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Bruce E. Freedman, M.D., F.A.C.S.
Breast Surgery
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1.

As long as I take my medication for heartburn I don't get the acid burning, however, when I lie down, I still notice regurgitation of stomach contents into my throat and mouth. Can anything be done for this?
Your acid symptoms are well controlled with the medication because they prevent the stomach from producing acid. However, you need to reconstitute a high-pressure zone at the esophagogastric junction to prevent regurgitation. Your lower esophageal sphincter is incompetent. This can be corrected with surgery.

2.

For the past few years Iíve had difficulty swallowing. My doctors have told me I have achalasia. Is there anything that can be done surgically?
Absolutely.
Achalasia implies there is a very hypertonic area at the esophagogastric junction as well as no peristaltic activity (contractions) of the esophagus. The procedure of choice for most patients is a laparoscopic Heller esophagogastric myotomy. This cuts one of the muscle layers of the esophagus and enables complete relaxation of the hypertonic area. Because of this, an anti-reflux procedure also done with the myotomy should be done to prevent heartburn. There are often non-surgical procedures as well as Botox injection and preventative dilations, but these options tend to be transient.

3.

I have ITP (idiopathic thrombocytopenic purpura). I was diagnosed with this because of my low platelet count. Is there anything that can be done so I wonít have to take steroids?
Yes, laparoscopic splenectomy can be done relatively easily, and can be extremely effective in the right setting to eliminate ITP.

4.

I was told I have an adrenal mass. Do I need surgery? Can it be done with a minimally invasive technique?
Surgery for adrenal tumors depends upon the size of the mass and whether or not it is a functioning tumor. Some adrenal tumors secrete certain compounds that do make surgery necessary. Tumors of the adrenal gland that are five centimeters or larger are recommended for removal because of the risk of being cancer. Most patients with an adrenal tumor are candidates for a laparoscopic approach, as long as your surgeon has the experience necessary to perform such surgery.

5.

Iíve been having severe right upper quadrant abdominal pain and pain in the middle of my upper abdomen frequently after eating primarily fatty type foods. The pain last anywhere from 30 minutes to 5-6 hours. What might this indicate?
Based on your symptoms, I suspect you may be experiencing gallbladder disease. Most patients with cholelithiasis (gallstones) experience postprandial (after eating) pain. The pain is most frequently in the right upper quadrant of the abdomen or the epigastrium. These pains may last for hours and may be associated with nausea and vomiting.

6.

Iíve been told I have gallstones. These were seen on ultrasound while they were evaluating my kidney. Do I need surgery?
Patients without symptoms that have gallstones (cholelithiasis) do not require surgery; those patients with symptoms should have surgery.

7.

Iíve been told I need my gallbladder removed. Will I miss it?
No, your gallbladder is basically a storage depot. Bile is made in the liver and stored and concentrated in the gallbladder. Once the gallbladder is removed, the bile (which aids in fat absorption) is stored in the liver.

8.

My doctor says I have Barrett's Esophagus on endoscopy. Will medication cause regression of my Barrett's?
Most likely, medication will not cause regression, but can keep the disease in check. Surgery with a fundoplication has been shown to cause regression with very little morbidity.

9.

My heartburn medication is no longer effective. Are there any other more permanent solutions?
For those patients resistent to medical management, laparoscopic fundoplication provides a safe, effective, and long lasting treatment for patients with severe gastroesophageal reflux. An overnight stay is all that is usually required, and most patients return to their normal activities within 1-2 weeks.

10.

My hematologist has told me I have hereditary spherocytosis. Frequently I have required transfusions because my abnormal red blood cells get destroyed. Can anything be done surgically to eliminate this problem?
Hereditary spherocytosis has to do with abnormally shaped red blood cells that are prematurely destroyed by the spleen due to their shape and fragility. These patients also have a higher incidence of gallstones, due to the increase in bilirubin from red cell destruction. Laparoscopic splenectomy, (the removal of the spleen) is the procedure of choice. You should have an abdominal ultrasound prior to surgery to evaluate your gallbladder and have that removed as well if any gallstones are present.

 
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