Understanding Common General Surgeries
Understanding Common General Surgeries
On this episode of Bariatric Friday, Kemal Erkan sits down with Dr. Ellen Pekar to discuss the topic of Understanding Common General Surgeries. General surgery is a specialty that primarily focuses on the abdominal organs, digestive tract, endocrine system, and breast tissue. General surgeons are trained to diagnose and treat a variety of conditions, frequently using minimally invasive or laparoscopic surgery. One such condition is a hernia, which is when an organ or fatty tissue squeezes through a weak spot in the surrounding muscle or connective tissue. Hernias most commonly occur in the abdominal or groin area, and may cause a noticeable bulge, pain or aching, and a feeling of pressure. Surgery is not always required, but is usually performed when they cause pain, grow larger, or become trapped. If there is redness in the area or it is affecting the patient’s daily life, that may also signal surgical necessity.
Gallbladder removal is another common general surgery; symptoms of gallbladder disease include pain in the upper right abdominal area, nausea, vomiting, and diarrhea. Dr. Pekar notes that many people have stones, but not everyone is symptomatic. Gallstones form when bile stored in the gallbladder hardens into stone-like material. They can form when bile contains too much cholesterol, too much bilirubin, not enough bile salts, or when the gallbladder does not empty properly. It is recommended to look into removal before it becomes acutely inflamed, as it can turn into a bigger procedure. Once your gallbladder starts to form stones, the issue will not resolve on its own. In severe cases, stones can go into the bile duct or pancreas and cause serious issues.
Diverticulitis is when small pouches in the colon become inflamed and infected. Early symptoms can include left lower quadrant pain, nausea, fever, changes in bowel habits, and tenderness in the abdomen when touched. Dr. Pekar underlines the importance of a patient-centered approach when it comes to treating diverticulitis, looking at how it affects the patient’s life, how many episodes they have, and whether or not it is worthwhile to take out the affected part of the colon. If very severe diverticulitis occurs, sometimes the colon needs to be removed and cannot be put back together.
Appendicitis is a medical emergency where the appendix becomes inflamed, typically due to blockage or infection. The appendix can be blocked by hardened stool, tumors, or other factors. It also tends to be seen more commonly in young males. Symptoms include sudden pain that begins on the right side of the lower belly, pain that worsens with coughing, walking, and other jarring movements, nausea and vomiting, loss of appetite, and a low-grade fever. If it is not treated, a hole can form in the appendix, allowing contents to leak into the abdominal cavity. When such an event occurs, it causes individuals to feel extremely ill and can warrant an ICU stay.
When it comes to surgical decision making, Erkan brings up the idea of “watchful waiting” versus when you know it is time to proceed with a surgery. Dr. Pekar talks about the importance of information and getting a clear picture of what is going on internally. She says that lab work, imaging, and a physical exam are usually performed. With all of that and a discussion with the patient’s medical history, they work together to come up with a plan. If it is a life-threatening issue, then the surgeon will usually push for an operation. Some high-risk factors for surgery include obesity, diabetes, heart disease, kidney disease, lung disease, or immunosuppression. To manage this high-risk population, properly informing the patient is key. It is also important to refer them to other specialists that can help optimize the patient’s health, which will help make the surgery safer.