Your visit and surgery: Q&A

Merrimack Thoracic & Esophageal Surgery is an independent practice caring for conditions of the lungs, esophagus, chest lining, mediastinum, diaphragm, and chest wall. These include lung nodules, lung cancer, reflux, hiatal hernias, swallowing disorders, and thoracic outlet syndrome. Our practice focuses on general thoracic and esophageal surgery, not heart surgery.

No. A referral is a request for a specialist evaluation, not a diagnosis or a decision to operate. Depending on the findings, the next step may be observation, additional testing, medical treatment, a procedure, or surgery. You should understand the reason for any recommendation and the alternatives before deciding.

Call (978) 775-1428. Have your insurance information and referring clinician’s details available. Referral and authorization requirements depend on your plan. We aim to arrange new-patient visits within approximately 3-5 business days when possible, with priority for urgent and cancer-related referrals. This is a scheduling goal, not a guaranteed appointment time.

Consultations are available at 19 Main Street, Salem, NH 03079, usually on Thursdays, and at Lowell General Cancer Center, 295 Varnum Avenue, Lowell, MA 01854, second floor, on Tuesdays. Confirm your location and time when scheduling. Your consultation location may be different from the hospital where a procedure is performed.

Bring your photo identification, insurance cards, medication and allergy lists, relevant medical records, and questions you want answered. Helpful records may include CT or PET scans and reports, breathing tests, endoscopy reports, biopsy results, and records of previous operations. Ask the office what is needed for your particular consultation.

Whenever possible, arrange access to the actual images as well as the written reports. Older scans may help show whether a finding has changed. Tell the office where imaging was performed so staff can explain the transfer process. Do not assume that hospitals in different systems automatically share all images.

Dr. Mane will review your symptoms, medical history, available tests, and treatment goals, and examine you as appropriate. The discussion may include whether more testing is needed, treatment options, and expected benefits and risks. A final recommendation may require records or results that are not yet available.

A support person can help you remember the discussion and organize questions. Tell the office when scheduling if you need an interpreter, mobility assistance, or other accommodations, and ask about the visit location’s current visitor arrangements. The Salem office has ramp and elevator access.

Yes. We offer second-opinion consultations and a separate written second-opinion and care-navigation program. Ask the office which service fits your needs and confirm its scope and payment arrangements before booking. Having your imaging, pathology, and previous treatment records available makes the review more useful.

Call (978) 775-1428 for scheduling changes and clinical questions. For records containing private health information, ask the office for an approved secure transfer method; the referral fax is (978) 346-3000. Do not send medical records, diagnoses, or test results through the general website form. Review the cancellation policy under Plan Your Visit.

The hospital is selected according to the operation, your medical needs, available resources, and insurance arrangements. Surgery is coordinated at Lowell General Hospital and hospitals within Merrimack Health. Our practice also offers benign esophageal surgery locally to patients in Southern New Hampshire through the facilities at Parkland Hospital in Derry. The office will confirm the hospital for your case.

Robotic surgery and video-assisted thoracoscopic surgery (VATS) use a camera and instruments through small incisions. With robotic surgery, the surgeon controls the robotic instruments; the robot does not independently perform the operation. Open surgery uses a larger incision. The appropriate approach depends on the condition, anatomy, and safety-not simply the availability of a robot.

Yes. A larger incision may be needed because of bleeding, scar tissue, anatomy, or other findings. Changing the approach can be the safest way to complete the operation. This possibility should be part of the consent discussion before surgery.

Tests depend on the planned operation and your health. Before lung surgery, these may include breathing tests, imaging, blood tests, and selected heart testing. Testing helps assess whether surgery is appropriate and how to reduce risk. Not every patient needs every test.

Do not stop or change medicines on your own. Your surgical, anesthesia, and prescribing teams will give specific instructions, especially for blood thinners, diabetes medicines, steroids, and supplements. Bring a complete list, including doses. Ask when any paused medicine should be restarted.

If you take a GLP-1 or GLP-1/GIP medication, such as Ozempic, Wegovy, Mounjaro, Zepbound, Trulicity, or a similar medication, please inform your surgical team. Our practice follows the perioperative medication policies of the individual hospital where your procedure will be performed. The anesthesia service at that hospital determines whether and when a GLP-1 medication should be held before anesthesia. Because requirements may differ between hospitals, follow the specific instructions provided by the hospital and anesthesia team for your procedure. Do not stop, continue, or change the timing of these medications based solely on general information on this website. If you have not received instructions or are uncertain which instructions apply to you, please contact our office before your procedure.

