Gallstones and Gallbladder Disease

Some people think of their gallbladder as being “expendable”. Not that anybody wants any of their organs to be removed, but since many people live a seemingly normal life after getting their gallbladder removed, many people don’t think their gallbladder plays an important role in their overall health. After all, how important can your gallbladder be if you can do just fine after it’s surgically removed? The gallbladder actually plays a very important role in your body. It is an essential part of the digestive system.

In the United States, about a million new cases of gallstone disease are diagnosed each year, and some 800,000 operations are performed to treat gallstones, making it the most common gastrointestinal disorder requiring hospitalization. Gallstones or gallbladder disease can quickly turn a great meal into a period of misery.

Gallstone disease is the most common disorder affecting the body’s biliary system, the network of organs and ducts that create, transport, store, and release bile. Bile is a thick fluid, made in the liver and stored in the gallbladder, which acts in the small intestine to digest fat. Bile contains cholesterol, water, proteins, bilirubin (a breakdown product from blood cells), bile salts (the chemicals necessary to digest fat), and small amounts of copper or other materials. If the chemical balance of bile contains too much of any of these components, particularly of cholesterol, crystals form and can harden into stones.

Bile is stored in the Gallbladder and is concentrated up to five times by the removal of water. Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. Bile contains water, cholesterol, bilirubin and other substances. Ideally these minerals remain in liquid form until they are passed out of the body. However, excessive amounts of these minerals in bile can cause them to crystallize.

These small crystals that form out of the saturated bile may begin to clump together. Any existing crystals makes it easier for other crystals to form. If they stay in the gallbladder too long, the crystals gradually grow larger until they become a gallstone so large that it cannot pass through the biliary ducts.

In terms of size, gallstones can be as small as a grain of sand or as large as a golf ball. A person can form one large stone in his or her gallbladder, or hundreds! About 10 percent of the population has gallstones, but the vast majority experiences no symptoms and need no treatment. However, in 1 percent to 2 percent of these people, gallstones can cause problems by lodging in bile ducts, stopping the flow of bile or digestive enzymes, and leading to severe abdominal pain, vomiting, inflammation, and even life-threatening infection.

Gallstone attack has some classic symptoms:

The most agonizing pain is experienced in the upper right part of the abdomen under the ribs. Usually it appears suddenly, sometimes an hour or two after eating a fatty meal. The pain may get worse quickly, and then last for several hours. Many times the pain may radiate to the back between the shoulder blades or under the right shoulder. Inhaling deeply, or moving, often makes the pain worse. The primary therapy for gallstones that are causing pain, inflammation, or infection is removal of the gallbladder.

A number of factors put people at higher risk of gallstones:

  • Gender: Women between the ages of 20 and 60 are 3 times more likely to develop gallstones than are men in the same age group. By age 60, 20 percent of American women have gallstones.
  • Age: The incidence of gallstone disease increases with age.
  • Genetics: Family history and ethnicity are critical risk factors in development of gallstones, though no gene responsible for gallstone formation has yet been discovered. African-Americans seem to have lower rates of gallstone disease than American Indians, whites, or Hispanics.
  • Obesity: Obesity is a significant risk factor, particularly for women. Obesity also slows down the emptying of the gallbladder.
  • Location of body fat: Belly fat, that spare tire around the middle, dramatically increases the chance of developing stones.
  • Diabetes: People with diabetes often have high levels of triglycerides in their blood, and these fatty acids tend to increase the risk of gallstones.

Even if you’re not at risk for gallstones, it is wise to maintain a healthy body weight, by among other things, sticking to a diet that is low in fat and cholesterol and high in fiber.

If you are in the Las Vegas area and suffering with gallstones or gallbladder disease, schedule a consultation with Dr. Shawn Tsuda.

Gallbladder Disease - Doctor with chalkboard on white background

Weight-loss Surgery Myths – Setting the Record Straight

If you are considering bariatric surgery, you’ve probably heard many of the popular myths. These run the gamut from horror stories to fairy tales. In reality, these procedures are neither as awful nor as fantastic as they’re made out to be. Here are some facts to help set the record straight about weight-loss surgery (WLS).

