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Clarence D. Lin, MD

Q: You Have Gallstones. Should You Have Gall Bladder Surgery?
A: The Guide to Good Health has consulted general surgeon Clarence D. Lin, M.D., to answer your questions about gall bladder surgery. Dr. Lin practices with St. Clair Medical Services, with partners Raye J. Budway, M.D., F.A.C.S., and Antonio J. Ripepi, M.D., F.A.C.S. He is a graduate of Johns Hopkins University and received his medical degree from New York University School of Medicine.

To contact Dr. Lin, please call (412) 942-7880.

Q: What are gall stones and how are they formed?
A: Gallstones are formed in the gall bladder, the organ that that sits just under the liver and stores bile, which helps break down fat from food in the intestine. The medical term for gallstone disease is cholelithiasis. Gallstones are composed of cholesterol and other substances and can vary greatly in size.

Q: What are the typical symptoms of gallstones?
A: Most people who have gallstones have no symptoms and are not even aware that they have them. When gallstones produce symptoms, the most common one is pain in the right side of their abdomen just below the ribcage, or in the mid-abdomen below the breast bone. This pain may radiate farther to the right side, the back and the right shoulder blade. The pain can be sharp and intense or dull and pressure-like. Although the pain may resolve, you will most likely have repeated episodes. Many people also experience bloating, nausea, and vomiting. The pain may be triggered by eating a heavy meal or rich foods.

Q: Who is likely to develop gallstones?
A: Gallstones are common. Approximately one in 10 adult Americans have one or more stones in their gallbladder; for adults over age 65 the rate is higher, with one in every five having gallstones. Gallstones are more common in women. Other risk factors are obesity; rapid weight loss; high fat and high cholesterol diet; diabetes; sickle cell disease and other hemoglobin disorders; and cirrhosis of the liver. Taking estrogen and certain medications increase one’s risk.

Q: How is the diagnosis made?
A: When a patient presents with these symptoms, we confirm the presence of gallstones by ultrasound or CT scan.

Q: What is the treatment?
A: The ideal treatment for gallstones that are symptomatic is surgery to remove the gall bladder, known as cholecystectomy. We can live healthy lives without the gall bladder; the body compensates. When I counsel my patients about surgical options for gallstone disease, I offer the “minimally invasive” approach, which is a laparoscopic cholecystectomy. This operation involves visualizing and removing the gallbladder utilizing a light or “scope,” a small video camera and thin instruments that work through several very small incisions in the abdomen. This surgery is safe and has several significant advantages: a much shorter hospital stay, decreased postoperative discomfort, and minimal scarring. With all surgeries, there is a risk of infection, bleeding and injury but with laparoscopic gall bladder surgery the risk is very low. The outcome is that the patient gets permanent relief from gallstone pain.

Q: What is the usual post-operative course?
A: I give my patients a nerve block, injecting a numbing medication that minimizes post-op pain. My patients have been very satisfied with this technique, as they have significantly less pain immediately following the operation, and pain control at home is easily managed without a narcotic prescription. Most patients use over the counter ibuprofen and Tylenol for a couple days.

After elective surgery, patients can usually resume normal daily activities the day after surgery. There are few limitations after gallbladder removal. I recommend avoiding foods that are fried or have high fat content, as this can cause abdominal pain, discomfort or diarrhea, as the body adjusts to not having a gallbladder. Some of my patients, at their follow-up visit, tell me that they have opted to continue this diet, with the goal of better wellness and health.

Q: What happens if you have gall stones and you don’t have the surgery?
A: Without the surgery, the symptoms will recur and may become more frequent and even life-limiting. In addition, one percent to two percent of patients per year develop major complications from gallstones, such as cholecystitis, choledocholithiasis (bile duct cysts), cholangitis (inflammation of the bile duct), and gallstone pancreatitis.

For more information, visit www.aetnamedicare.com and https://aetna.benefitscheckup.org/welcome-aetna/             

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