STOMACH PAIN CAUSES & TREATMENT

Abdominal Pain in Adults Overview

Abdominal pain can range in intensity from a mild stomach ache to severe acute pain. The pain is often nonspecific and can be caused by a variety of conditions. Many organs are found within the abdominal cavity. Sometimes the pain is directly related to a specific organ such as the bladder or ovary, while other times it is more diffuse or non-specific.. Usually, abdominal pain originates in the digestive system. For example, the pain can be caused by appendicitis, diarrheal cramping, or food poisoning.

The type and location of pain may help the physician find the cause. The intensity and duration of pain must also be considered when making a diagnosis. A few general characteristics of abdominal pain are as follows:

• Character of Pain: Abdominal pain can be sharp, dull, stabbing, cramp-like, knifelike, twisting, or piercing. Many other types of pain are possible.
  
• Duration of Pain: Abdominal pain can be brief, lasting for a few minutes, or it may persist for several hours and longer. Sometimes abdominal pain comes on strongly for a while and then lessens in intensity for a while.
  
• Triggering Events: The pain may be worsened or relieved by certain events, such as worse after meals, better with a bowel movement, better after vomiting, or worse when lying down.

Abdominal pain can make a person want to stay in one place and not move a muscle. Or the pain can make them so restless they want to pace around trying to find "just the right position."

The health care practitioner will try to pinpoint the area of the abdomen where the pain originates when determining the cause of abdominal pain. This is done by combining questions such as - "When you first had the pain, where did you feel it?" - with examination of the abdomen. Softly pressing on certain areas to elicit the pain and perhaps palpating other areas to examine the size and exact location of an organ are other parts of the physical examination.

When this is combined with general questions about the pain such as "Is the pain dull or sharp?" "How long have you had the pain?" and questions about your state of health - "Did you have to vomit?" - the health care practitioner can narrow down the possible causes of the pain.

Once the questions and physical exam are completed, the health care practitioner will either give the patient a diagnosis and advise on follow-up recommendations or order blood tests, and possibly X-rays and imaging studies to further help identify why the patient is in pain.

Abdominal Pain in Adults Causes

Many acute (short-term) and chronic (long-term) diseases cause abdominal pain.

• Diseases people worry about most are appendicitis, gallbladder disease, duodenal and gastric ulcers, infections, and pregnancy-associated problems.
  
• Doctors also worry about the following conditions: ruptured blood vessels, heart attack, liver and pancreas inflammation, kidney stones, problems with the blood circulation to the intestine, diverticulitis, and other diseases.

Abdominal pain may not arise from the abdomen.

• Some heart attacks and pneumonias can cause abdominal pain.
  
• Diseases of the pelvis or groin can also cause a pateint's abdomen to hurt.
  
• Certain skin rashes, such as shingles, can feel like abdominal pain, even though the person has nothing wrong inside their body.
  
• Even some poisonings, such as a black widow spider bite, can cause severe abdominal pain.

From the above it is apparent that abdominal pain can have many causes, some linked directly to the abdomen and others caused by non-abdominal disease. Sometime the cause of abdominal pain is not found by the patient's health care practitioner during the initial evaluation. In some cases, no specific cause is determined, and the pain gets better in hours or days.

Abdominal Pain in Adults Symptoms

Abdominal pain is a symptom. It may mean that the person has a medical problem that needs treatment.

Abdominal pain may go along with other symptoms. Try to keep track of the symptoms, because this will help the health care practitioner's find the cause of the person's pain.

When to Seek Medical Care

Call or see a health care practitioner if the affected person has any of the following:

• Abdominal pain that lasts more than six hours or continues to worsen
  
• Pain that stops the person from eating
  
• Pain accompanied by vomiting more than three or four times
  
• Pain that worsens when the person tries to move around
  
• Pain that starts all over, but settles into one area, especially the right lower abdomen
  
• Pain that wakes the person up at night
  
• Pain with vaginal bleeding or pregnancy, even if the person only thinks she might be pregnant
  
• Pain accompanied by fever over 101 F (33.3 C)
  
• Pain along with inability to urinate, move the bowels, or pass gas
  
• Any other pain that feels different from a simple stomach ache
  
• Any other pain that alarms the person, or concerns them in any way

If the person has any of the following, or cannot reach their health care practitioner, go to a hospital emergency department:

• The "worst pain of your life" or very severe pain
  
• Pain so bad the affected person passes out or almost passes out
  
• Pain so bad the affected person cannot move
  
• Pain and vomiting blood, or any vomiting that lasts more than six hours
  
• Pain and no bowel movement for more than three days
  
• Pain the person thinks might be in their chest, but they aren't sure
  
• Pain that seems to come from the person's testicles

Abdominal Pain in Adults Diagnosis

Diagnosing the cause of abdominal pain is one of the hardest tasks for a health care practitioner. Sometimes all that the practitioner can do is be sure that the pain does not require surgery or admission to the hospital.

