuals at a great risk for developing pre-cancerous lesions. Those suffering from IBD should have a colonoscopy 8 years after initial diagnosis, and then every 2 years to follow.

    How is colon cancer treated?
    The treatments for colon cancer and rectal cancer are somewhat different. After you are diagnosed with colon cancer, your physicians may order several tests including blood (CEA level) and imaging tests (typically CT scan or PET scan of your abdomen and pelvis). If your cancer appears to be early stage, then surgery is the next step. This involves removal of the involved segment of colon along with the mesentery containing the lymph nodes and reconnection of the bowel. In most cases, this can be accomplished by minimally invasive surgery such as laparoscopy or robotic-assisted surgery. At the Surgery Group of LA Dr. Yosef Nasseri is one of the most sought after and highly skilled robotic colorectal surgeons, utilizing the latest and most advanced surgical techniques to treat cancers of the colon and rectum. Once a tumor is evaluated by a pathologist, our team of specialist will then tailor and individual treatment plan to meet the patient’s specific needs

    How is rectal cancer treated?
    The treatment process for rectal cancer is heavily dependent on how far the tumor has penetrated into the wall of the rectum. After you have been diagnosed it is likely that several test including a CEA blood level, CT scan or PET scan of your chest, abdomen and pelvis will be order to analyze if the cancer has spread to other parts of the body. Usually an in office exam will also be conducted to assess how close the tumor is relative to the anus and sphincter muscles. In addition, a rectal ultrasound or pelvic MRI may also be performed to determine how deep the tumor has penetrated and to see if any lymph nodes have been invaded.
    For cancers affecting the lower portion of the rectum, a sphincter sparing surgery may be an option if the cancer has not affected the sphincter muscles. In certain cases, when the anal sphincter muscles are affected by the tumor, removal of the entire anus and rectum may be necessary in order to insure the highest possibility for a cure.

    Schedule a Consultation
    Every colon cancer patient deserves to understand the options available to him or her for treatment. While traditional hospitals can diagnose your cancer, they may not offer the most effective treatment options. To ensure you or your loved ones get the best care possible, please call our office to set up a consultation with Dr. Nisim.

  • Hemorrhoid Treatment & Surgery

    Hemorrhoid Treatment & Surgery

    What Are Hemorrhoids?
    Hemorrhoids are a common condition, affecting more than 3 million people each year. Everyone has some hemorrhoids, the cloud-like clusters of veins that lie just beneath the mucous membranes lining the lowest part of the rectum and the anus. The abnormal condition commonly known as hemorrhoids (or piles) develops when those veins become swollen and inflamed. Hemorrhoids may result from straining during bowel movements or from the severe pressure during pregnancy, among other things. Hemorrhoids may be located inside the rectum, known as internal hemorrhoids, or they may develop under the skin around the anus (external hemorrhoids).

    Abnormal hemorrhoids is a common ailment. By the age of 50, more than half of the adult population has had to deal with the discomfort and bleeding related to hemorrhoids.

    Fortunately, there are many effective treatment options available for hemorrhoids. Most people can get relief from symptoms using at home remedies and making a few simple lifestyle changes.

    Causes of Hemorrhoids

    • Straining during a bowel movement – causing excess tension and pressure on the rectal veins.
    • Chronic diarrhea – The overuse of the anal muscles and increased pressure from sitting for an extended period of time.
    • Constipation – This is the most common cause of hemorrhoids happens when the pressure used to pass stool fills the anal veins to the point of creating a hemorrhoid.
    • Obesity – The added pressure to the rectum and pelvic area from excess weight can form hemorrhoids.
    • Pregnancy – Pressure and weight on the pelvic area from the enlarged uterus can cause swelling of the anal canal.
    • Labor – The extreme pressure and force can also cause hemorrhoids.

    How to Avoid Getting Hemorrhoids
    The prevention of any unpleasant medical condition is key to living a long and healthy life. When it comes to preventing the occurrence of hemorrhoids here is what you should do:

    • Eat fiber – Add more fiber to your diet, either through food, a fiber supplement (such as Metamucil, Citrucel, or Fiber Con), or both. Fiber softens stools and makes them easier to pass, reducing the pressure that causes hemorrhoids. Add high-fiber foods like broccoli, beans, wheat, whole-grain foods, and fresh fruit to your diet. Start slowly, and gradually increase your intake to 25–30 grams per day.
    • Drink a lot of fluids – Drinking enough water is key to preventing the most common cause of hemorrhoids, constipation. Make sure you are staying adequately hydrated each day to promote healthy bowel movements and overall health. Fiber and water work go hand in hand to help move stool out of the body in an efficient manner.
    • Exercise – Regular moderate exercise contributes to keeping your bowel movements regular. For example, a brisk 20–30 minute walk each day can help stimulate bowel function. Additionally, the more time you spend on your feet, the less time you spend seated, putting pressure on your pelvic area.
      Avoid straining – Straining the pelvic area is the most basic cause of hemorrhoids. If you push too hard while trying to use the restroom, you can easily cause hemorrhoids. Heavy lifting activities can also contribute to pelvic pressure and cause hemorrhoids as well.
    • Treat the clot – When an external hemorrhoid forms a blood clot, the pain can be unbearable. If the clot has been present for longer than two days, apply over the counter treatments to try and relieve some of the symptoms. If the clot is more recent, the hemorrhoid can be surgically removed or the clot can be withdrawn from the vein in a minor in-office procedure performed by a surgeon.
  • Pilonidal Cyst Surgery & Treatment

