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General and Vascular Surgery

General Surgeons Treat Common Conditions

The Children's Hospital of Southwest Florida

“ A muscular organ, the gallbladder is stimulated to contract when we eat fatty foods,, ” Dr. Haicken explains.
There are a number of common conditions that require a referral to the general surgeon, but two of the more common issues often only require outpatient surgery or, at most, a night in the hospital. General surgeons Bertrand Fonji, M.D., and Barry Haicken, M.D., explain thyroid surgery and cholecystectomy—also known as gallbladder removal.

Thyroid Surgery

Nodules, which can be solid or filled with fluid, form on the thyroid, which is a gland located at the base of the neck. Some patients may not realize the nodules are there, while others have a persistent cough, difficulty swallowing, neck pain or voice changes. Whether the patient experiences symptoms or the nodules are found during a routine physical exam, a primary care physician will order an ultrasound to determine the size and shape of the nodule. Depending on the size of the nodule, a referral to the general surgeon may be the next step.

"If the nodule is larger than 1.5 centimeters, we do a biopsy to check for malignancy," Dr. Fonji explains. "Then, based on the biopsy, we decide whether to observe it or remove it. If the nodule is found to be cancerous, then we remove the thyroid. Sometimes, we only have to take half of the thyroid, and in that case, the patient does not need to take a thyroid supplement. But, if we take the whole thyroid, the patient needs to take a supplement once a day for the rest of his or her life. We also may remove the thyroid if a patient has hyperthyroidism, meaning the thyroid produces too much hormone."

The surgery is usually done as a same-day, outpatient procedure, unless the thyroid is removed completely—then the patient stays at the hospital overnight. "The procedure is done via one small incision in the neck," Dr. Fonji says. "Patients may experience minimal neck pain and can be treated with an over-the-counter pain reliever." Dr. Fonji adds that if the nodule is smaller than 1.5 centimeters and is not cancerous, the protocol is watchful waiting. But, if the nodule grows and affects a patient's ability to swallow or breathe, then surgery to remove the nodule is recommended

Cholecystectomy (Gallbladder removal)

The gallbladder is the organ that stores bile—or digestive fluid—overnight and between meals. "A muscular organ, the gallbladder is stimulated to contract when we eat fatty foods," Dr. Haicken explains. "This contraction squeezes the bile out of the gallbladder and into the intestines via the common bile duct. For some patients, the bile thickens and forms stones in the gallbladder."

When gallstones form and become lodged in the cystic duct, patients can experience pain in the upper abdomen or in the midline of the body, especially after meals. Patients also may experience excessive belching or flatus—gas generated in the stomach or bowels.

Some patients may visit their primary care physician, while others experience extreme pain and go straight to the emergency department. Either way, an ultrasound confirms the presence of stones and patients are referred to the general surgeon to discuss the option of removing the gallbladder.

"The surgery is done through four, ¼-inch incisions," Dr. Haicken says. "The laparoscopic approach allows the patient to go home the same day of the surgery or he or she may spend one night in the hospital." Compared to the former open technique that took nearly two hours and required lengthier hospital stays, the laparoscopic surgery takes about 45 minutes. Dr. Haicken adds that the body does not require the gallbladder to survive, so, for most patients with gallbladder disease, the laparoscopic gallbladder removal is the best option for treatment.

"Why gallstones form in some people and not others is unknown," Dr. Haicken says. "But, there are 20 million people walking around the United States with gallstones and one million gallbladder removals are done each year, so it is a very common condition." If you or someone you know experiences symptoms of thyroid nodules or gallstones, call your primary care physician.

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Going Inside Gallbladder Surgery

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Bertrand Fonji, M.D.
General Surgery
Lee Physician Group
1435 SE 8th Terrace
Suite B
Cape Coral, FL 33990
239-343-9960

Barry Haicken, M.D.
General Surgery
Lee Physician Group
1435 SE 8th Terrace
Suite B
Cape Coral, FL 33990
239-343-9960

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