Specialist Keyhole Surgeons

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Medical Conditions

Gallstones

Gallstones form when bile the liquid stored in the gallbladder hardens or precipitates into pieces of stone-like material. Risk factors for developing gallstones include being female, increasing age, pregnancy, obesity, and rapid weight loss.

Most people with gallstone's do not have any symptoms. When symptoms do develop the most common presentation is pain typically in the upper abdomen especially on the right side. Pain maybe associated with nausea or vomiting and often comes on following a meal. Attacks of pain which are short lived are known as Biliary colic. If pain is prolonged and inflammation of the gallbladder occurs this is known as cholecystitis.

Gallstones can be diagnosed on an ultrasound. Ultrasound uses sound waves to create images of organs and is the most sensitive way of diagnosing gallstones. Other tests that maybe used include CT, MRI, and HIDA scans. Occasionally a special endoscopic examination known as an ERCP is performed if it is suspected that the gallstones have moved into the ducts that drain the liver.

Generally if patients with gallstones have related symptoms and they are fit enough for surgery they should undergo a laparoscopic cholecystectomy.

Hernias

A hernia is an area of weakness in the wall of the abdomen through which abdominal contents may protrude. The most common hernia is an inguinal hernia, which is found in the lower abdomen or groin region.

Inguinal hernias are common because this is a point of natural weakness in the abdominal wall and some people are even born with hernias in this region. Another area of natural weakness is at the tummy button or umbilicus, where babies are joined to their mother's placenta via the umbilical cord. Patient's who have previously undergone major abdominal surgery through traditional open incision's have at least a 15% chance of developing an incisional hernia through their incision, which again illustrates a major advantage of laparoscopic surgery where incisional hernias are rarely seen.

Many patients with hernias only have minor occasional discomfort associated with their hernia, which rather presents as a bulge or lump at the site of the hernia. Occasionally abdominal contents may get trapped within a hernia, this is particularly concerning if this is bowel which may cause obstruction to the bowel or even worse cause the bowel to die if the blood supply to the bowel is involved. Whilst this is uncommon if a patient is fit enough for surgery they should have their hernia repaired to avoid this situation.

Hernia's left un-repaired will only get bigger with time. Only surgically repairing a hernia will fix the problem, there are no magic medications or non-surgical treatments to make hernias go away.

See also Laparoscopic hernia repair.

Heartburn / Reflux

There are many names, and acronyms to describe what most people commonly know as heartburn or reflux. The most common is gastro-oesophageal reflux disease, which is often shortened to either GORD or GERD depending on whether you live in the USA or not. Reflux is normally prevented by a muscular sphincter at the lower end of the oesophagus, which acts as a valve to prevent the contents of the stomach especially gastric acid refluxing up into the oesophagus.

Heartburn, a burning sensation typically felt behind the breast bone is the most common symptom of gastro-oesophageal reflux disease, but other symptoms include regurgitation with a bitter taste in the back of the mouth, and difficulties with swallowing. Less commonly reflux may aggravate the upper airways causing problems such as asthma or cause hoarseness of the voice.

In most cases of reflux there is an underlying weakness of the sphincter at the lower end of the oesophagus, so that the barrier preventing the movement or reflux of the contents of the stomach, which includes gastric acid, is greatly impaired. Weakness of the oesophageal sphincter maybe made worse by food or drinks containing caffeine such as coffee and chocolate, and is also impaired by smoking.

Obesity an ever increasing problem also worsens reflux. Acid, which enters the oesophagus, can damage the lining of the oesophagus, causing inflammation, and even ulceration when the damage is particularly severe. In response to this damage the lining of the oesophagus may even change so that it is more resistant to the effects of acid. This change in the lining is known as Barrett's oesophagus and whilst it may be seen as an adaptation the down side is that it does carry a small chance of turning cancerous.

