Watch and wait or operate?

Gallbladder disease is the result of buildup of cholesterol into stones.  The purpose of the gallbladder is to release fluid to digest fats. The fluid overtime can merge into stones. When the stones build up, the gallbladder contracts against them and/or can push them into the gallbladder tube.  Stones in the tube can further obstruct flow to the intestines triggering painful symptoms. While gallstones are present in 10-15% of adults, over two thirds of those patients will have symptoms. Symptoms of gallstones can occur after eating spicy or fat containing foods.  The pain is usually localized in the upper right abdomen and can be associated with nausea and bloating. An ultrasound can guide the diagnosis and treatment. If the gallbladder is found to be infected or has stones stuck in the drainage tube, surgery is the best option. There is less than a one percent risk of complications with the surgery.  Delaying surgery is a reasonable option as well with few caveats. Patients without infection can be managed as an outpatient with pain control and low fat diet modification. Each episode of symptoms, however, increases the likelihood of recurrence to 35% per year. Additionally, the stones can migrate down the drainage tube and get stuck, causing severe pain and occasionally pancreatitis which is excruciatingly painful.  Conversely, the gallbladder symptoms may not recur for months or ever. Verdict: <1% risk of surgery, Waiting can be pain free or result in recurrence of symptoms.

Hernias: A hernia is a defect in the abdominal wall through which structures inside the abdomen can protrude.  Hernias are found in the belly button, the groin or occur as a result of weakening of the abdominal wall with incisions.  Small hernias with minimal symptoms can be simply monitored with a few exceptions. Patients with chronic cough, constipation or occupations requiring heavy lifting are at increased risk of the protruding structures becoming trapped and requiring urgent attention.  Small hernia, though easy to repair, have low risk of structures protruding. However, if the contents become trapped, the small size tightens off the blood supply, requiring emergent surgery. Additionally, small hernias carry a risk of increasing in size over time.  Bigger openings are more difficult to fix and have a higher risk of recurrence after repair. Most physicians accept the “watch and wait” technique with small reducible hernias and opt to repair larger ones. 

Breast Mass: Finding a breast mass on a self breast exam is terrifying.  Often women feel that if they ignore the mass, it does not exist or may go away.  They do not have to deal with the fact that it might be cancer. Ignorance may feel like bliss but may be detrimental. Fortunately, smaller masses are more successfully treated and are less likely to be cancerous.  Specifically, masses smaller than an inch in women less than 35 years old have a decreased cancer risk and, if cancer is found, a 95% 5 year survival rate. Moreover, removing smaller amounts of tissue can result in less distortion of the breast.  To prevent worry, deformity and increase survival, always have any mass inspected by a doctor.

Author

Jenna Wishnew Dr Wishnew is a Board Certified General Surgeon practicing in the North Texas area She specializes in general surgery, gastroparesis, wound care, vein concerns and robotic surgery.