Complications of Gallstones

Gallstones are small rocks that form in the gallbladder that vary in size. There can be anywhere from a single large stone to multiple gravel-like stones. Many people with gallstones may never experience any symptoms. Symptoms vary from mild upper abdominal discomfort and bloating to severe pain due to life-threatening acute pancreatitis.

The presence of gallstones in a diseased gallbladder can be responsible for the mild symptoms of upper abdominal discomfort, bloating, and nausea; these symptoms can be confused with symptoms of other conditions, such as acid reflux or peptic ulcer disease. When one of the stones blocks the gallbladder the patient will experience severe upper abdominal pain which is "crampy", the condition is called biliary colic.
If the blockage is not relieved biliary colic can progress into acute cholecystitis, which is an emergency.

When the gallstones are responsible for the symptoms of pain, nausea, or vomiting patients should seek a surgical consultation to consider the option of laparoscopic cholecystectomy (gallbladder removal surgery) as soon as possible to avoid serious complications of the gallstones.

Botox Injection for Anal Fissure

Anal fissures are painful tears in the lower end of the anal canal, most commonly caused by constipation and spasm of the internal sphincter of the anus. When initial treatment (high fiber diet, stool softener, laxative) fails surgery becomes necessary to relieve the spasm of the sphincter by cutting part of the sphincter which allows it to relax. Instead of surgical treatment, Botox injection into the sphincter can achieve the same result without the possible complications of surgery -- which is mainly incontinence.
 
The Botox injection lasts for three to four months which causes the sphincter to relax and allows the tear to heal. It is important to maintain regular, soft bowel movements with a high-fiber diet, a stool softener and, if necessary, laxative to avoid recurrence of the anal fissure.

Mini Laparoscopy Takes It One Step Further

A laparoscopic procedure is a type of surgical procedure that allows a surgeon to access the inside of the abdomen and pelvis without having to make large incisions in the skin. It is also known as keyhole surgery. 

Laparoscopy is minimally invasive and already has many advantages over traditional open surgery, such as: small incisions, less pain, and shorter recovery times. This is done with an instrument called a trocar which requires 5-10 mm incisions.

"Mini Laparoscopy" takes things one step further by replacing  the 5 mm trocar (in conventional laparoscopy) with a 2 mm needle-like instrument (in mini laparoscopy). This means even smaller incisions, even less pain, and even shorter recovery times than conventional laparoscopy.

The advantages of mini laparoscopic procedures vs. conventional laparoscopic procedures are:

• Less trauma to the tissues and less strain on muscle
• Less pain
• Best cosmetic result possible

Mini laparoscopy can be utilized in most instances where conventional laparoscopy could be done in the past, such as: gallbladder procedures, hernia procedures, appendix removal procedures, and more. 

Robotic Procedures in General Surgery

Robotic surgery is a type of procedure that  is similar to laparoscopic surgery. To date there has been no evidence to support that the result of robotic surgery is superior to laparoscopic surgery.

The main advantage of robotic is the convenience for the surgeon, where the surgeon can see the area being operated on in a much clearer picture than laparoscopy; the surgeon is in a more comfortable position and can move in a more natural way during the procedure.

Another advantage for robotic surgery is when it is used in a difficult area in the abdominal cavity, which normally cannot be reached by laparoscopic instruments. Robotic surgery has higher expenses and requires longer surgery time without improvement in outcome compared to laparoscopic procedure. For this reason robotic surgery is not widely accepted as an alternative to routine laparoscopic surgery.

Giant Abdominal Wall Hernia

A giant abdominal wall hernia is a very large hernia of the abdominal wall that most often results from long standing ventral hernia and in many cases, failed multiple repair attempts.

This hernia is usually very difficult to repair because of large defect of the abdominal wall. To be repaired successfully, a technique of component separation can be used to allow the muscle and fascia (layer of fibrous tissue) to be sutured to each other in the midline to close the gap.

In the component separation technique the muscles are separated from each other to allow the tissue to be closed without tension. Most often this is reinforced with mesh, which is a medical material used to reinforce poly tissues.

Patients with giant ventral hernia who have had multiple failed repairs should not be discouraged from seeking a second opinion as they may be a candidate for component separation.