    Pilonidal Cyst Surgery & Treatment

    What Are Pilonidal Cysts?
    A pilonidal cyst (sacrococcygeal fistula) is an abnormal pocket in the skin that usually locates itself above the buttocks near the tailbone. The cyst looks much like a pimple and commonly contains hair and skin debris. If the cyst becomes infected it can result in a really painful abscess that requires clinical attention.
    Pilonidal cysts were first described in 1833 by Herbert Mayo. The term pilonidal is derived from the Latin words “pilus” (hair) and “nidus” (nest). While pilonidal cysts occur more frequently in men than in women, they are also more common in people of Middle Eastern and Caucasian descent than in other racial groups.

    Symptoms of Pilonidal Cysts

    • Pain, swelling and/or redness at the bottom of the spine.
    • Fever, drainage of pus or blood from an opening in the skin (usually with an odor).

    Treatment of Pilonidal Disease
    In many cases pilonidal disease can be easily treated by keeping the affected area clean and using antibacterial soap. In some cases, antibiotics may be needed to help control the infection. For recurring abscesses, or for very severe infections, the cyst must be opened and drained surgically.

    There are two types of surgical procedures available to treat pilonidal disease; incision and drainage or complete excision of the cyst. Treatment for this condition varies on a case by case basis and is dependent on the severity of the infection. An exam of the infected area should be done before determining which form of treatment is best for you.

    Incision and Drainage:
    The main technique for treating an infected pilonidal abscess is lancing the cyst and draining the pus within it. This is typically a simple procedure performed in office under a local anesthetic.

    Should an excision of the abscess be necessary, the area will be surgically opened and a complete debridement will be performed. This technique is often favored by physicians because there is a decreased risk in wound complications. Since the wound is being left open to heal, there is little risk of an actual wound infection.
    A more advanced technique is complete cyst excision using rotational skin flaps for the closure of the wound. These techniques allow for complete cyst excision followed by closure using a patient’s tissue. Although this technique can be technically more challenging, the outcomes for these pilonidal cyst treatments have demonstrated the shortest recoveries with the lowest recurrence and wound infection rates.

    If you are experiencing pain due to pilonidal disease, you should contact our office for an immediate evaluation.

  • Colonoscopy


    The Basics: What Is a Colonoscopy?
    Doctors perform a colonoscopy when they want to examine the large intestine (which includes the colon and rectum) for alarming changes or abnormalities. By inserting a long, thin, flexible tube into your rectum, a colonoscopy doctor can examine the lining of the large intestine.
    Equipped with a tiny camera and a small light, the scope can take images of the area and transmit them back to the medical team. The procedure can also be used to perform a biopsy or remove abnormal growths.

    Why Perform a Colonoscopy?
    There are many reasons for performing a colonoscopy. Your physician may order one if you’ve experienced any of the following:

    • Black or bloody stools
    • Chronic diarrhea
    • Abnormal CT scans or MRIs
    • Inflammatory bowel disease
    • Iron deficiency anemia
    • Unexplained weight loss

    Frequently, a colonoscopy doctor in Los Angeles will use the procedure to test for rectal or colon cancer. In some cases, they will perform a biopsy in order to confirm or deny a colorectal cancer diagnosis. Colonoscopies can also detect the presence of other potentially dangerous conditions of the large intestine, including:

    • Benign tumors
    • Ulcers
    • Polyps
    • Bleeding
    • Inflammation

    When to Get a Colonoscopy
    Anyone over the age of 50 should schedule a colonoscopy. If you have a family history of colorectal cancer, or if you’ve ever had adenomas, you might want to go in for an exam earlier. People with inflammatory bowel disease might also want to ask their doctor about a colonoscopy. Typically, patients schedule a test every 10 years if everything looks normal. If the results are abnormal, ask your doctor when and how often to schedule the next procedure.

    How to Prepare for a Colonoscopy
    In order for a colonoscopy to succeed, you must first do a little preparation. Colonoscopy prep requires a cleansing of the colon. The point is to remove anything that might block the doctor’s view of your intestine or that might confuse the results of the test (the presence of red liquid, for example, might be confused with blood).

    Usually, your doctor will ask you to follow a strict colonoscopy diet—no solid foods and only clear liquids for one to two days before the procedure. She may also ask you to avoid all food and drink starting at midnight on the night before the exam. In addition to the diet, you may have to take a laxative or perform an enema in order to clear the large intestine of any obstructions.

    What to Expect During a Colonoscopy
    Before the test, your medical team may give you a mild sedative and/or a painkiller. They will then ask you to put on a medical gown. You’ll lie on your side and pull your knees up to your stomach so they can begin the procedure.

