Friday, June 22, 2007

How To Remove Your Gallbladder

I have a lot of respect for the lowly gallbladder. It’s the unsung hero of digestion. The stomach is such a prima donna, always making such a fuss and getting all the glory. The small intestine, all long and windy, takes up all the room and takes all the credit for final digestion. The large intestine is bloated and slow. And what can I say about the rectum? But the gall bladder is so often overlooked. Why, without this lovely, bulbous, Kermit-the-Frog-green organ, your fatty food simply wouldn’t be digested properly, and the acidity of your intestines would be thrown off. It’s not easy being green. The gallbladder collects and processes bile from your liver, then that bile, mainly bilirubin, goes in and does its job to further digest your food and, let’s not forget, colorize what remains. Sadly, this wonderful little organ has to be removed in some patients when it stops working properly.

If you had to have your gall bladder removed, how do you think they would do it? Most likely they would make a small incision in your belly just to the right of the center of your abdomen. Using laparoscopy (i.e. the use of an endoscope to see inside the body cavity) and remotely-viewed surgical scissors, the surgeons would snip off the gall bladder, remove it through that hole in your belly, and sew you up. You’d be out of the hospital in a day, and would heal over the course of a few weeks. HERE is a YouTube video of a laparoscopic cholecystectomy (gall bladder removal) surgery.

But in the last couple months, a couple surgical teams have taken a very, VERY different approach at gall bladder removal. They believe that going through the body’s natural orifices, one can reduce pain, remove visible scarring, and produce a quicker recovery time. They call the procedure NOTES (natural orifice translumenal endoscopic surgery). Makes sense to me.

But the big question is, WHICH orifice is appropriate?

There are only so many choices.

Two methods come to mind as likely guesses: go through the mouth to the stomach or upper portion of the small intestine, or come up through the anus. I guess the only question you’d have to ask yourself is, “Which of my holes to I respect more?”

A team at Legacy Good Samaritan Hospital and Medical Center in Portland, Oregon, USA, chose the stomach (HERE is an article on it). Going through the patient’s mouth, they cut a hole in the stomach, reached through to do the snipping, pulled the gall bladder back through the hole in the stomach and back up through the mouth, then stitched up the incision. The surgery was a success, but I can only imagine the taste in that poor woman’s mouth afterward.

Patient (upon waking): “Doc, it tastes like I just barfed up my guts.”

Doc: “Yep. Would you like some mouthwash?”

Another team at New York Presbyterian Hospital/Columbia University Medical Center chose a substantially different orifice. No, they didn’t go through the ass. Well, not quite. They went through the patient’s VAGINA! (HERE is an article on it).

I would have liked to have seen the woman's face when the doctor suggested the procedure to her. That couldn't have gone well. The lead surgeon (Marc Bessler) reported his results at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) in Las Vegas on Sunday, April 22. The surgery was a success.

Patient (upon waking): “Did everything go all right, Doctor?”

Doc: “Congratulations! You’ve given birth to your gall bladder!”

Patient: “I think I’ll name it Billy Rubin.”

Ah! Now that’s medical progress for ya.

Image taken from HERE.


Maggie said...

Ahahha, you got me at Billy Rubin - good one.

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emedwriter said...

I write for Columbia so I've written about these procedures several times for Dr. Bessler and the others. This is hilarious - far more entertaining than the articles I do!

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