Gallstones are deposits that form on the inside of the gallbladder, the organ which sits under the liver and stores bile. Bile is a fluid produced by the liver that helps to digest fatty substances in the food we consume. Gallstones form over time when there is either too much bile salts or cholesterol in the body, often due to our food choices.

What are the symptoms of Gallstones?

Gallstones are common and occur more frequently in middle-aged women. The majority of people with stones actually have no symptoms.

When symptoms do cocur, this is usually in the form of abdominal bloating or pain in the upper portion or right side, usually triggered after a heavy meal of oily food. Occasionally this pain can move to the back or the tip of the right shoulder blade.

The pain can sometimes be severe, accompanied by fever or yellowing of the skin (jaundice) if the stone has fallen out of the gallbladder and becomes is stuck in one of the tubes leading from the gallbladder. This will require emergency treatment at the hospital.

Treatment involves antibiotics, painkillers and surgery to remove the entire gallbladder with the stones within.

Laparosopic Surgery for Gallstones

The treatment of choice is laparoscopic gallbladder surgery (cholecystectomy), where the entire gallbladder with the stones within are removed using cameras and precision instruments, through 4 small cuts (each 1 to 2cm in size) on the abdomen. The smaller cuts result in less pain, less infection risk, a shorter hospital stay and faster return to normal activities.

The traditional method of open surgery, where a longer 8cm to 10 cm cut on the right upper abdomen is made, is reserved in cases where the gallbladder is very stuck due to complications of the disease.

Life after Removal of Gallstones

Patients do not suffer any long-term side effects or malnutrition after removal of the gallbladder. Some patients may experience some diarrhoea in the first few weeks after surgery but this can be dealt with by avoiding oily foods and will disappear once the liver makes adjustment to having new storage space for the bile.

A hernia is an abnormal bulge or protrusion on the body.

The most common type is the inguinal (groin) hernia.

The Inguinal Hernia

This occurs at the groin through a weakness of the abdominal wall muscles near the pubic bone, called the inguinal region. This appears as a lump in the groin and usually occurs over months to years. Symptoms develop when it becomes large enough as more contents come out and this can include fat or even intestines as the hernia enlarges.

Some of the common symptoms include:

1. Dull aching sensation at the groin, with pressure or a feeling of ‘heaviness’
2. When the intestine protrudes towards the scrotum, it can causes pain down to the area surrounding the testicles
3. These symptoms tend to worsen with straining, e.g. coughing, sneezing, lifting heavy objects, constipation etc

Normally, the appearance of a hernia becomes more obvious in a standing posture, due to gravity and especially when coughing or straining as mentioned above. However, this can improve with a change in posture like lying down.

Treatment of Inguinal Hernia

The method of choice for treating hernia is surgery. This surgery involves reducing the protruding hernia contents and placing a mesh (plastic scaffold) to reinforce the weakened muscle layers. This can be done using the conventional open technique where a cut is made over the groin bulge. Today, the preferred option when feasible is using laparoscopy or keyhole surgery to perform the procedure.

In addition, it is important to address any factors contributing to the hernia such as straining, including chronic cough, constipation and lifting of heavy weights. This will improve results of surgery and reduce the risk of recurrence.

Conventional Surgery

Surgery can be performed using the conventional ‘open’ technique, where a cut is made over the protruding hernia to push back (or sometimes remove the protruding contents), repair the weakened tissues and placing the mesh for better support. This can be done as a day case under general anaesthesia. After surgery, the patient is advised to rest and avoid strenuous exercises and  straining activities for at least the next 4 to 6 weeks.

Laparoscopic Surgery

This procedure is also carried out under general anaesthesia. In this process 3 small 1cm incisions are made in a straight line from the belly button downwards. A slim high-definition camera (laparoscope) is put into the abdomen through one hole, with 2 slim operating instruments placed through the other 2.

The hernia is repaired in a similar way but from within and a mesh is also placed to strengthen the weakened areas. Since the procedure is done through smaller cuts, there is less pain and overall recovery time is shorter compared to the conventional technique.

This procedure is particularly useful for those with bilateral hernia as both sides can be repaired using the same cuts. Recurrent hernia, particularly those done previously with the conventional open technique, are also better done using the laparoscopic method as it will avoid going through old scar tissue and mesh, which could further complicated the repair.