    After inserting the tube, he will inflate the intestine with air so he can get a better picture of the inside. At this point, most people feel some degree of cramping in their abdomen. You may feel as if you need to make a bowel movement. Breathing deeply through your mouth can sometimes ease the discomfort by relaxing your muscles.

    Potential Colonoscopy Side Effects
    A colonoscopy is a relatively safe procedure, carrying few risks. That being said, potential side effects can occur. Depending on the type of procedure, risks could include:

    • Perforation of the intestine wall
    • Bleeding after a biopsy or tissue removal
    • Reactions to any sedatives administered before the test

    It’s best to discuss the risks with your doctor before scheduling a procedure.

Endocrine Surgery

  • Multiple Endocrine Neoplasia (MEN) Treatment & Diagnosis

    Multiple Endocrine Neoplasia (MEN) Treatment & Diagnosis

    If you suffer from multiple endocrine neoplasia (MEN), it’s important to find a medical professional with experience in treating endocrine conditions. The right endocrine specialist will work with you to determine treatment options to ensure your condition doesn’t impact your life any longer. For anyone looking for an endocrine specialist, the Surgery Group of Los Angeles offers treatment options for a variety of endocrine conditions, including M.E.N.

    Types of Multiple Endocrine Neoplasia
    MEN syndrome is a rare and inherited disorder that causes the endocrine glands to develop tumors. These pituitary tumors can be benign or cancerous. Other cases of the syndrome find no trace of tumors but, instead, the endocrine glands grow excessively. The condition has been diagnosed in infants as well as the elderly. The symptoms vary in the type of MEN, as well as which glands are impacted.

    MEN syndromes occur in three different types, including type 1, 2A, and 2B.

    Type 1
    Type 1 involves the development of tumors or excessive growth and activity of two or more endocrine glands. The patient may suffer from pituitary tumors, parathyroid tumors, pancreas tumors, and/or tumors on the adrenal gland.
    With type 1 MEN, most patients have tumors on their parathyroid glands and, most often, the tumors are benign. However, the tumors cause the glands to produce excessive amounts of parathyroid hormone. This can cause excessive levels of calcium in the blood, which can lead to kidney stones.
    The tumors can also cause other health issues, including peptic ulcers, hypoglycemia, menstrual abnormalities, and high levels of corticosteroid hormones.

    Type 2A
    Type 2A MEN is indicated by tumors or excessive growth of the thyroid, adrenal, and/or thyroid glands. Those with type 2A MEN are likely to develop medullary thyroid cancer. Patients may also suffer from cutaneous lichen amyloidosis and Hirschsprung’s disease. Those with tumors on the adrenal glands are also likely to have high blood pressure and increased calcium in the blood.

    Type 2B
    Type 2B MEN may consist of neuromas, medullary thyroid cancer, and/or Pheochromocytomas. Type 2B MEN is caused by a genetic mutation and typically develops at an early age. With this condition, thyroid tumors grow much faster and spread more rapidly. Patients are also likely to have glistening bumps in their mucous membranes—namely, the tongue, lips, lining of the mouth, and on the eyelids. The condition has been linked to digestive tract issues, as well as spinal abnormalities.

    There are several tests that can be used to diagnose MEN. Common options include genetic tests, hormone tests via urine and blood, as well as certain imaging tests. Each test is used to identify any genetic abnormalities, especially mutations in the RET that are known to cause MEN. If a member of your family suffers from MEN, be sure to get tested, as this condition is often hereditary.

    Treatment Options
    Since there is no known cure for MEN, treatment options include tumor removal and, sometimes, removal of the thyroid gland. Doctors often prescribe medications to correct hormonal imbalances caused by overactive endocrine glands.

    Dr. Nisim specializes in endocrine surgery. If you’ve been diagnosed with MEN, don’t hesitate to contact us to discuss treatment options. Call our office to discuss your surgical needs and comprehensive care.

  • Reviewing TSH Levels: What Is Normal?

    Reviewing TSH Levels: What Is Normal?

    There are all sorts of factors that are used as markers to indicate your thyroid health. One of these factors concerns the TSH levels in your blood. By looking at results from a simple blood test, a doctor can determine if you suffer from hypothyroidism or hyperthyroidism. In fact, using these levels is an ideal way to not only understand your thyroid health but to also determine the most ideal treatment option.

    What Is TSH?
    TSH, which stands for thyroid stimulating hormone, is a hormone that is produced by the pituitary gland. TSH stimulates the production of triiodothyronine (T3) and thyroxine (T4), which are produced by the thyroid gland.

    In the pituitary gland, another hormone, known as thyrotropin-releasing hormone (TRH), stimulates the release of TSH. As TSH goes into the thyroid, the levels are dictated by T3 and T4 levels in your blood.

    The Link Between T3, T4, and TSH
    If your body has low levels of T3 and T4, more TSH is produced in order to stimulate the thyroid. On the other hand, when T3 and T4 level are high, the body produces less TSH.

    While TSH levels are heavily dependent on T3 and T4 levels, there are other factors that have an influence, including:

    • Genetics
    • Iodine deficiency or excess
    • Pregnancy
    • Medications
    • Inflammation of the thyroid gland
    • Thyroid cancer

    Because TSH is symbiotic with thyroid hormones, TSH levels are often observed as a way to determine your thyroid health. Low TSH and T3/T4 levels often indicate hypothyroidism, while low TSH levels and high T3/T4 levels are signs of an overactive thyroid.