The health care practitioner may ask these or similar questions to try to determine what is causing the patient's pain. Some may seem unrelated to the patient's current condition, but try to answer them as completely as possible. The answers to these questions can help the health care practitioner find the cause of the patient's pain more quickly and easily.

• How long have you had the pain?
  
• What were you doing when it started?
  
• How did you feel before the pain started?
  
• Have you felt OK over the last few days?
  
• What have you tried to make the pain better? Did it work?
  
• What makes the pain worse?
  
• Does the pain make you want to stay in one place or move around?
  
• How was the ride to the hospital? Did riding in the car hurt you?
  
• Is the pain worse when you cough?
  
• Have you thrown up?
  
• Did throwing up make the pain better or worse?
  
• Have your bowel movements been normal?
  
• Are you passing gas?
  
• Do you feel you might have a fever?
  
• Have you had a pain like this before? When? What did you do for it?
  
• Have you ever had surgery? What surgery? When?
  
• Are you pregnant? Are you sexually active? Are you using birth control?
  
• Have you been around anyone with symptoms like this?
  
• Have you traveled out of the country recently?
  
• When did you eat last? What did you eat?
  
• Did you eat anything out of the ordinary?
  
• Did your pain start all over your stomach and move to one place?
  
• Does the pain go into your chest? Into your back? Where does it go?
  
• Can you cover the pain with the palm of your hand, or is the hurting area bigger than that?
  
• Does it hurt for you to breathe?
  
• Do you have any medical problems such as heart disease, diabetes, or AIDS?
  
• Do you take steroids? Pain medicine such as aspirin or Motrin?
  
• Do you take antibiotics? Over-the-counter pills, herbs, or supplements?
  
• Do you drink alcohol? Coffee? Tea?
  
• Do you smoke cigarettes?
  
• Do you use cocaine or other drugs?

Physical examination will include a careful examination of the patient's abdomen, heart, and lungs in order to pinpoint the source of the pain.

• The examiner will touch different parts of the abdomen to check for tenderness or other signs that indicate the source of the pain.
  
• The examiner may do a rectal exam to check for small amounts of blood in the stool or other problems such as a mass or internal hemorrhoids.
  
• If the patient is a man, the doctor may check the penis and testicles.
  
• If the patient is a woman, the doctor may do a pelvic exam to check for problems in the uterus, Fallopian tubes, and ovaries.
  
• The doctor also may look at the patient's eyes for yellow discoloration (jaundice) and in the mouth to be sure the patient is not dehydrated.

Laboratory tests may not help to find the cause of the abdominal pain. However, if combined with the information gained from the questions the patient was asked and the physical examination performed by the health care practitioner, certain blood or urine tests may be ordered and could assist in determining the diagnosis.

• One of the most important tests is to see if a woman is pregnant.
  
• A raised white blood cell count may mean infection or may just be a reaction to the stress of pain and vomiting.
  
• A low blood count (hemoglobin) may show that the patient is bleeding internally, but most conditions that involve bleeding are not painful.
  
• Blood in the urine, which may not be visible to the eye, may suggest the patient may have a kidney stone.
  
• Other blood tests, such as liver enzymes and pancreas enzymes, can help determine which organ is involved, but they do not point to a diagnosis.

Radiology studies of the patient's abdomen can be useful, but are not always necessary or helpful.

• Occasionally, an X-ray will show air outside of the bowel, meaning that something has ruptured or perforated.
  
• An X-ray also can help diagnose bowel obstruction.
  
• Sometimes X-rays can show a kidney stone.

Ultrasound is a painless procedure useful in finding some causes of abdominal pain.

• This may be done if the health care practitioner suspects problems with the gallbladder, pancreas, liver, or the reproductive organs of women.
  
• Ultrasound also assists in the diagnosis of problems with the kidneys and the spleen, or the large blood vessels that come from the heart and supplies blood to the lower half of the body.

