Frequently Asked Questions
Have questions about the conditions Lincoln Surgical Associates treats? We may be able to answer it right here!
Gallbladder
The gallbladder really doesn't produce anything. It's simply a storage bag. Bile is made in the liver, transported to the gallbladder, and will sit there until you eat. When the gallbladder is stimulated to empty, it's like a little bag pump. Without the gallbladder, the same bile can be stored in the bile ducts that connect the liver and the biliary tree to the bowel.
Typical gallbladder disease presents as pain in the right side and the right upper abdomen. Usually, it's after eating a fatty or rich meal and can last for a couple of hours. Usually, a patient will come to me with that, and the diagnostic test is doing an ultrasound to identify gallstones. Sometimes we do an additional scan called the HIDA scan, which actually measures how well the gallbladder empties. If you have the classic symptoms of the pain and a positive imaging test, that's very indicative of the gallbladder causing problems.
How we take care of the gallbladder varies from patient to patient depending on why the gallbladder is a problem. In one patient, the gallbladder may need to be removed. Whereas if the patient has multiple medical problems, medical diseases that prevent them from being put to sleep or maybe on blood thinners, we do work closely with our radiology colleagues to do more non-surgical procedures to get them out of trouble immediately. Then, in a more elective setting, we discuss the pros and cons of keeping the gallbladder versus taking it out where we can control more variables than when a patient presents through the emergency room.
Treatment for gallbladder disease or gallstones would be what we call laparoscopic cholecystectomy. Those use small incisions in the abdomen to remove the gallbladder using a camera, and it is removed through the belly button.
Gallbladder surgery is very satisfying because the results are pretty immediate. It's a day surgery. Patients go home, and their symptoms are gone. A very small percentage of patients have loose stool issues from gallbladder surgery, but usually that's self-limiting as your body adjusts to not having a gallbladder. Rarely do you need to have some medicine to treat that effect.
Gastroparesis
Gastroparesis is where the stomach doesn't necessarily function as well as it should. It doesn't grind up food and push it through into the small bowel as quickly as it should. Patients a lot of times will complain of bloating, nausea, vomiting, and abdominal pain.
Depending on the type of gastroparesis you're dealing with (diabetic, idiopathic, narcotic) determines the way we treat it.
Diabetic gastroparesis
There are a couple of procedures that can be offered.
- Pyloroplasty - We cut the muscle between the stomach and the first part of the small bowel called the duodenum. That can either be done endoscopically (no incisions on the belly but a scope down the throat) where we cut that muscle. That's called a POEM or pylorum endoscopic pyloromyotomy. The other one can be done laparoscopically with tiny incisions through laparoscopic ports with long instruments and a long camera with a lighted tube on the end of it.
- Gastric stimulator - Sometimes we actually skip the pyloromyotomy in diabetic gastroparesis, and we put in what we call a gastric stimulator. That's this implantable device that helps to stimulate the stomach function and squeezing in order for it to help empty.
Idiopathic gastroparesis
With idiopathic, we usually start with a pyloromyotomy or pyloroplasty, just like we talked about for diabetic gastroparesis, using either an endoscopic or laparoscopic approach. We can move on to other techniques after that.
It really takes the right patient and expectations to know exactly where to head with gastroparesis.