Follow the fasting instructions supplied for your specific procedure by the hospital and anesthesia team. Rules may differ for solid food, clear liquids, and medicines. Esophageal conditions can also affect preparation. Contact the team before the procedure if the instructions are unclear or you accidentally eat or drink outside the allowed times.

Stop smoking as early as possible and ask for help quitting. Discuss alcohol use openly, especially regular heavy use. Stay active within your abilities, follow nutrition advice, and arrange transportation and help at home. Report a new illness or worsening symptoms before surgery. Your team may recommend additional preparation based on your health.

Risks vary by operation and may include bleeding, infection, blood clots, pneumonia, heart-rhythm problems, injury to nearby structures, and anesthesia complications. Lung surgery can cause a persistent air leak; esophageal surgery has different risks, including leakage or swallowing problems. Serious complications, including death, are possible. Ask about your individual risks, expected benefits, and alternatives.

No. A lung nodule is a finding on a scan, not a diagnosis of cancer. Some nodules can be monitored; others need further imaging or a biopsy. Decisions depend on features such as size, appearance, change over time, and your medical history. Follow-up remains important even when surgery is not recommended.

Bronchoscopy uses a thin camera to examine the airways. Endobronchial ultrasound (EBUS) adds ultrasound to help evaluate nearby structures and guide needle sampling, often of chest lymph nodes. These tests may help diagnose or stage a condition without a chest incision. They can require sedation or anesthesia and are different from surgery to remove a lung tumor.

A wedge resection removes a small piece of lung containing the abnormality. A segmentectomy removes an anatomical segment of a lobe. A lobectomy removes one entire lobe-not the whole lung. A pneumonectomy removes an entire lung and is needed less often. The choice depends on the diagnosis, location, cancer stage when relevant, and lung function. Smaller is not always better.

Breathing tests and, when needed, other assessments help estimate how much lung function would remain. Recovery depends on your starting lung health, the amount removed, and other medical conditions. Some patients need temporary oxygen; others may need it longer. Your likely breathing function and oxygen needs should be discussed before surgery.

Possibly. Surgery is one part of treatment for some lung cancers. Imaging, lymph-node findings, the final pathology report, and tumor testing may affect whether treatment is recommended before or after an operation. Some patients are better treated without surgery. Your surgical and oncology teams will discuss the options that fit your cancer and overall health.

No. Many people can be treated without an operation. Surgery may be considered for appropriately evaluated reflux, troublesome regurgitation, symptomatic hernias, or complications. The decision depends on symptoms, anatomy, test results, previous treatment, and operative risk. A hernia’s size alone does not determine the best treatment.

A hiatal hernia occurs when part of the stomach moves through the diaphragm into the chest. Repair generally returns the stomach to the abdomen and narrows the enlarged opening. An antireflux procedure may be added. The repair can often be minimally invasive, but the approach is individualized.

A fundoplication uses the upper part of the stomach to reinforce the valve area between the esophagus and stomach, helping reduce reflux. The wrap may be partial or complete. The choice balances reflux control and possible swallowing or gas-related side effects. This is not an operation to remove the esophagus.

These tests answer different questions. Endoscopy examines the lining of the esophagus and stomach. A barium swallow shows anatomy and movement during swallowing. Manometry measures esophageal muscle function. Reflux monitoring measures reflux exposure. Together, selected tests help determine whether an operation is likely to address the cause of your symptoms.

Usually, for a period of time. Your instructions may begin with liquids and then progress to softer foods. Smaller meals, careful chewing, and avoiding foods or drinks that worsen bloating may be recommended. Follow your operation-specific diet rather than advancing on your own. Report persistent vomiting or an inability to keep liquids down promptly.

Yes. Temporary swallowing difficulty and bloating can occur, and some patients have persistent symptoms, need medication again, or develop a recurrent hernia. Surgery does not guarantee permanent freedom from reflux medicines. New or persistent symptoms need assessment; they do not automatically mean another operation is necessary.

Achalasia affects how the esophagus moves food and how its lower valve relaxes. A Heller myotomy divides selected muscle fibers to make it easier for food to enter the stomach, often with a partial antireflux procedure. Other options include endoscopic myotomy (POEM) or balloon dilation. Treatment depends on the type of achalasia and your health.

An esophagectomy removes part or most of the esophagus. The digestive tract is reconstructed, usually using the stomach. It may be recommended for selected esophageal cancers or other serious conditions. It is a major operation with a different recovery from reflux or hiatal hernia surgery, and is not required for every esophageal cancer.