CT scan is a special type of x-ray that provides useful information about the liver, pancreas, kidneys and ureters, spleen, and small and large intestine, including diseases such as appendicitis and diverticulitis.

You and your health care practitioner should discuss the diagnostic needs for an X-ray, and the potential radiation exposure before proceeding with any X-ray examination.

The health care practitioner may perform no tests at all. The cause of the patient's pain may be clear without any tests and may be known not to be serious. If the patient does undergo tests, the practitioner should explain the results to them.

Abdominal Pain in Adults Treatment

Self-Care at Home

Abdominal pain without fever, vomiting, vaginal bleeding, passing out, chest pain, or other serious symptoms often get better without special treatment.

• If the pain persists or if the person believes the pain may represent a serious problem, they should see a health care practitioner.
  
• A heating pad or soaking in a tub of warm water may ease the person's pain.
  
• Over-the-counter antacids, such as Tums, Maalox, or Pepto-Bismol, also can reduce some types of abdominal pain. Activated charcoal capsules also may help.
  
• Acetaminophen (common brand names are Arthritis Foundation Pain Reliever, Aspirin Free Anacin, Panadol, Liquiprin, Tylenol) may help. This product should be avoided if liver disease is suspected. Try to avoid aspirin or ibuprofen (common brand names are Advil, Motrin, Midol, Nuprin, Pamprin IB) if stomach or ulcer disease is suspected. These drugs can make some types of stomach ache worse.

Medical Treatment

The patient's treatment will depend on what the doctor thinks is causing the abdominal pain.

The patient may be given IV (intravenous) fluids. The health care practitioner may ask the patient not to eat or drink anything until the cause of the pain is known. This is done to avoid worsening certain medical conditions (for example adding food to the stomach if there is a ruptured ulcer) or to prepare the patient in case they need to have surgery (an empty stomach is better when general anesthesia is needed).

The patient may be given pain medication.

• For pain caused by bowel spasm, they may be given a shot in the hip, arm, or leg.
  
• If the patient is not throwing up, they may receive a drink that has antacid in it or pain medication.
  
• Although the patient's pain may not go away completely, they have the right to be comfortable and should ask for pain medicine until they are made comfortable.

Surgery

Some types of abdominal pain require surgical treatment.

• If the patient's pain comes from an infected internal organ, such as the appendix or gallbladder, they will be admitted to a hospital and will need surgery.
  
• Bowel obstruction sometimes requires surgery, depending on what is causing the obstruction.
  
• If the patient's pain comes from a ruptured or perforated organ, such as the bowel or stomach, they will need immediate surgery and will be taken directly to an operating room.

Follow-up

If the person is allowed to go home after their evaluation, they may be given instructions about what they can and cannot eat and drink and which medications they may take. The person may be told to return to the emergency department if certain conditions occur.

If the person is given no specific instructions, then follow these recommendations:

• As soon as you feel like eating, start with clear liquids.
  
• If clear liquids cause no further pain or vomiting, progress to bland foods such as crackers, rice, bananas, applesauce, or toast.
  
• You may return to a normal diet in a few days if your symptoms do not return.

Go back to the emergency department or to your doctor in the following situations:

• Your pain worsens or if you start vomiting, get a high fever, or cannot urinate or move your bowels.
  
• You have any symptom that seems worse or alarms you.
  
• Your abdominal symptoms are not better in 24 hours.

Abdominal Pain in Adults Prevention

If the diagnosis is determined, the person should follow the instructions specific for that diagnosis.

• If, for example, an ulcer causes the pain, the person must avoid nicotine, caffeine, and alcohol.
  
• If it is caused by gallbladder disease, the person should avoid greasy, fatty, and fried foods.

Abdominal Pain in Adults Prognosis

Overall, many types of pain go away without surgery, and most people need only relief from their symptoms.

Medical causes of abdominal pain generally have a good outcome, but there are exceptions.

Surgical causes of abdominal pain have varying outcomes depending on the severity of the condition and the person's underlying medical condition.

• If the patient has uncomplicated appendicitis or uncomplicated gallstones, they should recover from the surgery with no long-term problems.
  
• If the patient has a ruptured appendix or infected gallbladder, recovery may take longer.
  
• Abdominal pain from a perforated ulcer or blocked bowel may mean major surgery and a long recovery.

For problems with a major blood vessel, such as rupture or blood clot, the prognosis may be poor.

In general, the older the patient and the more underlying conditions the patient has, the worse the outcome of a surgical intervention.

