Total Body Surgical Blog

GERD.....Sounds like something bad doesn't it??  GERD is an abbreviation for gastroesohageal reflux disease.  It describes a number of symptoms and issues that can occur when the esophagus becomes irritated by stomach acid when it spills back into the esophagus.  As we all know, the stomach is the holding chamber for what we eat.  It produces acid and is able to churn the food, acid, and mucous together to begin the process of digestion.  The stomach is protected from the acid by the mucous that it produces.  The way the food gets from the mouth to the stomach is through the esophagus.  The esophagus is a tubular structure that is covered with cells that are not capable of protecting themselves from acid.  Where the stomach and esophagus come together is called the esophago-gastric junction (EG junction).  This is where the esphagus leaves the chest and enters the abdomen.  It is supposed to be an area of higher pressure and an angle that prevents reflux of stomach contents from the stomach into the esophagus.  This image may help you understand.....

Reflux can happen to all of us.  The symptom of the problem is "heart burn".  Belching stomach contents into the esophagus exposes the lining of the esophagus to acid causing discomfort and at times, severe pain that can be severe enough to be mistaken for a heart attack. 

For most of us, this is an infrequent event and we take a Tums and it is just a bad memory.  For others, it can become a daily problem that alters their life.  Often, it is associated with a hiatal hernia.  This is a widening of the hole in the diaphragm where the esophagus leaves the chest.To treat this problem, in most cases, there are medications that can control it.  Many times, medication can eliminate the symptoms and make the problem manageable.  If not controlled, some may develope scar tissue that can lead to stricture.  Others can have cellular changes that can increase cancer risk...it is a problem that should not be ignored. 

What happens if medications don't work??  GERD and hiatal hernia can be treated surgically.  When treated this way, the problem is usually cured.  The procedure we use is called a fundoplication.  We tighten the opening in the diaphragm then wrap the upper part of the stomach around itself to re-create the angle at the end of the esophagus stopping the reflux.

  I do the procedure laparoscopically with five small incisions.  In rare cases it may require open surgery.

  Hospital stay for this procedure is a couple of days and recovery time is fairly short.

Hopefully this will give you some insight into a common disease, how to treat it medically and surgically.  See your Doctor for treatment and if you need a surgical option....come see us at Total Body Surgical where we can help.

It hurts when I eat!!!  This is a common complaint I hear almost daily.  As you know, at Total Body Surgical, we not only take care of Cosmetic Surgery patients, Vein patients, and obesity problems but General Surgical problems too.  Many times, procedures can be combined to tackle two problems at once. 

Abdominal pain comes in all forms and everyone experiences it differently.  Pain in the right side of the abdomen under the ribs is a very common problem.  This type of pain is usually the indicator of a failing gallbladder.  It starts with pain after fatty foods but may advance to pain after any food.  This pain may be felt in the back, usually at the tip of the shoulder blade.  It may also present as indigestion.  The pain usually starts as mild discomfort but as time goes on, it becomes more severe with spells becoming closer and closer together.  It may be associated with nausea and vomiting as well as changes in bowel activity.

What is a gallbladder???? 

The gallbladder is a small, pear shaped organ at the base of the liver seen in the picture above. What does it do??  It is a small storage depot for bile.  What is bile?  Bile is a salt in solution that is formed and recirculated by the biliary system in the liver.  What does it do?  Bile is a solution that helps us digest and absorb dietary fat.  Without it, fat just sails on through the digestive system and causes diarrhea.  With it, the fat is emulsified and absorbed to use for energy.  When a meal is eaten that contains fat, the normal gallbladder is stimulated to release a bolus of bile into the intestine.  The bile mixes with the fat and it is digested and absorbed.  What goes wrong to cause pain and gallstones? Pain is caused when the gallbladder is stimulated and it cannot contract properly.  This causes a cramping type of pain (colic) in the right upper abdomen, back, etc.  Bile is a salt in solution.  If you take a jar and put salt and water in it, mix it up and keep it moving, the salt stays mixed in the water.  If you stop the mixing, it can settle and form crystals at the bottom of the jar and if you roll those crystals around they can come together to form larger crystals or stones.  This is what happens to the gallbladder.  It loses its ability to release the bile when stimulated and the bile salt comes out of solution and eventually the crystals form gallstones.  The stones are a symptom of the real problem....the gallbladder itself. 

Once the symptoms become severe enough, most people will seek medical attention.  The diagnosis is made with some fairly simple tests.  First, the ultrasound.  This is a simple and pain free test to detect stones.  If stones are present and you are having symptoms the gallbladder should be removed....more about that in a minute.   If the ultrasound is negative and the symptoms are convincing, usually a HIDA scan is ordered.  This test is done to see how the gallbladder is working.  It involves an injection to fill and then another to stimulate it to work.  If it does not eject its bile normally, it should be removed.

Today the gallbladder is almost exclusively removed using a laparoscope.  This is usually an out patient procedure done through small incisions and recovery is pretty quick.  Incision placement is pretty standard... Here is a picture of gallstones....not too pretty.