    Understanding TSH Levels
    In adults, the average TSH level ranges from 0.4 to 4.0 mIU/L. Ideal levels are below 2.5, and anything above 2.5 is considered at-risk. Levels above 4.0 mIU/L are a good indication of an underactive thyroid gland, also known as hypothyroidism. For levels below 0.4 mIU/L, chances are that the thyroid is overactive—also known as hyperthyroidism.

    Unless you’re already scheduled for a blood test, chances are you won’t know that your TSH levels are potentially imbalanced. This means that it’s crucial to understand the symptoms of hypothyroidism as well as hyperthyroidism.

    Common symptoms of hypothyroidism include weight gain, fatigue, weakness, dry skin, hair loss, and irritability. Hyperthyroidism causes symptoms, including appetite changes, fatigue, difficulty sleeping, and increased sweating.

    Treatment for TSH Level Imbalances
    Treatment for TSH level imbalances requires properly treating the underlying thyroid condition. If you experience any of the symptoms above, it’s important to seek medical attention to receive the treatment you need.

    For most patients, medication is useful in balancing thyroid hormone levels. For others, surgery may be required to remove a part of the gland.

    Professional Thyroid Treatment
    Do you suffer from the symptoms of hypothyroidism or hyperthyroidism? If so, make today the day you take charge of your health.

    Dr. Nisim is experienced in diagnosing and treating thyroid conditions. Call our office today to schedule an appointment and to get your thyroid health back to optimal levels.

    What Is a Thyroid Nodule? Causes, Symptoms, and Treatment Options Explained
    Thyroid nodules affect up to 50% of the population 1 and in some cases may require surgical removal. Let's take the mystery out of this common condition and explore the treatment options.

    Do you have a lump in your throat?
    A nodule is just that, a lump or growth on the thyroid gland. The thyroid gland is located in the throat and produces hormones that regulate metabolism. These lumps can occur in groups and may be solid or filled with fluid. 90% of thyroid nodules are non-cancerous, 2 and the remaining 10% are rarely life-threatening.

    Nodules are more common in women than men. Your risk of developing nodules increases with age, exposure to radiation, and may have a genetic component.
    The types of nodules include:

    • Adenomas . These are an overgrowth of normal thyroid tissues. They may be classified as warm (producing normal hormones), cold (producing no hormones), or hot (over-producing hormones).
    • Thyroid Cysts . When an adenoma begins to degenerate, it may turn into a fluid-filled cyst. These are typically benign but may contain solid tissues that should be checked for cancer risk.
    • Thyroiditis . This is a chronic inflammation of the thyroid gland which may be caused by bacteria or a condition known as Hashimoto's disease, which causes hypothyroidism.
    • Multinodular Goiter . A goiter is any enlargement of the thyroid, including those caused by multiple nodules. One cause is iodine deficiency, which is very rare in the US due to the availability of iodized salt.
    • Thyroid Cancer . Most nodules are not cancerous, but if they are hard, large, or cause pain they become one of the primary thyroid removal reasons. If there is concern that a nodule might be cancerous, a biopsy will be needed, and thyroid surgery may be the best option for treatment.

    What are the symptoms of thyroid nodules?
    Very small nodules may not be noticeable. Unless you notice the lump yourself, it will probably be found during a doctor's examination.

    Hormone-related symptoms : rapid irregular heartbeat, unexplained weight changes, nervousness, fatigue, depression, and constipation.
    Enlargement-related symptoms : visible enlargement, difficulty swallowing or breathing, hoarse voice, or pain at the base of the neck.

    When is thyroid surgery the best treatment?
    If you experience any of the above symptoms or if a biopsy indicates there is a risk of cancer, thyroid surgery may be the best option for a full recovery. 3 Your thyroid surgeon will fully explain the procedure which will involve removal of the nodules or, depending on your diagnosis, may include a partial or complete removal of the thyroid gland.

    How long does it take to recover from thyroid surgery?
    Utilizing minimally invasive surgery techniques, we use the best technology available to minimize pain and eliminate visible scarring. You may be able to go home the same day, and be back at work in a week, although you should avoid strenuous activity for two weeks.

    We believe everyone is entitled to the best possible care and a comfortable patient experience before, during, and after necessary surgery. Reach out to us today to schedule an examination and learn more about your options.

  • Minimally Invasive Parathyroidectomy Specialists

    Minimally Invasive Parathyroidectomy Specialists

    Being diagnosed with hyperparathyroidism or parathyroid cancer may result in a good deal of confusion and questions because you may not even be aware of the function of the parathyroid glands or the conditions that can affect them. Even within the medical community, hyperparathyroidism is frequently underdiagnosed, and it may not be treated effectively without the use of surgery to remove affected glands and tumors impairing their function.

    With our help at The Surgery Group of Los Angeles, you can gain a better understanding of hyperparathyroidism and your treatment options available through our skilled surgical team.

