Frequently Asked Questions, General Surgery

Q I have a small hernia in my groin and it is not bothering me. Does it really need to be repaired?

A If an adult has a groin hernia that is not causing symptoms, and is not getting larger, usually it can be safely observed. It is advisable to have the hernia checked by a general surgeon to make sure that there is no intestinal entrapment. If the intestine is stuck in the hernia your surgeon will probably recommend a repair. Children with inguinal hernias should have a surgical repair.

Q During my last pregnancy my doctor told me that she discovered stones in my gall bladder. This was determined when they did an ultrasound of my baby. Is it advisable for me to have my gall bladder removed?

A The majority of gall bladders that have stones don't have to be removed. Typically, stones within the gall bladder don't cause problems and the person will never have to have a gall bladder operation. However, some people are plagued with symptoms that suggest a symptomatic or diseased gall bladder with stones and these people are referred to a general surgeon for evaluation and possible removal of the gall bladder.

Q I have heard that almost any general surgery operation can be done laproscopically resulting in less pain, shorter hospital stay, and better outcome. Is this correct?

A Your presumption is partially true. What can be done and what should be done can be quite different. There are unique, serious risks of laproscopic surgery. The General Surgeons in Fairbanks are highly credentialed, well trained, and are all members of the American College of Surgeons. There are alternatives, risks, and benefits to any given surgery treatment. If you are contemplating general surgery a frank discussion between your surgeon will help determine what approach is best for you.

Q The last time I was in the lower 48, I responded to an advertisement that was offering a total body CAT Scan to determine if I had any hidden cancers or problems. The business told me I would have to pay cash. I have great medical insurance but they refused to pay for the study. Wouldn't doctors be saving more lives if they discovered cancers at an early stage?

A The focus in modern medicine is prevention and early detection of disease. There are tried and true strategies for early detection of cancer that include: patient education & self exam, taking a good medical history and account of symptoms, physical examination, mammography, colonoscopy, chest X-ray, blood studies, etc. Presently, the evidence suggests that total body screening CAT scans are not only expensive and dangerous, but they can prompt further dangerous, invasive studies. Screening studies should be ordered by your primary care provider.

Q My cancer specialist is recommending IV chemotherapy but tells me that the veins in my arms won’t be able to handle it. A special temporary surgically implanted IV is being recommended. What are the options?

A The goal is for the chemotherapy to be delivered to a higher flow vessel so that the medicine is quickly diluted so that the vessel does not get irritated. The following are three of the more common approaches: 1. Infusa port: A small, soft tube placed into a high flow vessel runs to a small reservoir, about the size of a bottle cap. This is implanted under the skin just below the collar bone. It is accessed using a special needle. 2. Hickman Catheter: Similar to the infusa port but there is no reservoir and the tubing comes out of the skin and is anchored to the chest. 3. PICC line: The soft tubing passes from a high flow vein out a smaller vessel on the arm where it is anchored. Your cancer specialist will recommend the specific type that is best for you.

Q What is the most important thing that I can do to avoid having to see a general surgeon.

A Don’t use tobacco products. Don’t abuse drugs or alcohol. Wear protective helmets. Wear seatbelts. Avoid junk food. Eat plenty of fiber. Get plenty of exercise. Seek preventive care from your primary care provider.

Q My friend was just diagnosed with advanced colon cancer and she is an athletic, healthy individual. I can’t help but wonder if there is a lingering cancer in my colon.

A Certainly report any change in your bowels, abdominal pain, or blood in your stools. If you are 50 years or older you should get a colonoscopy or equivalent study. Discuss your concerns with your personal provider who can perform or arrange for the appropriate studies.

Q Over the past 10 years I have gained 20 pounds and I notice an enlarging ridge running from my umbilicus, up the middle, all the way to my chest. After doing some checking I am concerned that I might have a hernia.

A It sounds like you have a diastatis of the rectus muscles or a ventral hernia. A diastatis is when the muscles pull away from the midline of the abdomen but the connecting tissue is still intact. Technically, this is not a hernia because the intestines haven’t broken through the abdominal wall. The remedy is to lose weight and an operation is probably not warranted. A ventral hernia is when the middle portion of the abdominal wall connecting tissue has torn and intestines are able to move outside of the abdominal wall. There can be problems from ventral hernias such as intestinal entrapment. Your primary physician or general surgeon can best advise you on your condition and what to do.

Q After my operation should I avoid taking the pain pills unless I just can’t endure the pain?

A No. You should try to keep your pain under control from the start. In the long run you will require less narcotic than if you are playing catch up with severe pain. Keep in mind that narcotics cause constipation so you should consider taking a stool softener such as Colace 100 mg 3 times a day. Narcotics can also cause nausea if taken on an empty stomach. In addition to narcotics, I often prescribe an NSAID (ibuprofen or ketorolac) which should not be taken on an empty stomach either.