  We can live normally without a gallbladder in most cases, especially a sick one.  Some people may experience a little diarrhea that usually resolves but most importantly, the pain is gone.  If the disease is not treated, the stones can escape the gallbladder and get into the duct causing bigger problems that we won't discuss here.  The gallbladder can also become infected which can be an emergency.

This procedure can also be combined with a tummy tuck when done electively.  The incisions are not made through the skin but under it so nobody will ever know....pretty cool!

Come see us at Total body surgical Cosmetic and Vein Clinic where we can discuss General surgical, Cosmetic, Vein, and Obesity issues.  Don't forget our special pricing AND keep an eye out for our soon to be announced spring roll out!

Speaking of bulges....This week we are going to shift gears a little and talk about some General surgery.  When we look at the abdomen and see something bulging, it usually means there is a hernia present.  Hernias are a very common problem.  Many people are born with them.  The most common places for this type of hernia is in the groin area (usually in men) or in the belly button or umbilicus.  These areas are where natural weaknesses are present from either the umbilical chord or where the testicles descend.  Other hernias that can form present themselves in the mid line of the abdomen or more commonly in incisions from other surgeries. 

What exactly is a hernia??  Our abdominal wall is composed of layers of muscle and connective tissue.  The connective tissue looks like a thin tendon.  All of us who have cut up meat or a chicken have noticed the shiney layer of whitish, tough tissue that surrounds the muscles....this is connective tissue or fascia.  Pound for pound it is very tough and it is responsible for holding in the contents of the abdomen and gives the muscles something to pull on when they contract.  A hernia occurs when there is a hole created in this layer and contents of the abdomen poke through that hole.  The mid line of the abdomen (especially the belly button) and the groins are the weakest areas and therefore are the most common sites for naturally occuring hernias.  Here is a picture of an inguinal hernia...

Here is a photo of what the hole looks like from the inside using a laparoscope and as you can see, with the contents removed, there is an actual hole.

  Hernias become a problem when things get stuck in them...things like intestines, fatty tissue, and other contents of the abdomen.  They can also cause discomfort due to stretching of the wall of the abdomen with straining to lift, urinate, or have a bowel movement.  Things can also become stuck, lose blood supply and die within the hernia.  Small hernias may never cause a problem.  These are the common hernias of the abdominal wall.  I won't cover the more obscure ones due to time and the others are fairly uncommon.

How do I fix them??  Today I usually fix them with laparoscopy.  This allows me to repair them with mesh that incorporates into the surrounding tissue creating a strong patch.  It also cuts down on incision size, wound infections, recovery time (minimally) and I think leads to a better repair because I can see the defect or hole better.  The mesh is placed with a great deal of overlap and tacked in place.  Meshes have small holes in them into which our bodies incorporate scar tissue making them very strong....like chain link fence on grass, the collagen holds them mesh in place making it very hard to move.  Recovery times are usually about 6-8 weeks allowing the mesh to scar in.

So, if you have a hernia, come see us at Total Body Surgical where we not only do Cosmetic surgery and Vein surgery but are professionals at General Surgery too!!

Don't forget our specials and friend us on Face Book PLEASE!!    

Sorry everyone!! An Internet crash at the Grove address forced me to delay writing this installment.  The double edged sword of modern technology. 

This week I want to discuss removing the large varicose veins.  This was once done with larger incisions that left unsightly scarring.  We now perform what is called the European Micro phlebectomy.  What that means is that the veins are removed using a technique developed in Europe.  The difference is that this technique leaves very little scarring and is much more Cosmetically appealing than the old way.

The large varicosities that we see in the leg is usually not the actual disease.  As discussed in previous blogs, this disease is from incompetent valves in the saphenous system in most cases.  These big and ropey veins develope in response to the increased pressure in veins deeper in the leg.  Once closed with the laser, the deeper veins no longer feed these enlarged "branches" or varicosities.  When this happens a number of problems can occur, they can become painful, they can clot and cause phlebitis, they can cause skin color changes.  These problems will usually resolve with time but can be miserable. 

How is the procedure done??  After closing the system that is feeding the visible varicose vein, the large ropey veins are marked with a marker with the patient standing.  Local anesthesia is injected into the areas to be removed and in our office, IV sedation is given.  Once the local has taken effect, very small incisions are made and small instruments are used to grab the vein, elevate it, and tease it out from under the skin.  It is completely removed if possible.  The incisions are no more than a couple of millimeters in size (less than an eighth of an inch).  No stitches are placed, and a compression dressing is applied with Coban to hold pressure.  Some minor bruising may occur that lasts for a few days, the wounds may leak minimally for about 24 hr or so.  We have patients walk out of the office and most experience very little discomfort after.  The wounds heal very well and usually go unnoticed after 6 months or so.  Once removed, the painful and ugly source of embarassment is gone.

Next week....Cosmetic sclerotherapy and how to get rid of spider veins.

Call Total Body Surgical today for YOUR vein evaluation 918-786-7780!