    What Are the Parathyroid Glands?
    There are four parathyroid glands located in the neck, just behind the thyroid. These glands and the thyroid are both essential parts of the endocrine system. While they share very similar names, they have completely separate functions in the body. The parathyroid glands are very small—typically about the size of an apple seed—and they are responsible for regulating the levels of calcium in the body.

    Because calcium plays so many roles in the human body, from the building blocks of the skeletal system to the contraction of muscles, to the communication of nerves, even a small imbalance of this mineral can cause widespread health issues. Most commonly, calcium imbalances related to parathyroid disorders are caused by an over-activity of these glands due to the growth of non-cancerous tumors, which is known as hyperparathyroidism.

    What Are the Signs and Symptoms of Parathyroid Issues?
    The symptoms of hyperparathyroidism can vary greatly, and many of them overlap with symptoms of other conditions—including common thyroid disorders. Therefore, it is important to take a broad look at a patient’s health with a complete blood panel to accurately diagnose hyperparathyroidism.

    Below, you can get a look at some of the most likely signs and symptoms of parathyroid malfunction, which may prompt you to seek specialized care and parathyroid treatment from The Surgery Group of Los Angeles.

    • High calcium levels
    • Low vitamin D
    • Kidney stones
    • Bone aches and pains
    • Mood and/or memory disturbances
    • Gastric reflux disease
    • Fatigue
    • High blood pressure

    Hyperthyroidism is a condition that causes an overactive thyroid gland. This means that the gland produces too much thyroxine. High levels of this hormone speed up the metabolism and can cause mood swings, irritability, nervousness, weakness, and heat sensitivity. Other symptoms include problems sleeping, thin skin, irregular heartbeat, sudden weight loss, and brittle hair.

    More often than not, these symptoms are only noticeable in older adults. In younger people, the symptoms are much more subtle.

    Parathyroid Hyperplasia
    Parathyroid hyperplasia is a parathyroid disease that can cause hyperparathyroidism. This condition leads to elevated parathyroid hormone levels, as well as blood calcium levels. Elevated calcium levels can cause several symptoms, including kidney stones, lethargy, constipation, and nausea.

    Parathyroid Cancer
    Parathyroid cancer is a rare form of the disease in which malignant cells form in the tissues of the parathyroid glands. Symptoms of parathyroid cancer include a lump in the neck, as well as feeling tired, weakness, nausea, loss of appetite, and extreme thirst. To diagnose this form of cancer, tests are conducted to examine the neck, as well as blood tests.

    Parathyroid Adenoma
    A parathyroid adenoma is a benign tumor that is located on one of the parathyroid glands. This tumor causes the gland to release more parathyroid hormone, which can lead to hyperparathyroidism. Treating parathyroid adenoma requires parathyroid surgery, also known as a parathyroidectomy, to remove the tumor.

    How Are Parathyroid Problems Treated?
    Because hyperparathyroidism is often a result of a benign tumor of the parathyroid glands, parathyroid surgery is often necessary to address the condition. Unlike an overactive thyroid that can be treated with medication and other conservative treatments, the parathyroid glands will not return to normal function until tumors have been removed.

    Fortunately, modern surgical techniques have facilitated procedures that leave minimal scarring, with reduced damage to healthy tissues for more successful surgical outcomes. Our parathyroid surgeon Dr. Cohen and his team specialize in minimally invasive parathyroid surgery. Unlike traditional parathyroid surgery, you don't need to worry about an unsightly scar across your neck.

    Minimally Invasive Parathyroidectomy - What Is MIP?
    For the last few years, MIP has become the preferred method of removing tumors on the parathyroid glands. The surgery has a high success rate and a much lower complication rate when compared to traditional parathyroid surgery.

    The surgery involves removing tumors from the impacted parathyroid gland. Patients who have parathyroid disease typically only have tumors on one of the glands. In the past, surgery involved opening the neck to expose all four of the glands, but, with MIP, a very small incision (less than an inch!) is used to remove the tumor. With minimally invasive surgery, there’s less risk of complication, a reduced recovery period, and a nearly invisible scar.

    How Long Does the Surgery Take?
    Because of the small size of the parathyroid glands, surgery can take up to four hours. After being put to sleep under general anesthesia, your surgeon will not only need to locate the impacted gland, the tumors will need to be carefully removed to ensure there is no disruption to the surrounding nerves and blood vessels. Though an intricate surgery, complication rates are very low.

    After surgery, you will be able to go home. Since anesthesia lasts hours after surgery, you won't be able to drive yourself, so be sure to have transportation available. Post-surgery, you can expect soreness and mild pain in the neck, as well as:

    • Swelling
    • Pain around the incision area
    • Tingling or numbness
    • These symptoms usually go away after a few weeks. Be sure to give yourself a week to heal before participating in physical activity.
    • Benefits & Advantages of Minimally Invasive Parathyroidectomy
    • No Hospital Stay

    For many, the idea of being away from home can be uncomfortable. While this surgery requires the use of general anesthesia, patients are usually able to go home after the procedure has been completed. This means no hospital stay, allowing you to recover in a familiar environment. Quick Recovery Timey

    Because minimally invasive parathyroid surgery doesn't require a large scar, the recovery time from the procedure is much quicker. This means lower levels of postoperative pain. In just a few weeks after surgery, you'll be back to your old routine. Minimal Scarring

    If you've looked at traditional parathyroid surgery, chances are you've seen the large scar that trails across the neck. For some patients, the scar can be a huge cosmetic issue that keeps them from undergoing surgery, but, with minimally invasive parathyroid surgery, the scar is small and nearly invisible! At just about an inch long, the scar is hardly noticeable and won’t leave you feeling insecure.

