ABOUT DR. FROST
General surgery is fast-becoming a sub-specialty field.
Patients with breast problems are seen by breast surgeons. Patients with colon problems go to a colorectal specialist.
So shouldn't patients with gallbladder disease have the opportunity to go to a gallbladder specialist?
DR. FROST IS THAT SPECIALIST.
Has been practicing general surgery in South Florida for over 25 years.
Is Board Certified in general surgery.
Specializes in gallbladder surgery.
Performed over 5000 gallbladder surgeries.
Is residency-trained in laparoscopic cholecystectomy -- Removal of the gallbladder.
Trained with one of the pioneers of the technique when it first became the accepted procedure.
Fellow of the ACOS (American College of Osteopathic Surgeons).
The busiest general surgeon at Memorial Hospital West for a number of years.
Is an associate clinical instructor at Nova Southeastern University Medical School.
He is also clinical preceptor for third- and fourth-year medical students.
Interviewed by Channel 7 Health Reports about gallbladder surgery.
Years of Experience
Operations per Year
The gallbladder is...
a very small organ under the right ribs and liver which helps in digestion.
Signs and symptoms of gallbladder
disease often mimic
HEARTBURN or INDIGESTION.
Patients frequently experience nausea, bloating or a
gassy feeling and pain in the upper abdomen,
especially after eating certain foods.
Gallbladder disease is most often caused by gallstones
which can be easily diagnosed/found by a sonogram -
a painless test performed similar to an x-ray.
Once diagnosed, gallbladder disease can be taken care of with a minimally invasive procedure called laparoscopy.
This is an operation done under general anesthesia through four small "poke holes." This procedure usually takes less than an hour to perform and the patient is discharged the following day.
Laparoscopic surgery allows for decreased pain, increased mobility and faster return to normal everyday life.
This benefits the patient with more complicated gallbladder disease and often avoids the need for a large incision on the abdomen. Recuperation time is much shorter with laparoscopic surgery.
Laparoscopic Cholecystectomy (Removal of the Gallbladder)
Today, the standard of care is laparoscopic cholecystectomy. The laparoscope is a long tube with lenses at one end connected by fiber optics to a small television camera. This system allows the surgeon to operate within the abdomen while viewing a television screen.
The procedure is performed under general anesthesia. An intravenous (IV) is started and antibiotics are given prior to the surgery to reduce the rate of infection. Patients don't remember anything about the surgery because medication is given via the IV to make patients sleepy. After the anesthesia has begun, four small incisions (called port sites) are made on the abdominal wall. A special needle is inserted into the abdomen to inflate the abdomen with carbon dioxide gas. This distends the abdomen and creates space to insert the instruments. The laparoscope and laparoscopic instruments with long handles are inserted through the incisions and into the abdomen. The entire operation is then performed while viewing the organs magnified on a television screen.
The gallbladder is dissected off the surrounding structures. The cystic duct that attaches the gallbladder to the common bile duct is dissected and divided between metal clips. In some cases, a tiny catheter may be inserted into the cystic duct to inject dye and take X-rays to visualize any stones that may be blocking the common bile duct. If common bile duct stones are present, they may be removed with laparoscope common bile duct exploration by opening up the abdomen and exploring the duct or by ERCP. After the cystic duct is divided, the gallbladder is further dissected off of the liver bed and a tiny artery that supplies blood to the gallbladder called the cystic artery is divided between metal clips.
The gallbladder is then removed through one of the ports in the abdominal wall and the tiny incisions in the abdominal wall are closed after removing any gas left in the abdominal cavity. When there is spillage of bile, the local abdominal cavity is throughly cleansed with saline solution and a small drain may be left in place. This may be removed the same evening or the next day when drainage ceases. The operation usually takes less than an hour and the patient is discharged the following day.
The incidence of complications after cholecystectomy is relatively low, especially in experienced hands, but can include:
Complications of a general anesthetic.
Injury to the bile ducts or right hepatic artery.
Injury to other abdominal organs.
Deep vein thrombosis.
Respiratory or urinary infections.
The patient usually has minimal pain that is well controlled with medication. Patients are discharged home with a prescription for pain medication. Patients eat a normal light diet on the day after surgery and may be able to return to light work in three to four days. It is preferable to avoid exertion and heavy work for a couple of weeks though one can take regular walks, showers, and ride in a car if necessary. Driving can be attempted several days post-operatively. Follow-up in Doctor Frost's office is in seven to ten days. Return to work varies, but can be as early as one week.
REASONS FOR REMOVAL
1. Biliary Colic
Intermittent pain in upper abdomen often after eating and occasionally associated with nausea or bloating. The pain is usually short lived "attacks" can be come more intense and frequent. These patients usually have the luxury of meeting with a surgeon and scheduling surgery electively.
2. Acute Inflammation and Cholecystitis
Acute cholecystitis is a situation where there is acute inflammation and irritation of the gallbladder. As the process progresses the gallbladder can begin to die and become gangrenous and eventually perforate or rupture. The pain is usually severe enough to seek out medical attention. Often times these patients are first seen by a surgeon in the emergency room. Surgery is often urgent or emergent.
3. Gallbladder Polyps
Although gallbladder polyps are usually benign (non-cancerous), they may turn into cancer similar to colon polyps. Age greater than 50 and size of the polyp greater than one centimeter are usually associated with an increased chance of polyps turning into cancer. These can often be followed with ultrasound every 4 to 6 months but occasionally have to be removed.
4. Biliary Dyskinesia (Dysfunction of the Gallbladder)
Often patients with upper abdominal pain will have a sonogram or ultrasound to see if they have gallstones. If no stones are seen in the gallbladder and the pain persists, a second test can be performed to evaluate the gallbladder's ability to squeeze out bile - a digestive enzyme. If this test is abnormal, removal of the gallbladder usually takes away these signs and symptoms.
5. Biliary Pancreatitis
Biliary Pancreatitis is an inflammation of the pancreas and can occur from a gallstone popping out of the gallbladder and entering the bile duct. This can cause blockage of the duct and back pressure leading to inflammation of the pancreas. This is a common cause of pancreatitis. Removal of the gallbladder can prevent a recurrent problem.
601 N. Flamingo Rd., Suite 319
Pembroke Pines, FL 33028
Tel: (954) 442-8786 | Fax: (954) 442-3767
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