Q What is the big deal with colonoscopy?

A Colon cancer is potentially lethal and starts as a polyp. If the polyp is removed before it turns into a cancer, then cancer is prevented. Colonoscopy utilizes fiber optics to allow a doctor to visualize the inside of the colon and remove polyps. Everybody should get a screening colonoscopy at the age of 50 or at a younger age if there is suspicion. Fairbanks is fortunate to have a good number of doctors who do an excellent job at colonoscopy. This serious topic should be discussed with your primary care doctor.

Q Why can’t I have my appendicitis treated with powerful antibiotics instead of surgery?

A In short, treatment with antibiotics alone usually won’t work. In the likely event that the appendix goes on to rupture, death will result without aggressive surgical intervention.

Q Now that I am getting older should I take it easy in order to prevent getting a hernia like my father?

A Usually, a person first notices a hernia of the abdominal wall during heavy lifting or exertion. However, these events are not the cause of the abdominal wall defect. If exertion were the cause of hernias then construction workers should have more hernias than office workers which they do not. We know that there are congenital defects of the abdominal wall that enlarge with time. Also, with age the connecting tissues weaken and breakdown. There is a causal relationship between smoking cigarettes and hernias. The best prevention is to maintain healthy body tissue by eating healthy and staying in shape.

Q My husband recently had a colonoscopy and a cancer was discovered. He said that he would rather die than have a colostomy bag. I really want him to get treatment and am wondering if the colostomy bag is absolutely necessary.

A For the most part the answer is "No." Colostomies are usually not necessary for the treatment of colon cancer. Usually the segment of colon with the cancer can be removed and the ends hooked together. There are some occasions where a temporary colostomy is necessary and even more rare occasions where permanent colostomy is necessary. Most likely, your husbands surgeon will be able to tell you and your husband the odds of his needing a colostomy bag.

Q My cousin was peppered with buckshot in a hunting accident. Fortunately, they say that he has no major internal injuries but now has many lead pellets remaining in his body. I am really concerned about lead poisoning and it seems that all of the pellets should be removed.

A It does sound like your cousin is fortunate. It turns out that people tend not to get lead poisoning from lead bullets and buckshot. The risk and potential complications of removing the buckshot are greater than the risk of leaving the pellets in place. Finding pellets in tissue is a lot like finding needles in a haystack, even with the use of X-ray. There is serious risk of damaging surrounding structure (nerve, vein, artery, tendon, etc) if removal is attempted.

Q I have been having pain in my stomach , especially when I eat greasy foods. Studies have revealed that I have stones in my gall bladder. My doctor wants to refer me to a surgeon to have my gall bladder removed. My husband had kidney stones that were removed without surgery with some type of shattering device. I would like to have my gall bladder stones shattered. Why is this option being offered to me?

A The removal of kidney stones is greatly facilitated by shattering with extra-corporeal shockwave lithotripsy. Unfortunately, this approach just doesn't work with gall bladder stones. If your symptoms are bad and your symptoms are truly the result of gall bladder stones, then you should strongly consider having your gall bladder removed using a minimally invasive laproscopic approach.

Q It has become apparent that I need to have my gall bladder removed. Should they just go ahead and remove my appendix while they are in there to prevent me from getting appendicitis in the future?

A "If it ain't broke, don't fix it" is the current thinking. If the risks vs benefits of leaving the asymptomatic appendix alone are weighed against the risks vs benefits of removing an asymptomatic appendix a person is better off with the appendix being left alone.

Q I have a groin hernia that is bothering me. My surgeon recommends that I have it repaired with mesh. I am concerned about having a piece of foreign material planted into my body. Are there risks of rejection or having a bad reaction to the mesh?

A There is no perfect or risk free operation. The likely hood of complications from implanted mesh is very low. If mesh is used the recurrence rate is less that one in twenty. If mesh is not used the recurrence rate is greater. When evaluating the risks versus benefits of using mesh, mesh usually wins out. You and your surgeon should discuss the risks and benefits of mesh in detail before your operation. I have never seen mesh "rejected" but on very rare occasion (every several years) I have seen mesh get infected. Sometimes infected mesh will heal on it's own and sometimes it must be removed.

Q I heard about a child what was in an automobile accident he ended up a paraplegic and got a colostomy as a result of wearing a seat belt. Isn't this an example of where a person would have been far better off not wearing a seatbelt?