    Complications of Parathyroidectomy
    As with any surgical procedure, there are risks and complications to be aware of. A hematoma is a rare post-surgery risk which causes bleeding in the neck. Most hematomas occur within the first six hours of surgery but can form weeks later. To prevent a hematoma from forming, your doctor may recommend blood thinners before and after surgery.

    After surgery, hoarseness can occur as a result of a laryngeal nerve injury. These nerves can become irritated during removal of the parathyroid gland. Hoarseness is temporary and usually goes away within a few weeks. In serious cases, hoarseness can last up to six weeks.

    Low calcium levels can also persist after surgery because of the removal of too much parathyroid tissue or because the other parathyroid glands have become inactive. To treat low calcium, your doctor may recommend calcium supplements, as well as vitamin D. Supplementation is usually temporary and can end as soon as the parathyroid glands return to their normal function.

    What to Expect From Surgery
    The thought of being put to sleep and having an area on your neck operated on can induce all sorts of worries and fears. You can rest assured that you are in safe hands during the duration of the procedure. Our team will work to ensure we successfully complete the operation and that you are comfortable afterward.

    With parathyroid surgery, you will be unconscious after being administered general anesthesia. Because the glands are so small, this surgery can take up to four hours. Your surgeon will need to spend time locating the glands, and then carefully removing them to avoid disrupting nerves and blood vessels in the area. The complication rates for this type of surgery are extremely low.
    After surgery, you will more than likely be released to go home. You will want to ensure that a loved one can transport you to your house, as it’s unsafe to drive after surgery. There are a few side effects of surgery, including:

    • Soreness or mild pain in your neck
    • Pain in the incision area
    • Swollenness and/or bruises
    • Tingling, numbness, and tightness

    These symptoms are entirely normal and may last for weeks after surgery. You will want to take it easy the first week, post-surgery. Avoid strenuous activity, as well as excessive chewing and talking, as this can irritate your incision. It’s important to get clearance from your parathyroid surgeon before exercising or participating in other physical activity. Endocrine diseases are best treated by specialists. Dr. Nisim will work with you to determine the best treatment option for you. Whether it is surgery or medication, our goal is to treat your condition and get you back on the road to health and happiness.
    If you have questions about surgery or want to learn what other treatment options are available, you can count on us!

General Surgery

  • Bile Duct Obstruction & Biliary Surgery

    Bile Duct Obstruction & Biliary Surgery

    A bile duct obstruction refers to a blockage of the bile ducts, tubes that transport bile from the liver to the small intestine by way of the gallbladder and pancreas. Depending on the severity of the condition and the underlying cause, biliary surgery may be needed in order to clear the obstruction or even to remove the gallbladder. Options include both open surgery and minimally invasive (laparoscopic) surgery.

    Understanding Biliary Disease
    A biliary obstruction is a serious condition. If left untreated, it can be life-threatening. In order to understand why, you must first understand what a bile duct is and how it functions.

    Bile is essential to digestion. A green or yellow-brown fluid secreted by your liver, stored in your gallbladder, and released into your small intestine, its job is to digest and absorb fats, as well as to flush waste products from your system.

    Serious problems can occur when the liver is unable to produce bile, or when the tubes that transport it become blocked. Diseases of the bile duct include everything from cancer to PBC (Primary Biliary Cirrhosis), a possible autoimmune disorder that causes the gradual destruction of the liver and bile ducts.

    The Culprits Behind Bile Duct Problems
    A number of conditions can cause a bile duct blockage. They include:

    Gallbladder Stones – The most common culprits are gallstones, small pieces of cholesterol or bile that form in the gallbladder. Typically benign and asymptomatic, they can sometimes cause painful obstructions that require immediate removal.

    Bile Duct Stones – Most gallstones are small enough to pass through the bile ducts without causing problems. In some instances, they can get stuck, creating an obstruction within the bile duct itself.

    Bile Duct Cancer – A rare but serious condition, cancer of the bile duct can also lead to blockage. Cancer cells can appear anywhere within the biliary system, but often they form:

    • In the liver
    • In the bile duct near the liver
    • In the bile duct near the small intestine

    Why Biliary Surgery ?
    Surgery is the standard treatment for a blocked bile duct. Doctors typically advise patients with painful gallstones to seek immediate treatment. That’s because a blockage can cause a dangerous infection or a buildup of bilirubin that eventually leads to chronic liver disease. More often than not, surgeons will perform a cholecystectomy—a procedure which involves the removal of the gallbladder.