GALL BLADDER STONE& IT'S TREATMENT

Gallstones Overview

Gallstones (commonly misspelled gall stones or gall stone) are solid particles that form from bile in the gallbladder.

• The gallbladder is a small saclike organ in the upper right part of the abdomen. It is located under the liver, just below the front rib cage on the right side.
  
• The gallbladder is part of the biliary system, which includes the liver and the pancreas.
  
• The biliary system, among other functions, produces bile and digestive enzymes.

Bile is a fluid made by the liver to help in the digestion of fats.

• It contains several different substances, including cholesterol and bilirubin, a waste product of normal breakdown of blood cells in the liver.
  
• Bile is stored in the gallbladder until needed.
  
• When we eat a high-fat, high-cholesterol meal, the gallbladder contracts and injects bile into the small intestine via a small tube called the common bile duct. The bile then assists in the digestive process.

There are two types of gallstones: 1) cholesterol stones and 2) pigment stones.

1. Patients with cholesterol stones are more common in the United States; cholesterol stones make  up approximately 80% of all gallstones. They form when there is too much cholesterol in the bile.
   
2. Pigment stones form when there is excess bilirubin in the bile.

Gallstones can be any size, from tiny as a grain of sand to large as a golf ball.

• Although it is common to have many smaller stones, a single larger stone or any combination of sizes is possible.
  
• If stones are very small, they may form a sludge or slurry.
  
• Whether gallstones cause symptoms depends partly on their size and their number, although no combination of number and size can predict whether symptoms will occur or the severity of the symptoms.

Gallstones within the gallbladder often cause no problems. If there are many or they are large, they may cause pain when the gallbladder responds to a fatty meal. They also may cause problems if they move out of the gallbladder.

• If their movement leads to blockage of any of the ducts connecting the gallbladder, liver, or pancreas with the intestine, serious complications may result.
  
• Blockage of a duct can cause bile or digestive enzymes to be trapped in the duct.
  
• This can cause inflammation and ultimately severe pain, infection, and organ damage.
  
• If these conditions go untreated, they can even cause death.

Up to 20% of adults in the United States may have gallstones, yet only 1% to 3% develop symptoms.

• Hispanics, Native Americans, and Caucasians of Northern European descent are most likely to be at risk for gallstones. African Americans are at lower risk.
  
• Gallstones are most common among overweight, middle-aged women, but the elderly and men are more likely to experience more serious complications from gallstones.
  
• Women who have been pregnant are more likely to develop gallstones. The same is true for women taking birth control pills or on hormone/estrogen therapy as this can mimic pregnancy in terms of hormone levels.

Gallstones Causes

Gallstones occur when bile forms solid particles (stones) in the gallbladder.

• The stones form when the amount of cholesterol or bilirubin in the bile is high.
  
• Other substances in the bile may promote the formation of stones.
  
• Pigment stones form most often in people with liver disease or blood disease, who have high levels of bilirubin.
  
• Poor muscle tone may keep the gallbladder from emptying completely. The presence of residual bile may promote the formation of gallstones.

Risk factors for the formation of cholesterol gallstones include the following:

• female gender,
  
• being overweight,
  
• losing a lot of weight quickly on a "crash" or starvation diet, or
  
• taking certain medications such as birth control pills or cholesterol lowering drugs.

Gallstones are the most common cause of gallbladder disease.

• As the stones mix with liquid bile, they can block the outflow of bile from the gallbladder. They can also block the outflow of digestive enzymes from the pancreas.
  
• If the blockage persists, these organs can become inflamed. Inflammation of the gallbladder is called cholecystitis. Inflammation of the pancreas is called pancreatitis.
  
• Contraction of the blocked gallbladder causes increased pressure, swelling, and, at times, infection of the gallbladder.

When the gallbladder or gallbladder ducts become inflamed or infected as the result of stones, the pancreas frequently becomes inflamed too.

• This inflammation can cause destruction of the pancreas, resulting in severe abdominal pain.
  
• Untreated gallstone disease can become life-threatening, particularly if the gallbladder becomes infected or if the pancreas becomes severely inflamed.

Gallstones and Diet

The role of diet in the formation of gallstones is not clear.

• We do know that anything that increases the level of cholesterol in the blood increases the risk of gallstones.
  
• It is reasonable to assume that a diet with large amounts of cholesterol and other fats increases the risk of gallstones, but it is also important to remember that the amount of cholesterol in your bile has no relationship to your blood cholesterol.
  