Myth: All bariatric surgery involves stomach stapling.

  • There are many different types of gastrointestinal procedures for weight loss, some of which reduce the functioning size of the stomach and others that bypass parts of the digestive tract, reducing absorption of calories and nutrients. Different types of surgeries offer different results, and some are more suitable for particular people than others.

Myth: People who get weight-loss surgery don’t have willpower.

  • Many bariatric surgery patients have struggled for years, pushing themselves to extremes to lose weight and keep it off. They understand that surgery is a final option when everything else has failed. The surgery, recovery and lifestyle changes that accompany WLS require both courage and determination on the part of the patient.

Myth:  Bariatric surgery is only for the morbidly obese.

  • Obesity is only one of the criteria that qualify patients for surgery. Overweight patients may also be candidates if they have one or more health problems that might be reduced or alleviated by weight loss such as diabetes, sleep apnea, hypertension, arthritis, and high cholesterol.

Myth: Bariatric surgery is extremely dangerous.

  • Any type of surgery has associated risks, such as complications or even death. However, a number of recent advances have helped to minimize risks. Surgeries are usually done laparoscopically with mini-incisions that result in faster healing, less pain, and less scarring.

Myth: You will finally be skinny after bariatric surgery.

  • Losing just 50% of excess weight and keeping it off is considered a success story. That’s still going to be overweight in the eyes of most people. Plus, your skin isn’t necessarily going to tone up and be free of drooping after weight loss. However, the health benefits in reducing weight-related problems like sleep apnea often occur even in patients who don’t lose all the weight they would like.

Myth: Weight loss from bariatric surgery is permanent.

  • Unfortunately, even this one is not true. In fact, some regain is likely. Part of this is simply the body adjusting and learning to store fat even on a very restricted diet. At other times, a patient’s failure to adhere to the post-surgery lifestyle recommendations plays a role.

Myth: You should only have WLS if you are done having kids.

  • It isn’t safe to get pregnant in the first year or two after bariatric surgery. You simply won’t be getting enough nutrients to support a growing fetus. After you are done losing weight (if you are taking all your supplements and monitoring your health carefully), getting pregnant should be okay. This is something to discuss with your bariatric surgeon.

Myth: After bariatric surgery, you won’t be able to eat anything that tastes good.

  • Patients who undergo gastric bypass may need to avoid very sweet foods because it can cause side effects like dizziness and nausea. Patients who have a duodenal switch typically need to keep fatty foods to a minimum. However, many patients can and do eat their favorite foods after they recover from surgery. They just eat very small portions.

Myth: You can never be far from a bathroom after WLS.

  • In the aftermath of surgery, you may find yourself having some “emergency” bathroom visits. However, symptoms like diarrhea and vomiting should subside over time as you get a better handle on how your altered digestive system responds to food.

Myth: Bariatric surgery is reversible.

  • Gastric banding is usually reversible. That’s because the stomach and intestines are not cut or stapled with this surgery. Gastric bypass may be reversible, but this is a very involved surgery. It’s more difficult to put everything back where it was, and there is a risk that the revision won’t restore normal function. Sleeve gastrectomy and duodenal switch entail actual removal of part of the stomach without reattaching it lower on the intestine. This type of surgery is not reversible.

Surgery for weight reduction is not a miracle procedure. Weight loss surgery is designed to assist the morbidly obese in developing a healthier lifestyle. A surgical weight loss operation is a useful tool for weight loss, but it is a surgical procedure that requires a substantial lifelong commitment. The surgery alone will not help someone lose weight and keep it off. The patient must change eating and exercise habits. Without changes to the daily pattern of eating and activity, the patient is likely to regain the weight over time.

 

Tips for Choosing the Right Surgeon for You

Whether you need a complicated, invasive surgery or a simple out-patient operation, choosing the right surgeon can seem overwhelming. Even what should be relatively straightforward procedures such as gallbladder removal or hernia repair can sometimes result in serious complications, so you always want to be in good surgical hands. Here are some tips on finding the surgeon and hospital that are best for your situation.