    Surgery may also be an option for patients who suffer from cancer, as long as they have a reasonable chance of recovering from the operation. Surgery may involve a widening of the duct or even removal of some or part of the surrounding organs.

    Understanding the Risks
    Most surgeries are relatively safe, particularly when performed using minimally invasive techniques. That being said, there are risks. They include:

    • Infection around or in an incision
    • General anesthesia risks
    • Internal bleeding
    • Injury to the bile duct, small intestine, or liver
    • Bile leakage

    Surgery to treat cancer can be more serious, depending on how far it has progressed and how much of the surrounding organs need to be removed.

    Learn More and Schedule an Appointment
    Dr. Nisim uses state-of-the-art surgical techniques to treat biliary disorders and provides expert, personalized care to each of our patients. Contact us to schedule an appointment. We’ll discuss your condition and do what we can to create a customized treatment plan that fits your needs and comfort level.

  • Hernia Surgery

    Hernia Surgery

    Hernia surgery has come a long way since the days of a one-size-fits-all procedure. While traditional methods are still valid, medical advances have expanded the options available to patients. New surgical technology means less invasive techniques, faster recovery times, and less chance of recurrence. At the Surgery Group of LA, we offer cutting-edge treatment for all types of hernia.

    Understanding Hernias
    Organs are held in place by muscles and other connective tissue. When an organ pushes through this protective barrier, it’s called a hernia. Often, this occurs when the supportive structure becomes weakened and can no longer do its job. The majority of hernias appear in the abdominal area, either the belly or the groin, although they occasionally crop up in other locations such as the upper thigh or diaphragm.

    How Serious Are Hernias?
    Most hernias are non emergent medical conditions. Although they never disappear on their own, they do not always cause serious problems. Minor, painless bulges may not need immediate treatment, so long as they do not worsen over time.

    That being said, some complications can be dangerous. When the intestines get trapped inside a hernia, it’s called strangulation, and it could lead to loss of blood supply to the area. To prevent the possibility of strangulation, doctors recommend hernia surgery for most patients. The question usually isn’t if a patient needs surgery, but when. Some can wait. Others can’t.

    Types of Hernia
    Hernias have different names, depending on where they appear and what causes them. Common types include:

    • Inguinal hernia: The most common type of hernia, it occurs in the groin area.
    • Umbilical hernia: When the intestines push through the belly button.
    • Femoral hernia: Often confused with an inguinal hernia, it affects the upper thigh, near the groin.
    • Epigastric hernia: Appears between the belly button and the sternum.
    • Incisional hernia: Occurs as a result of abdominal surgery.
    • Hiatal hernia: When the stomach pushes through the diaphragm.

    Symptoms of Hernias
    The primary symptom of a hernia is a soft bulge or protuberance somewhere around the abdomen. A bump in the groin or scrotum area, around the pubic bone, is a common sign of an inguinal hernia. The lump sometimes goes away when pushed or when the person lies down. If it doesn’t, the case may be more serious and may require immediate surgery.

    People may experience pain or discomfort in the affected area, particularly when lifting, bending, or coughing. Hernia pain is somewhat common but not universal; often a bulge appears without any unwanted sensations. Signs of strangulation include nausea, vomiting, and the sudden onset of pain. Anyone who feels these symptoms should call a doctor and discuss their options.

    Hernia Repair
    Surgery is the only option for removing a hernia. Fortunately, they are relatively easy to repair. In general, patients have two options:

    • Open tension surgery
    • Laparoscopic mesh surgery

    If a patient opts for traditional open surgery, a Los Angeles hernia surgeon will make a 3-6” incision in the abdomen and then sew the edges of the surrounding tissue together before closing the incision. Open surgery may be the only effective treatment for larger hernias.

    Laparoscopic inguinal hernia surgery, a newer method, is less invasive, requiring only tiny incisions and smaller instruments. Instead of sewing the tissue together, the inguinal hernia doctor will reinforce the weak tissue with a mesh insert.

    If you’re seeking laparoscopic hernia repair, call us to schedule a consultation. Dr. Nisim will listen to you and evaluate your condition. He will then make an individual recommendation based on your particular circumstances. Equipped with all the necessary information, you can make an informed decision and choose the proper procedure for your situation.

  • Gallbladder Surgery

    Gallbladder Surgery

    Gallbladder removal surgery, also known as a cholecystectomy, is a common procedure that involves the removal of the gallbladder, the pear-shaped organ that sits below the liver and aids in digestion.

    Most people undergo the procedure after developing gallstones—small and hard formations that can cause pain or infection.

    The surgery is relatively safe. These days, surgeons perform the operation using minimally invasive techniques whenever possible. That allows most patients to return home the same day.

    What Causes Gallbladder Problems?
    The gallbladder plays a role in digestion. It stores bile, which is created in the liver, and then releases it into the small intestine, where it helps the body break down food.

    Sometimes, hard formations called gallstones develop inside the gallbladder. Made of either cholesterol or bile, these small pieces can sometimes cause pain or infection.

    There are other forms of gallbladder disease, such as polyps or cancerous growths, but most gallbladder problems are caused by gallstones.