A It sounds to me like the child in question was not properly fitted into the seat belt. Most likely, the lap component of the belt was riding too high and was up on his abdomen. When his body accelerated forward during the crash it was stopped by the lap belt. Because the belt was too high the lower back hinged in the wrong place and injured the spinal cord. If the belt is low on the lap and snug, it is more likely that hinging will place at the waist which can flex without damaging the spine. It is critical that children are properly fitted in appropriate seat restraint devices. This type of unfortunate injury can also occur in adults. Again, the lap belt should be low and snug.

Q Our doctor tells me that our new born baby has a hernia and that it will probably go away with time. I had a hernia a few years ago and it continued to enlarge until I had it repaired. Is there anything that I should worry about?

A Your child probably has an umbilical hernia or bulge under the navel region. The majority of umbilical hernias found in children will heal without surgery or treatment. Should the bulge become hard and not reduce back into the abdominal cavity or should your baby become unusually fussy, there could be problems and you should seek immediate medical attention. It is of note that with teenagers and adults umbilical hernias will not heal without surgery. Inguinal hernias are quite separate from umbilical hernias and inguinal hernias will not heal without an operation.

Q My father died from colon cancer when he was in his sixties. How does that affect my chances of getting it too?

A Having a family history is a major risk factor for developing Colon or any other type of cancer, but even without any family history it is the 2nd most common cancer in the US.

As a rule every individual should have a screening colonoscopy at the age of 50 or earlier if you have a positive family history. Changes in bowel movement change in consistency, darkening or blood in stools, weight loss or decreasing stamina are some of the symptoms of colon cancers and should they develop immediate medical advice from your primary care doctor should be sought, regardless of family history.

Q I recently discovered that I have gallbladder disease and that I need surgery. I have never had surgery and don’t know what to expect?

A Most gallbladder surgeries done nowadays are done laproscopically where under direct visualization with a camera and special instruments the gallbladder is removed, unless there is a strong indication otherwise. It is a minimally invasive procedure where the entire procedure is done through very tiny incisions after the patient is asleep. Patients are usually well enough to go home the next day with minimal pain or discomfort. If you have symptomatic gallbladder disease you should talk to your surgeon and he would help you get a better understanding of the alternatives, risks and benefits of this type of surgery.

Q I have always had a bulge in my abdomen near my belly button which I was able to push back. Lately I have been having trouble pushing it back in, I don’t think it is a big deal but my wife thinks I should see a doctor. What should I do?

A From what you are describing it sounds like you have what is called an umbilical hernia. If it is no longer reducible than it may have fat, peritoneum or even bowel stuck inside it. It is a potentially serious condition if bowel gets trapped in the opening of the hernia. It can lead to bowel necrosis which is a surgical emergency.

I agree with your wife and I think you need to see your doctor immediately.

Q Lately I have been having pain in my stomach after eating certain foods. I think it is just reflux but my friend had similar symptoms and it turned out she had gallbladder disease. How can I be sure of what it is?

A Gallbladder disease presents as right upper or mid abdomen pain, which is crampy in character and associated with fatty food intolerance, nausea, bloating or indigestion. But having these symptoms are not exclusively diagnostic of gallbladder disease. If you have noticed pain in your abdomen regardless of its origin you should see your doctor. With the help of appropriate questions and workup he/she would be able to pinpoint the source and hopefully be able to help you.

Q I have always been slightly overweight but for the past six months I have lost about 15 pounds without even trying? I am very happy about the weight loss but I don’t understand why it has happened?

A While losing weight is great, unintentional weight loss is usually a sign of a serious underlying health condition such as chronic infection, autoimmune disease, chronic inflammatory disease or even cancer.

It should not be taken lightly and you should see your doctor immediately for a thorough evaluation.

Q Two of my very close friends were diagnosed with colon cancer in the last few years. What conditions predispose a person to have colon cancer?

A Colon cancer is the second most common cancer in the US. Risk factors for colon cancer include

  1. High fat low residue diet.
  2. Family history, age, previous colon cancer
  3. Certain genetic conditions
  4. Ulcerative colitis, Crohn’s disease

Because of its high prevalence it is recommended that all adults at the age of 50 or earlier in the presence of strong family history should get a screening colonoscopy.

Q I have had difficulty having bowel movements for many years but yesterday I noticed blood around my stools? This was very worrying, what does it mean?

A Frank bleeding per rectum or blood mixed with or around stools are indeed alarming symptoms. The incomplete list of conditions that can cause this include, hemorrhoids, anal fissures, angiodysplasia (faulty blood vessel), polyp or even cancer.

In any case you should immediately see your doctor so he/she could determine the source and cause of your bleeding.

 

page last updated 8-jul-13
copyright 2008, denali surgical specialists llc
web design: viable alternatives | contact: skip via

Please be aware that any medical information printed from www.denalisurgical.com should be considered general and informational and should not be construed as medical advice. Contact Denali Surgical Specialists (907 456-3100) for more information.