• Loosing weight rapidly seems to increase the risk of gallstones and so does skipping meals.
  
• Obesity is a risk factor for gallstones.
  
• Eating a fatty or greasy meal can precipitate the symptoms of gallstones.

Gallstones Symptoms

Most people with gallstones (60% to 80%) have no symptoms. In fact, they are usually unaware that they have gallstones unless symptoms occur. These "silent gallstones" usually require no treatment.

Symptoms usually occur as complications develop. The most common symptom is pain in the right upper part of the abdomen. Because the pain comes in episodes, it is often referred to as an "attack."

• Attacks may occur every few days, weeks, or months; they may even be separated by years.
  
• The pain usually starts within 30 minutes after a fatty or greasy meal.
  
• The pain is usually severe, dull, and constant, and can last from one to five hours.
  
• It may radiate to the right shoulder or back.
  
• It occurs frequently at night and may awaken the person from sleep.
  
• The pain may make the person want to move around to seek relief, but many patients prefer to lay still and wait for the attack to subside.

Other common symptoms of gallstones include the following:

• nausea and vomiting,
  
• fever,
  
• indigestion, belching, bloating,
  
• intolerance for fatty or greasy foods, and
  
• jaundice (yellowing of the skin or the whites of the eyes).

Warning signs of a serious problem are fever, jaundice, and persistent pain.

When to Seek Medical Care

If a person has an episode or recurring episodes of abdominal pain 30 minutes to one hour following meals, call a health care practitioner for an appointment.

Go to a hospital emergency department if the person has this abdominal pain with any of the following conditions:

• the abdominal pain cannot be controlled with over-the-counter pain medication;
  
• the person begins vomiting or develops a fever, chills, or sweats; or
  
• the person has jaundice.

Gallstones Diagnosis

Upon hearing the patient's symptoms, the health care practitioner will probably suspect gallstones. Because the symptoms of gallbladder disease can resemble those of other serious conditions, he or she will ask the patient questions and examine them to try to confirm this diagnosis and rule out other conditions.

There is no blood test that can identify gallstones.

• Blood will be taken for tests that can help to determine if the gallbladder is obstructed, if the liver or pancreas is inflamed or not functioning properly, or if the patient has an infection.
  
• If you are a woman, the blood may also be tested to check for a possible pregnancy,
  
• Urine may be tested to rule out kidney infection. Kidney infections can cause abdominal pain similar to that caused by gallstones.

Ultrasound is the best test to examine the gallbladder for stones.

• Ultrasound uses painless sound waves to create images of organs.
  
• Ultrasound examinations are very good at seeing abnormalities in the biliary system, including stones or signs of inflammation or infection.
  
• This is the same technique used to look at a fetus in a pregnant woman.
  
• Finding gallstones by ultrasound does not diagnose gallbladder disease. The doctor has to correlate the ultrasound findings with the patient's symptoms.

An alternative to ultrasound is an oral cholecystogram (OCG).

• An X-ray is taken of the gallbladder after the patient swallow pills containing a safe, temporary dye.
  
• The dye helps the gallbladder and gallstones show up better on the X-ray.

Both ultrasound and OCG can detect gallstones in the gallbladder about 95% of the time.

• Ultrasound is usually the first choice because it is completely noninvasive and involves no exposure to radiation.
  
• If either test gives an uncertain result, another test usually is necessary.

These tests are the alternatives to ultrasound and OCG. They are better choices if gallstones have left the gallbladder and moved into the ducts.

• Cholescintigraphy (HIDA scan): This is a test in which a solution is injected into an IV line in the patient's arm. The liquid is absorbed by the liver, then passed on to be stored in the gallbladder (much like bile). The solution contains a harmless radioactive marker, which is seen by a special camera. If the gallbladder is inflamed or blocked by gallstones, none of the marker is seen in the gallbladder.
  
• CT scan: This test is similar to an X-ray, however more detailed. It shows the gallbladder and the biliary ducts and can detect gallstones, blockages, and other complications.
  
• Endoscopic retrograde cholangiopancreatography (ERCP): A thin, flexible endoscope is used to view parts of the patient's biliary system. The patient is sedated, and the tube is passed through the mouth and stomach and into the small intestine. The device then injects a temporary dye into the biliary ducts. The dye makes it easy to see any stones in the ducts when X-rays are taken. Sometimes a stone can be removed during this procedure.

A chest X-ray may be performed to make sure there are no other reasons for the abdominal pain.

