General Surgery
Women’s College Hospital provides General Surgery services for conditions such as gall bladder disease, hernias, and anorectal conditions.
While all of our surgeons perform surgical procedures at Women’s College Hospital, some of our surgeons also work in the Women’s College Hospital clinics, and other surgeons have their clinics at other hospitals.
Contact
Women’s College Hospital
76 Grenville Street
Floor 5
Phone: 416-323-6014
David Urbach MD, MSc, FRCSC, FACS
Professor of Surgery and Health Policy, Management & Evaluation
Director of Perioperative Services
General Surgery
David Urbach is Head of the Department of Surgery and Director of Perioperative Services at Women’s College Hospital, and Professor of Surgery and Health Policy, Management and Evaluation at The University of Toronto. His clinical practice focuses on minimally invasive surgery, particularly gastrointestinal, hernia, adrenal and obesity surgery. He is a Senior Fellow at the Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV), and Senior Scientist at the Institute for Clinical Evaluative Sciences (ICES). His research program focuses on surgery-related health services research, including measurement of the quality and outcomes of surgical care, and methods for the evaluation of surgery and other health technologies.
Office: Administrative – 416-323-7712 Clinical: 416-323-7309
Karen Devon MD, MSc, FRCSC, FACS
Assistant Professor and Medical Director of the Endocrine Surgery Program
Endocrine and General Surgery
Since joining Women’s College Hospital in 2012 Karen continues to be actively involved in various leadership roles including Undergraduate Medical Education Coordinator for Surgery at WCH, Co-Director of the MHSc Bioethics course, and the promotion of humanism and professionalism in surgery. She led the interdisciplinary team that received the 2016 WCH Excellence in Collaborative Innovation Award for the development of the Outpatient Thyroid Surgery Program at WCH. She leads the Department of Surgery Ethics Group, and facilitates the Postgraduate Medical Education (PGME) Surgeon in Society Program. Recognized internationally for excellence in patient care, innovation, research and education
Office: 416-323-6400 ext 7352
Dr. David Lim MDCM MEd PhD FRCSC
Clinical Associate Surgeon
Postdoctoral Fellow, Women’s College Research Institute
Breast Oncology Surgery and General Surgery
Dr. David Lim is a Breast Surgical Oncologist and General Surgeon and Women’s College Hospital’s Interim Division Head for the Henrietta Banting Breast Centre. He is currently a Postgraduate Fellow within the Canadian Institute of Health Research at the Women’s College Research Institute collaborating on breast cancer research.
- Dr. Jesse Pasternak
- Dr. Ted Ross
- Dr. Jaime Escallon
- Dr. Michael Reedijk
The Toronto Anorectal Program (TARP) is a collaborative benign anorectal surgery clinic that brings together the practice of four University of Toronto faculty colon and rectal surgeons. The Clinic operates as a centralized model, meaning that when a patient is referred to the clinic and appropriate for care, they will be seen for an initial consultation by the next available surgeon.
Following the consult, patients who are suitable for surgery will be scheduled with the next available surgeon to complete the procedure. This means that a patient may have a different surgeon for their consult and subsequent surgery.
The centralized model helps low complexity patients experiencing some anorectal conditions receive surgical care as fast as possible.
The clinic provides care for various benign perianal diseases, including hemorrhoids, anal fistulas, anal fissures and anal polyps.
The Toronto Anorectal Program (TARP) team consists of:
- Dr. Marisa Louridas
- Dr. Mantaj Brar
- Dr Anthony DeBuck
- Dr. Ted Ross
The hernia surgery program provides team-based care for people with hernias of the groin or abdominal wall. This is what you can expect from our program:
- You will be scheduled for the next available appointment at our clinic
- You will have an in-person assessment and examination by a surgeon who specializes in hernia care
- If appropriate, the surgeon will recommend that you have surgery to repair your hernia
- You will be scheduled for the next available appointment for surgery
- If you do have surgery, an expert hernia surgeon will perform your procedure
- The surgeon who performs your surgery may not be the same surgeon who did your initial assessment
- You will have a virtual (video) follow-up appointment after surgery unless an in-person examination is required
Toronto Anorectal Program (TARP)
Patient Referral Form (.pdf)
Please fax your referral to the Toronto Anorectal Program (TARP) at Women’s College Hospital at 416-323-6172
OCEAN Referral Link
Ocean eReferral Network: For more information about eReferral can be found here.
Hernia Program
Anorectal Clinic Information
Anorectal Clinic Patient Resources (.pdf)
Hernia Surgery – Repair of Inguinal (groin) Hernia Information
- A hernia is a gap or “weakness” in the muscles and tendons of the abdominal wall, that creates a bulge under the skin. Some hernias are present since birth, while others develop over time.
- Common areas where hernias occur are in the groin (“inguinal”), belly button (“umbilical”), and at the site of a previous operation (“incisional”).
- Hernias may cause pain or discomfort during heaving lifting, coughing, straining, or prolonged standing/sitting.
- A hernia that becomes “stuck” and cannot be pushed in is a potentially serious problem that could require urgent surgery.