Eating is usually restarted in stages under the surgical team’s direction. Smaller, more frequent meals and changes to eating and sleeping habits are often needed. Some patients need temporary tube feeding. Your team will monitor swallowing, weight, hydration, and nutrition, and explain which symptoms should prompt a call.

A pleural effusion is fluid between the lung and chest wall. Treatment depends on the cause, symptoms, and whether the fluid returns. Options may include drainage, a longer-term drainage catheter, or pleurodesis, which helps the chest linings adhere to reduce recurrent fluid accumulation. Fluid around the lung does not automatically mean cancer.

A pneumothorax occurs when air collects around the lung. Some cases can be managed without surgery. An operation may be considered for a persistent air leak, recurrence, or other important risks. Surgery may address the leaking area and include a procedure to reduce recurrence. Sudden severe breathlessness or chest pain requires emergency assessment.

Decortication removes a thickened layer of tissue that can prevent a lung from expanding, sometimes following infection or longstanding inflammation. It is different from removing a lung. Whether drainage, medicines, or surgery is appropriate depends on the cause and the condition of the lung and surrounding space.

The mediastinum is the space between the lungs. A mass in this area may require observation, a biopsy, or removal, depending on its features. A thymectomy removes the thymus gland and may be considered for a thymic tumor or selected patients with myasthenia gravis. Not every mass needs the same operation.

First-rib resection may be part of treatment for selected patients with thoracic outlet syndrome, where nerves or blood vessels are compressed near the collarbone and first rib. Surgery aims to relieve that compression. The diagnosis, type of compression, and response to other treatment determine whether an operation is appropriate.

Diaphragm plication tightens and stabilizes a weakened or paralyzed side of the diaphragm to help improve breathing mechanics in selected patients. It does not directly repair the damaged nerve. Evaluation is needed to determine whether the diaphragm problem is responsible for symptoms and whether surgery is likely to help.

There is no single recovery timeline for thoracic surgery. Some diagnostic procedures are outpatient; lung and other chest operations may require several days in hospital, and major esophageal operations often need longer. Returning home is not the same as full recovery. Ask for an estimate specific to your procedure, health, and work demands.

Some discomfort is expected, including after small-incision surgery. Treatment may combine medicines and local or regional anesthesia. Numbness, tingling, or sensitivity around chest incisions can occur. The aim is pain control that allows breathing, coughing, sleep, and movement. Report pain that is worsening or not controlled by your prescribed plan.

Many chest operations require a temporary tube to drain air and fluid. Removal depends on lung expansion, air leakage, and drainage-not a fixed day. Some patients go home with a tube and a specific care plan. Do not clamp, disconnect, or otherwise adjust a chest tube unless your care team has instructed you to do so.

Walking and prescribed breathing exercises generally begin early, with help when needed. Increase activity gradually and balance it with rest. Stairs may be possible when you can manage them safely. Heavy lifting and strenuous exercise restrictions depend on the operation. Follow the limits in your discharge instructions, even when the incisions look healed.

Do not drive while taking medicines that make you sleepy or before you can safely steer and brake. Work timing depends on stamina and job demands; physical jobs may need longer restrictions. Air travel after chest surgery requires clearance from your surgical team. Do not use a generic online timeline as permission to resume these activities.

Biopsy and surgical pathology reports may take several days, and specialized testing can take longer. Follow-up timing depends on your operation and discharge plan. Ask who will communicate the results and contact the office if the expected update or appointment is missing. Do not wait for a scheduled visit to report a new problem.

Call 911 for severe or sudden difficulty breathing, severe chest pain, fainting, stroke-like symptoms, or uncontrolled bleeding. For fever, worsening pain, increasing wound redness or drainage, persistent vomiting, inability to keep liquids down, new leg swelling, or a chest-tube problem, contact your surgical team promptly. Seek urgent in-person care if symptoms are worsening and you cannot reach the team. Do not use this website for urgent concerns.

Coverage depends on your exact plan, the service, and where care is provided. Confirm network status and referral or authorization requirements with the office and your insurer before scheduled care. Deductibles, copays, and coinsurance may apply. Do not assume every hospital or clinician involved has the same network status.

Contact your insurer for the stated reason and notify the office. Ask whether the issue involves authorization, missing information, coding, network status, or a coverage decision, and what correction or review process applies. Keep the denial notice. A denial is not, by itself, an explanation of what treatment is medically appropriate or what you ultimately owe.

An episode of care may involve separate providers or facilities and separate charges. Compare each bill with the corresponding insurance explanation of benefits, which is not itself a bill. Call the practice billing office at (978) 762-3754 for practice billing questions. Contact the organization named on a hospital or other provider’s bill about its charges.