• Sometimes problems in the chest (such as pneumonia ) can cause pain in the upper abdomen.
  
• Occasionally the chest X-ray can also show stones in the gallbladder.

As most gallstones are asymptomatic, many times gallstones are diagnosed when the patient undergoes a test for another reason.

Gallstones Treatment

Gallstones Self-Care at Home

After a diagnosis of gallstones, the patient may choose not to have surgery or may not be able to have surgery right away. There are measures the patient can take to relieve the symptoms to include:

• intake of only clear liquids to give the gallbladder a rest,
  
• avoid fatty or greasy meals, and
  
• take acetaminophen (Tylenol, etc.) for pain.

Call a health care practitioner if symptoms worsen or if new symptoms appear. Abdominal pain with vomiting, fever, or jaundice warrants an immediate visit to a doctor's office or a hospital emergency department.

Gallstones Medical Treatment

There is no permanent medical cure for gallstones. Although there are medical measures that can be taken to remove stones or relive symptoms, they are only temporary. If a patient has symptoms from gallstones, surgical removal of the gallbladder is the best treatment. Asymptomatic (producing no symptoms) gallstones do not require treatment.

Extracorporeal shockwave lithotripsy (ESWL): A device that generates shock waves is used to break gallstones up into tiny pieces.

• These tiny pieces can pass through the biliary system without causing blockages.
  
• This is usually done in conjunction with ERCP to remove some stones.
  
• Many people who undergo this treatment suffer attacks of intense pain in the right upper part of the abdomen after treatment.
  
• The effectiveness of ESWL in treating gallstones has not been fully established.

Dissolving stones: Drugs made from bile acids are used to dissolve the gallstones.

• It may take months or even years for the gallstones to all dissolve.
  
• The stones often come back after this treatment.
  
• These drugs work best for cholesterol stones.
  
• They cause mild diarrhea in many people.
  
• This treatment is usually offered only to people who are not able to have surgery.

If an individual goes to an emergency department, an IV line may be started, and pain medication and antibiotics may be given through the IV.

If the patient's health permits it, the health care practitioner will probably recommend surgery to remove the gallbladder and the stones. Surgical removal helps prevent future episodes of abdominal pain and more dangerous complications such as inflammation of the pancreas and infection of the gallbladder and liver.

• If there is no infection or inflammation of the pancreas, the operation to remove the gallbladder can be performed immediately or within the next several days.
  
• If there is inflammation of the pancreas or infection of the gallbladder, the patient will most likely be admitted to the hospital to receive IV fluid and possibly IV antibiotics for several days prior to the operation.

Gallstone Surgery (Cholecystectomy)

The usual treatment for symptomatic or complicated gallstones is surgical removal of the gallbladder. This is called cholecystectomy.

Many people who have gallbladder disease are understandably concerned about having their gallbladder removed. They wonder how they can function without a gallbladder.

• Fortunately, you can live without your gallbladder.
  
• Living without a gallbladder does not require a change in diet.
  
• When the gallbladder is gone, bile flows directly from the liver into the small intestine.
  
• Because there is nowhere to store bile, sometimes bile flows into the intestine when it is not needed. This does not cause a problem for most people, but causes mild diarrhea in about 1% of patients.

Laparoscopic removal: Most gallbladders are removed by laparoscopic cholecystectomy. The gallbladder is removed through a small slit in the abdomen using small tube-like instruments.

• The tube-like instruments have a camera and surgical instruments attached, which are used to take out the gallbladder with the stones inside it.
  
• This procedure causes less pain than open surgery.
  
• It is less likely to cause complications, and has a faster recovery time.
  
• A laparoscopic procedure is preferred if it is appropriate for the patient.
  
• The procedure is performed in an operating room with the patient under general anesthesia.
  
• It usually takes 20 minutes to one hour.
  
• A general surgeon performs the operation.
  
• In some cases a laparoscopic procedure is started and then changed to an open abdominal procedure (see below).

Open removal: The gallbladder is sometimes removed through a 3 to 6 inch incision in the right upper abdomen.

• The open procedure usually is used only when laparoscopic surgery is not feasible for a specific person.
  
• Common reasons for doing an open procedure are infection in the biliary tract and scars from previous surgeries.
  
• About 5% of all gallbladder removals in the United States are done as open procedures.
  
• This procedure is performed in the operating room with the patient under general anesthesia.
  
• It usually takes 45 to 90 minutes.
  