Once you have narrowed down your list of potential surgeons, schedule a consultation. If you have a fairly urgent need for surgery, you may have to cross surgeons off of your list purely because of the wait for a visit. Otherwise, plan to meet with at least two surgeons and discuss your potential surgery.

Things to ask:

  • Is surgery necessary? The best way to avoid surgical errors is to avoid surgery entirely, so ask about the effectiveness and safety of alternatives. Compare those with the risks of surgery and the chance that it will help you.
  • Is your board certification up-to-date? Look for a surgeon who has undergone the necessary training, even after being in clinical practice, to maintain board certification in his or her specialty.
  • What’s your experience? Ask how many operations the surgeon has performed in the past year and how that compares with his or her peers.
  • What are your success, failure, and complication rates? Not all will be able or willing to tell you, but the good ones should.
  • What’s the hospital’s infection rate?
  • Does the hospital follow best practices? The federal Centers for Medicare and Medicaid Services tracks how frequently hospitals give antibiotics on schedule, control blood sugar in heart-surgery patients, prepare skin properly before incisions and take other steps proven to help prevent surgical complications.Make the right choice.

You may be expected to schedule a surgery at the end of the consultation. If you are not confident that you have found your ideal surgeon, do not schedule the surgery. Either way, it’s fine to ask for a day to consider everything the doctor has said before making the surgery official.

If the surgeon you consulted with is not your ideal surgeon, schedule a consultation with a different surgeon. Even if you think the first surgeon is your best choice, a second opinion from another surgeon can be valuable. Most types of insurance will allow for two or three consultations. If you believe you have found your ideal surgeon you can schedule your surgery, confident in your decision.

If you’re looking for an experienced general surgeon in the Las Vegas area, Dr. Shawn Tsuda specializes in minimally invasive surgical techniques including the laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, sleeve gastrectomy, foregut surgery, ventral and inguinal hernia repairs, endoscopy, and basic laparoscopy. Schedule a consultation to learn what he can do for you.

 

 

Hernias and Surgery

Anyone who sews or does even simple crafts or carpentry knows that for a project to be well made, the seams have to be just right so that they don’t pull apart.

Our bodies are like that too. If our numerous “seams” aren’t made just right, they can pull AdobeStock_117491372 (3).jpgapart and let body parts slide into places they don’t belong. The abdomen is surrounded by muscles to keep the stomach, small intestine, and colon where they belong, but if one of these organs starts to slip though a weakness or a hole in the muscles, it’s called a hernia.

Other parts of the body can have organ herniation too. By definition, a hernia is a bulge or protrusion of an organ through a muscle or other structure that normally serves to keep it contained. However, when people talk about hernias, they are usually talking about the abdomen. While there are many types of abdominal hernias (hiatal, umbilical, or incisional), mentioning a hernia usually means they are talking about one in about the groin.

Risk factors for developing a hernia include:

  • family history
  • premature birth
  • chronic cough
  • constipation
  • lifting heavy weights
  • being overweight
  • smoking
  • Pregnancy

Surgery is often the only way to truly repair a hernia. Hernia repair can be done using traditional open surgery or minimally invasive surgery.

Open Surgery: With open surgery, a large incision is made in your abdomen that allows your surgeon’s hands to reach and touch your organs.

Minimally Invasive Surgery: Minimally invasive surgery is also known as laparoscopy. It is done through a few small incisions using long, thin surgical instruments and a tiny camera. The camera takes images inside your body and sends them to a video screen in the operating room to guide doctors during surgery.

da Vinci Surgery is another minimally invasive surgical option for adult patients facing abdominal hernia surgery. The da Vinci System features a magnified 3D HD vision system and special wristed instruments that bend and rotate far greater than the human hand. da Vinci technology enables your surgeon to operate with enhanced vision, precision, and control.