- Severe, continuous pain, skin redness, and tenderness may develop when bowel has slipped through the hernia and becomes entrapped or strangulated.
Image description: 3 columns:
1. Types of Hernias: Abdominal wall hernias appear as bulges or lumps. Sometimes they appear only when there is a strain on the abdominal wall. The image shows an illustrated torso with various spots circled pointing out the different types of Hernias: Incisional hernia, umbilical hernia, indirect inguinal hernia, direct inguinal hernia, femoral hernia.
2. Abdominal wall anatomy – shows a cross section of the abdominal wall
3. Potential Risk of having a hernia:
Incarcerated hernia: Incarceration is when intestines slide into a hernia and cannot be pushed back into the abdomen. Incarcerated hernais may cause some pain and discomfort.
Strangulated hernia: When blood is unable to flow to intestines incarcerated in the hernia, strangulation occurs. Strangulated hernias are very painful and must be repaired surgically as soon as possible.
- A hernia does not get better over time and will not go away by itself.
- There are no exercises or physical therapy regimens that can make a hernia go away.
- An operation is the only way to repair a hernia.
- Once a hernia becomes uncomfortable, interferes with activities of daily living, or a surgeon determines that it is at risk of complications, a surgical repair is usually recommended.
- Open Inguinal Hernia Repair with surgical mesh is an effective and time-tested technique to fix a groin hernia from the outside using permanent mesh material. The incision is usually 8-10 cm long. This is considered the gold standard technique for hernia repair, and most groin hernias all over the world are repaired using this technique.
- Although a general anesthetic may be used, at Women’s College Hospital the repair is usually performed under local anesthetic with sedation, or spinal anesthetic.
- Open repair is the preferred approach for very large hernias or recurrent cases previously repaired laparoscopically. Patients with medical problems may also benefit from this approach by avoiding a general anesthetic.
- In general, you should feel better with each passing day.
- You will go home the day of your surgery. An adult is required to help take you home following surgery.
- An adult must stay with you at your home for the first night after surgery.
- Postoperative pain usually lasts a few days and may require the use of pain medications. Prescription opioid pain killers are usually not required, but if you do take prescription pain killers, it is important to use stool softeners or fiber supplements to avoid constipation or straining.
- Some nausea and vomiting may occur as a side effect of both the surgery and the medications used for anesthesia.
- Light activity such as walking is encouraged after surgery to prevent blood clot formation and pneumonia.
- It is common to experience bruising and swelling in the surgical site. The swelling usually feels like a firm mass under the skin incision. This is normal and disappears over the weeks/months after surgery.
- You will probably be able to return to normal activities within about 1-2 weeks, including driving, light lifting and working. However, heavy lifting should be avoided for at least 4 weeks.
- The plastic dressings over the surgical paper strips may be removed after 48 hours. You can shower starting the day after your operation. The paper strips will eventually fall off the skin within a week.
- Incisions will heal in 4-6 weeks, eventually softening and fading over the next year.
- A follow-up appointment should be made within 3-4 weeks following the operation or earlier if there are any concerns.
- Surgical mesh has been used in surgery for many decades and continues to be used safely in thousands of patients daily around the world.
- Surgical mesh is a lattice constructed of the same types of materials used in surgical sutures (e.g., polypropylene).
- In general, large hernias require surgical mesh to cover the defect. Without the use of surgical mesh, many large hernias would re-occur after surgery.
- While some patients have complications due to infection or exposure of surgical mesh, this is not common. If problems do occur because of surgical mesh, additional surgery may be required to remove the mesh.
- While there are risks associated with any kind of operation, most patients experience few or no complications and quickly return to normal activities.
- Difficulty urinating after surgery can occur and may require placement of a catheter to drain the bladder.
- Bruising and swelling (seroma) around the hernia site can occur and will gradually resolve on its own in the vast majority of patients. While there can be a large amount of swelling immediately after surgery, this disappears over time (weeks).
- Chronic (long-term) pain may rarely occur due to scarring or healing at the surgical site, or injury to nerves during the repair. This type of pain may gradually decrease with time as result of continued healing. The risk of developing chronic pain is about 5%.
- Impairment of sexual function occurs on approximately 5% of men following inguinal hernia repair.
- Any time a hernia is repaired, there is a chance it can come back. The risk of recurrence of a groin hernia at any time in the future is about 8%.
- The use of mesh helps to reduce the risk of recurrence.
- Obesity, diabetes, and cigarette smoking can increase the risk of recurrence.
- Surgical complications of hernia repair are infrequent (<1%), but include the following:
- Wound infection
- Bleeding
- Bladder or bowel injury
- Nerve injury
- Injury of the sperm tube (vas deferens) coming from the testicle
- When to contact your surgeon:
- Persistent high fever over 38⁰C
- Severe or worsening abdominal or groin pain
- Persistent nausea or vomiting (inability to tolerate oral intake)
- Increasing abdominal or groin swelling
- Swelling, redness, bleeding or foul-smelling drainage from incision
- Persistent cough or shortness of breath