• A general surgeon performs the operation.

Occasionally, ERCP is done just before or during surgery to locate any gallstones that have left the gallbladder and are located elsewhere in the biliary system. These can be removed at the same time as surgery, eliminating the risk that they might cause a complication in the future. ERCP also may be performed after surgery if a gallstone is later found in the biliary tract. Sometimes ERCP is done without surgery, for example in people who are too frail or ill to undergo surgery.

Gallstones Follow-up

If the gallbladder has been removed, office visits to the general surgeon are required to check the operation sites one to three times following the operation. No other follow-up or long-term care is required.

Gallstone Prevention Diet

A low-fat, low-cholesterol diet can prevent symptoms of gallstones but cannot prevent formation of stones. It is not known why some people form stones and others do not.

Gallstones Prognosis

If gallstones block one of the biliary ducts, the result is inflammation and swelling of the organs "upstream" of the blocked duct.

• This complication alone can cause symptoms and warrants treatment, possibly surgery.
  
• If untreated, it can lead to more serious conditions such as infection and damage to the gallbladder, liver, and pancreas.
  
• If these organs sustain enough damage, they can no longer carry out their normal functions. This is a life-threatening complication.

If a patient has surgery, you should know the following:

• A person who has had laparoscopic surgery to remove the gallbladder may leave the hospital 12-48 hours after surgery and return to full activities within three weeks.
  
• If open surgery was required to remove the gallbladder, recovery takes a little longer. The person may leave the hospital within three to seven days and could resume normal activity after a six week recovery period.
  
• The most common complication of surgery is damage to the biliary tract. If bile leaks out of the biliary system, it can cause an infection.

If a person chooses not to have their gallbladder removed, it is likely you will have recurring abdominal pain and possibly complications.

OBESITY & IT'S TREATMENT

me obese.

Obesity means accumulation of excess fat on the body. Obesity is considered a chronic (long-term) disease, like high blood pressure or diabetes. It has many serious long-term consequences for your health, and it is a leading cause of preventable deaths in the United States (with tobacco use and high blood pressure). Obesity is defined as having a body mass index (BMI) of greater than 30. The BMI is a measure of your weight relative to your height. See the Body Mass Index Calculator.

Obesity is an epidemic in the United States and in other developed countries. More than two-thirds of Americans are overweight, including at least one in five children. Nearly one-third are obese. Obesity is on the rise in our society because food is abundant and physical activity is optional. On the bright side, recent data suggest that childhood obesity, while still high, may no longer be on the rise.

Each year, Americans spend billions of dollars on dieting, diet foods, diet books, diet pills, and the like. Another $75 billion is spent on treating the diseases associated with obesity. Furthermore, businesses suffer an estimated $20 billion loss in productivity each year from absence due to illness caused by obesity.

Obesity Causes

Weight gain occurs when you eat more calories than your body uses up. If the food you eat provides more calories than your body needs, the excess is converted to fat. Initially, fat cells increase in size. When they can no longer expand, they increase in number. If you lose weight, the size of the fat cells decreases, but the number of cells does not.

• Obesity, however, has many causes. The reasons for the imbalance between calorie intake and consumption vary by individual. Your age, gender, genes, psychological makeup, and environmental factors all may contribute.
• Genes: Obesity tends to run in families. This is caused both by genes and by shared diet and lifestyle habits. Having obese relatives does not guarantee that you will be obese.
• Emotions: Some people overeat because of depression, hopelessness, anger, boredom, and many other reasons that have nothing to do with hunger. This doesn't mean that overweight and obese people have more emotional problems than other people. It just means that their feelings influence their eating habits, causing them to overeat.
• Environmental factors: The most important environmental factor is lifestyle. Your eating habits and activity level are partly learned from the people around you. Overeating and sedentary habits (inactivity) are the most important risk factors for obesity.
• Sex: Men have more muscle than women, on average. Because muscle burns more calories than other types of tissue, men use more calories than women, even at rest. Thus, women are more likely than men to gain weight with the same calorie intake.
• Age: People tend to lose muscle and gain fat as they age. Their metabolism also slows somewhat. Both of these lower their calorie requirements.
• Pregnancy: Women tend to weigh an average of 4-6 pounds more after a pregnancy than they did before the pregnancy. This can compound with each pregnancy.
• Certain medical conditions and medications can cause or promote obesity, although these are much less common causes of obesity than overeating and inactivity. Some examples of these are as follows:
• Cushing syndrome
• Depression
• Certain medications (examples are steroids, antidepressants, birth control pills)
• Prader-Willi syndrome
• Polycystic ovarian syndrome
• Obesity can be associated with other eating disorders, such as binge eating or bulimia.
• The distribution of your body fat also plays a role in determining your risk of obesity-related health problems. There are at least two different kinds of body fat. Studies conducted in Scandinavia have shown that excess body fat distributed around the waist ("apple"-shaped figure, intra-abdominal fat) carries more risk than fat distributed on the hips and thighs ("pear"-shaped figure, fat under the skin).

