What Is Bile Reflux? And Do I Need to Worry About It?
Bile, a yellowish-green enzyme, is secreted by the liver and stored in the gallbladder. The gallbladder injects it into the small intestine to assist with the breakdown of food, especially fats. Bile reflux is precisely as it sounds – like its more well-known cousin, acid reflux – and involves the movement of liquid upward through the G.I. tract into the stomach (and sometimes esophagus) when it should be flowing downward instead.
How Long Does a Mesh Hernia Repair Last
Over the years, mesh hernia repairs have become the gold standard in repairing hernias simply because… mesh works! In the days when we used conventional suture repairs, back before we had the current crop of advanced meshes, the risk of a recurrent hernia (one that reopened) was significant. This recurrence was because of the significant pulling force or tension placed on the tissue to close the hernia defect. This is only exacerbated by intraabdominal pressure caused by excess abdominal fat or activities such as weightlifting, coughing, or even sneezing.
Today, hernia mesh is thinner and more advanced than ever. Along with these advances in technology has come longevity as well. The customized nature of today’s hernia meshes means we can accurately predict the body’s inflammatory response and choose a mesh that best suits the patient. As such, it is common to see the mesh last for the rest of the patient’s life, with less worry of migration or curling. We are closing hernia defects with far fewer complications than ever before.
How Weight Loss & Gallstones Are Linked
Some patients find that when they start on the merry-go-round of dieting, or even if they’ve had weight loss surgery and are losing a significant amount of weight, they develop gallstones. Millions of people go on diets every year, and hundreds of thousands have bariatric surgery, yet only a tiny number of those end up having their gallbladders removed. Let’s talk about gallstones for a second to understand why.
Many of us have gallstones and will never even know it. Gallstones can be very small or large, but about 90% of cases are asymptomatic. This is because gallstones only become symptomatic when they block the outflow of bile from the gallbladder or when one escapes and lodges in the common bile duct. As such, those who have had their gallbladder removed represent a small fraction of the overall population with gallstones.
The Problem With GERD Medication Beyond Its Side Effects
Previously in our blog, we have talked about proton pump inhibitors or PPIs and how they have gone from a temporary solution to acid reflux symptoms to a therapy many patients have continued for months or even years. PPIs come with several long-term side effects, not least of which is the potential for vitamin deficiencies, infection, and bone fractures. As such, we always stress to our GERD patients that surgery is the only true solution to chronic acid reflux. And this is considered if lifestyle change, including improved diet and exercise and losing weight, has not made a difference.
However, another consideration to understand does not revolve around the side effects of PPIs themselves but rather the continued reflux, albeit non-acidic, that a patient will experience while on medication.
Should Your Gallbladder Be Removed Prophylactically During Bariatric Surgery?
As you may know, while Dr. Huguet and Dr. Peterson are general surgeons performing a wide range of surgeries on common and complex abdominal conditions, they also specialize in bariatric or weight loss surgery. Bariatric surgery can be an effective option for patients suffering from obesity who have not seen improvement from years or even decades of diet and exercise, as well as non-surgical therapies like weight loss medication and structured diet programs. We are often asked about the potential for gallstone development in the early months after bariatric surgery when the patient loses significant weight. If you have researched gallbladder disease, you may know that one of the most significant risk factors for gallstones is rapid weight loss – exactly what happens after a bariatric procedure. So, the question is: should the gallbladder be removed regardless of symptoms during the primary bariatric procedure to avoid another surgery?
Driving After Your Surgical Procedure
As part of your postoperative instructions, we’ll include the activities you can and can’t perform after any abdominal surgical procedure. One such limitation is driving. For most abdominal surgery patients, driving will not be possible several days after surgery. There are a few reasons for this.
- First, in the immediate recovery period after the surgical procedure, patients will still be under anesthesia and will not have the capacity to drive themselves home. This makes it very important to have a friend or a loved one who can pick you up from the surgery center, take you home, and get settled.
- Second, you will experience abdominal pain from the incisions and the procedure for several days after surgery. In the first few days post-op, this pain will likely preclude you from making an emergency stop by pressing the brake firmly. As such, you will be somewhat impaired until the discomfort subsides.
- Lastly, some patients will require narcotic medication to manage pain after the procedure. Most patients will not require narcotic medication beyond the first couple of days after surgery, but while taking it, they most certainly cannot drive. Most patients can safely drive once the drug has been flushed from their system, which takes about 48 hours from the last dosage.
Am I Too Old for Hernia Surgery?
Age is always a factor in surgical intervention, and we are often asked if they are too old for hernia surgery. This conversation should be had with a qualified general surgeon like Drs. Huguet or Peterson. When it comes to aging and hernia surgery, there are two primary considerations as to whether a person of advanced age should have their hernia repaired.
Should I Worry About Blood in My Stool?
Seeing blood in the toilet after a bowel movement can be jarring. But does blood in the stool necessarily mean that you have a significant colorectal issue? The answer is nuanced; ultimately, seeing a qualified colorectal surgeon is the best course of action in most cases. However, let’s discuss some of the most common reasons for blood in the stool and what you should do about them.
Bright red blood usually involves bleeding closer to the anus, in the lower digestive tract. The blood is bright red because it hasn’t had time to coagulate. Common causes can include:
Impediments to Recovery After Hernia Surgery
Hernia surgeries come in various flavors, but all share a common trait: a defect in the abdomen’s strong, supportive layer of tissue known as the fascia. The fascia works to essentially keep abdominal contents in place, so when it is perforated (for example, due to wear and tear or surgery), abdominal contents begin to push through. Unlike bones and muscle, the fascia cannot repair itself, so surgery is the only definitive treatment option for a hernia
Unfortunately, while you may hear otherwise on the Internet, there is no proven method for fixing a hernia without surgical intervention. Hernia belts, exercises, and time will not fix the problem and may even cause the hernia to worsen more quickly.
Once you’ve had hernia surgery, though, what are the common pitfalls that cause complications after surgery?
How Many Gallstones Do I Have & Does It Matter?
If you’re not too squeamish, we encourage you to look at our surgical video that shows Dr. Huguet opening a gallbladder full of gallstones. It’s not the most pleasant thing to see, but it shows just how much your gallbladder can hold. Is having lots of large gallstones within your gallbladder normal, and do gallstones present differently in different people? Also, does having many or just a few gallstones increase your risk for gallbladder pain and cancer?