    Why Would Doctors Recommend Gallbladder Removal Surgery?
    A cholecystectomy is a common gallstones treatment method. A physician may recommend gallbladder removal if:

    • A patient experiences gallbladder pain due to gallstones
    • The gallbladder stones block the bile duct (a condition known as choledocholithiasis)
    • The gallbladder becomes inflamed or infected (a condition known as cholecystitis)
    • Gallstones cause the pancreas to become inflamed

    Are There Any Risks?
    Laparoscopic gallbladder surgery is a minimally invasive technique for removing the gallbladder. As such, it is a relatively low-risk procedure. Possible complications include:

    • General anesthesia risk
    • Infection to the incision area
    • Internal bleeding
    • Injury to the bile duct, small intestine, or liver
    • Blood clots

    In general, the risk of complications correlates with overall health. The healthier you are, the fewer risks you face.

    There is also a very small chance that the surgeon will have to transition from a laparoscopic, or minimally invasive surgery, to open surgery. If the surgeon notices unexpected inflammation, for example, he or she may need to make a larger incision.

    How Should I Prepare for the Procedure?
    If you’re scheduled for surgery, you should take a few steps to prepare.

    Fast for at least eight hours. You should avoid all food and drink in the hours leading up to the surgery, starting the night before.
    Ask your doctor about any medications. You may need to stop taking certain medications and continue taking others.
    Arrange transportation. Make sure you have a reliable way to get to and from the surgery. Be prepared in case a laparoscopic surgery turns into an open surgery and you have to stay an extra day in the hospital.

    What Should I Expect During and After the Operation?
    Before the procedure, you will be given general anesthesia. As soon as you’re unconscious and prepped for surgery, the surgeon will make a few small incisions in your abdomen.

    The surgeon will then insert a small tube fitted with a lighted camera. The camera will send real-time images to a monitor. The surgeon will use the screen as a guide while removing the gallbladder with surgical instruments.

    After removal, the surgical team may take special x-ray or ultrasound images in order to ensure that there are no problems with the bile duct or with loose gallstones

    If, at any time, the surgeon happens to notice scar tissue, or if bleeding occurs, then a larger incision (approximately six inches) may be required.

    What Next?
    After the procedure, you should feel relief from pain. Most likely, you’ll have no trouble digesting food. Since the gallbladder isn’t required for healthy digestion, most patients experience no ill effects.


  • Melanoma Treatment & Surgery

    Melanoma Treatment & Surgery

    Melanoma kills an estimated 9,940 people in the US annually.

    UVA and UVB Rays: Melanoma is caused mainly by intense, occasional UV exposure (frequently leading to sunburn). Blistering sunburns increase your risk of getting melanoma. Tanning beds/booths are especially known to increase your odds of being affected by this cancer as they expose your body to tremendous amounts of UV rays. Those who are genetically predisposed to the disease are also at a higher risk.

    Moles: Moles can be atypical and can be precursors to melanoma. Even regular moles, if present in large quantities can increase your risk for melanoma.

    Personal History: If you’ve already had melanoma or you have a history of carcinomas you run an increased chance of recurrence. Similarly, if a first degree relative is diagnosed with melanoma, you are in a melanoma-prone family and may want to examine your skin monthly to avoid having anything go unnoticed. Also, a compromised immune system for whatever reason is likely to increase your risk.

    Melanomas often resemble moles; some even develop from moles.

    Color: The majority of melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue or white.

    Shape: if you notice a mole that you think may be atypical, draw a line through this mole. if the two halves do not match, it is asymmetrical. If the mole is benign, the mole’s border will appear smooth. Melanoma will present itself with uneven borders and edges. Any changes in size, shape, color, elevation, or any new symptom such as bleeding, itching or crusting constitutes as a warning sign for melanoma and clinical examination is advised.

    Location: The melanoma can be found almost anywhere on the body, but is most likely to occur on the trunk in men, the legs in women, and the upper back in both.

    Acral-lentiginous melanoma while rare, can affect the spaces between your toes, the palms of your hand, the soles of your feet, your scalp or your genitals. can also develop melanoma.

    Mucosal melanoma develops in the mucous membrane that lines the nose, mouth, esophagus, anus, urinary tract and vagina. Mucosal melanomas are especially difficult to detect because they can easily be mistaken for other far more common conditions.

    Ocular melanoma affects the eye and can result in blurry vision. this type is most commonly diagnosed through an eye exam.

    These are sometimes referred to as hidden melanomas because they occur in places most people wouldn’t think to check. When melanoma occurs in people with darker skin, it’s more likely to occur in a hidden area.

    If melanoma is recognized and treated early, it is almost always curable, but if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. The first step in treatment is the removal of the melanoma. It is recommended that the procedure be done in a sterile environment. That being said, in some cases of thin melanoma, our surgeons can remove the suspicious mole with an in office excision under local anesthesia. If the melanoma is persistent and very aggressive our doctors may refer you to other forms of treatment such as chemotherapy, radiation, or immunotherapy.

Office Location

5925-A Truxtun Ave., Bakersfield, CA 93309
Phone: 661-865-5650
Fax: 661-865-5651

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Abraham Avi
Nisim, MD
General Surgeon

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