Early clinical data suggests: da Vinci Ventral Hernia Surgery offers the following potential benefits:

  • Low rate of pain
  • Low rate of the hernia returning
  • Low rate of surgeon switching to open surgery
  • Short hospital stay

Your doctor controls the da Vinci System, which translates his or her hand movements into smaller, precise movements of tiny instruments inside your body. Dr. Shawn Tsuda is one of a growing number of surgeons worldwide offering da Vinci ® Surgery. Schedule an appointment to discuss the best treatment for you.

GERD Suffering Can Be a Thing of Your Past with LINX

For gastroesophageal reflux disease or GERD sufferers, life is often dictated by just how bad their acid reflux and spasms are on any given day. Many live in fear of pain caused by esophageal spasms so severe they’re sometimes mistaken for a heart attack. Now there is hope for those who are afflicted with chronic GERD – a procedure called the LINX® reflux management system. It keeps stomach acids from traveling up the esophagus and causing GERD.

Generally referred to as reflux, GERD affects 20 percent of the population. It’s caused by a weak muscle in the esophagus that allows stomach acid to enter the esophagus and cause chronic inflammation. GERD sufferers typically have burning pain in their chests and throats, trouble swallowing, and the feeling of food sticking rather than being properly swallowed. The worst cases can put a patient at risk for esophageal cancer and chronic pulmonary disease.

Reflux can sometimes be managed by lifelong medications, but severe cases can require surgery. About 60 percent are well controlled on medication, but there’s a gap of patients who aren’t. Approved by the Federal Drug Administration in 2012, the LINX surgery is designed to target the gap population.anatomy-demon

LINX is a series of titanium beads with magnetic cores connected together as a small bracelet with titanium wires. A surgeon implants the bracelet laparoscopically around the esophagus to increase the tone of the valve that normally prevents stomach acid from traveling up the esophagus. The power of the magnetic beads keeps a weak or failed lower esophageal sphincter closed, and the normal pressure generated by swallowing expands the magnets of the device and allows the sphincter to open.

 

If you suffer from uncontrolled GERD, schedule an appointment with Dr. Shawn Tsuda. He can assess your situation and explain your treatment options.

The Laparoscopic Technique

The Laparoscopic Technique | Dr. Shawn TsudaMany surgeries are being done these days without having to use the traditional large incision that leaves large scars and long recovery times. Laparoscopic surgery is the umbrella term that is used for this type of surgery. Laparoscopic techniques have revolutionized the field of surgery with benefits that include decreased postoperative pain, earlier return to normal activities following surgery, fewer postoperative complications, and the added bonus of being virtually scarless. Laparoscopic surgery, sometimes called keyhole surgery or minimally invasive surgery (MIS), is a widely accepted surgical technique that uses small incisions and long pencil-like instruments to perform operations with a camera.

Today, almost all abdominal surgeries are performed laparoscopically including:

  • hernia repairs
  • gastric bypass
  • bowel resection
  • organ removal

Laparoscopic surgery has successfully replaced open surgery as the preferred treatment option for issues such as bariatric surgery and gallbladder removal. The treatment of gastroesophageal reflux disease (GERD) is now also carried out using laparoscopic techniques too.

Laparoscopic surgery is also known as MIS because the surgeon is able to use a laparoscope with a small camera on it to go directly where the surgery is needed. This allows surgeons to find out where or even if a larger incision is needed to perform an operation.

Laparoscopic surgery involves several small incisions, which is why it is sometimes called keyhole surgery. The Laparoscope goes into one small incision and special surgical instruments go into the others. The scope is attached to a video monitor, so the surgeon can see what is going on inside the body part that is being examined.

Because of the less invasive nature of the surgery, laparoscopic surgery recovery time is shorter than that of traditional surgery. Most laparoscopic surgery can be done on an outpatient basis, although depending on the specific surgery, an occasional hospital stay is necessary.

As with any surgery, it is normal to feel tired for a few weeks after a procedure. Your specific recovery time will depend on your physical condition when you went in for the surgery.

If you are considering surgery, contact Dr. Tsuda to see if a laparoscopic procedure is right for you.

Read more online at: http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/laparoscopic%20surgery/WHAT%20IS%20LAP%20SURGERY.html