The effects of reflux can be seen on endoscopy. A procedure where a flexible scope is passed through the mouth in to the oesophagus, stomach and first part of the small intestine. This is normally done whilst the patient is sedated and allows direct visualization of the lining of the oesophagus to detect changes such as inflammation and ulceration. Biopsy of any areas of concern may also be taken. Other tests which maybe used to diagnose reflux include oesophageal manometry and 24 hour Ph monitoring, these test are usually performed before contemplating anti-reflux surgery.

Mild or occasional reflux is extremely common in the general population and most patients with such symptoms can be managed with simple antacids along with lifestyle changes such as weight loss and avoiding food or fluids, which aggravate reflux symptoms. Other patients with more persistence symptoms may require suppression of stomach acid production by medications. A small group of patients despite medications will still have severe symptoms, these patients may be candidates for anti-reflux surgery.

See also Anti-Reflux surgery

Obesity

Australia like most western societies is currently faced with an epidemic of obesity and obesity related diseases, which will soon overtake smoking as the number one cause of premature or early death. Well over half the population are now categorized as being at least overweight and sadly around 5% of the population can be categorized as being morbidly obese which at least doubles the annual risk of premature death.

In terms of health risk, not only is absolute weight important but also the relationship between weight and body proportions such as height and abdominal circumference. Doctors tend to classify levels of obesity based on a ratio between a patients weight divided by their height squared to give a number known as a Body Mass Index or BMI.

Body Mass Index

 

BMI (kg/m2)

Risk of obesity related diseases

Normal

20 – 24.9

 

Overweight

25 – 29.9

 

Obese

30 – 34.9

High risk

Morbidly Obese

35 or greater

Very high risk

Super Obese

50 or greater

Extremely high risk

Based on BMI individuals can then be categorized into varying weight categories including obese and morbidly obese categories.

Whilst BMI is not always accurate especially in individuals with large amounts of muscle mass such as professional athletes, for most non-active individuals it is a pretty good indicator of disease risk. Individuals with a BMI over 35 are classified as being morbidly obese which puts them at significant risk of having or developing obesity-related diseases.

Morbid obesity is directly linked to many diseases including diabetes, high blood pressure, elevated cholesterol levels, sleep and respiratory disorders, which when mixed together form a deadly combination which can eventually lead to heart attacks, strokes and a number of other fatal conditions. Beyond these, obesity often also causes and contributes to musculoskeletal problems such as osteoarthritis and lower back pain which ultimately makes the individual less mobile, and unable to exercise which again contributes to a vicious circle of more weight gain and increasing levels of obesity.

Many patients are also surprised to hear that many common cancers such as breast cancer and prostate cancer are also more common and much more difficult to treat in obese patients. Other conditions such as infertility, sexual dysfunction, and depression are also very common in obese individuals and all contribute to an understandably frustrating and poor quality of life.

So if there is so much at risk and so many good reasons to lose weight why don’t people just go on a diet and simply lose the weight? Well most obese people have tried that simple theory not just once but multiple times and whilst most people can lose some weight, most people who are morbidly obese cannot lose enough weight to make a significant difference and sadly very few can keep it off for prolonged periods of time.

There are many reasons why people struggle to lose and keep weight off, some of them are due to the immobility associated to obesity, some are simply because people have a tendency to return to the same lifestyle which caused their obesity initially. More recently Scientist’s have also discovered hormones such as Ghrelin that are secreted in increasing levels as people lose weight. Hormones like Ghrelin stimulate areas within the brain, which control appetite, so that as people lose weight their appetite unfortunately increases so that eventually many people break their diets and start to put the weight back on.

Unfortunately the large majority of morbidly obese individuals ultimately fail diets as well as medical treatment with medications such as xenical, and return to their pre-diet weight or worse end up regaining even more weight. Obesity surgery is the only treatment, which has been proven in long term trials to produce significant and sustained weight loss over many years in individuals suffering from morbid obesity. If you would like to read more about surgery, follow this link to information on Obesity surgery.

See also Obesity Surgery