When to Seek Medical Care

If you are obese, you should have a primary care physician who follows you closely and monitors you for the known complications of obesity such as diabetes and hypertension.

• If you are overweight or obese and don't know how to lose weight
• If you are concerned about the effects of a weight-loss diet or increased physical activity on your other medical problems
• If you are unsuccessful at losing weight on your own
• If you are concerned about the safety of your weight-loss method

Diagnosis of Obesity

Weight-to-height tables

These tables give general ranges of healthy weights and overweight for adult height. The tables do not take into account individual conditions. For one thing, they do not distinguish fat from muscle, water, or bone. They are much less helpful than body mass index in identifying risk of health problems related to weight.

Body fat percentage

Many health professionals agree that percentage of body weight that is fat is a good marker of obesity. Men with more than 25% fat and women with more than 32% fat are considered obese.

Body fat percentage is difficult to measure accurately, however. Special equipment is needed that is not found at most medical offices. The methods used at health clubs and weight-loss programs may not be accurate if not done properly. Inexpensive scales for home use that estimate body fat are now widely available. They may not be entirely accurate, but are generally consistent, so may be used over time to track one's progress.

Waist measurement is also an important factor. People with "apple" shapes, who tend to put on weight around their waist, have a higher risk of obesity-related health problems. This includes women with a waist measurement of greater than 35 inches and men with a waist measurement of greater than 40 inches.

Body mass index

A measure called the body mass index (BMI) is used to assess your weight relative to your height. It is defined as weight in kilograms divided by height in meters squared (kg/m ²). It can also be calculated for weight in pounds and height in inches.

Body mass index is closely related to body fat percentage but is much easier to measure. Therefore, it is used by many primary care providers to identify obesity. The greater your BMI, the higher your risk of developing health problems related to excess weight.

To calculate your body mass index, follow these steps:

• Multiply your weight in pounds by 705
• Then divide by your height in inches
• Divide this by your height in inches again

What does BMI tell you?

• Normal weight = 18.5-24.9
• Overweight = 25.0-29.9
• Obese = 30 or greater
• Morbidly obese = 40 or greater

To calculate your body mass index on the Internet, fill in your height and weight at the web site of the government's National Heart, Lung, and Blood Institute's Obesity Education Initiative.

Obesity Treatment

For most people who are overweight or obese, the safest and most effective way to lose weight is to eat less and exercise more. If you eat less and exercise more, you will lose weight. It is as simple as that. There are no magic pills. Diets that sound too good to be true are just that.

Self-Care at Home

By decreasing daily calorie intake by 500 calories or expending an extra 500 calories during exercise each day, you will lose about 1 pound per week.

Decreasing your calorie intake by 10 calories a day will equal one pound of weight loss after one year.

Any good diet plan will include exercise. It helps to increase metabolism and is one less opportunity to eat during the day. You should exercise for at least 30 minutes, five times a week. Regular exercise also helps your heart and lungs and lowers triglyceride levels that can cause heart disease. It also increases the HDL ("good cholesterol") levels. Even simple measures such as taking the stairs instead of the elevator and short walks eventually add up to a lot of calories burned. Commercial fitness programs such as Boot Camp can help you start or improve upon a fitness program.

Group support programs such as Weight Watchers or Take Off Pounds Sensibly, known as TOPS, provide peer support and promote healthy habits.

For those who don't have the time to make it to support groups, there are now many free or low cost apps available for the iPhone, iPad, or Android which help determine and track calories, nutrition, and calorie expenditure. Try LoseIt!, Weight Watchers Mobile, Restaurant Nutrition, 40:30:30, Diet Point, or Noom Weight Loss Coach.

For a more complete discussion of lifestyle changes that are helpful in losing weight, see Weight Loss and Control.

Of special interest to women who have gained weight after having a baby is the fact that breastfeeding helps you shed some extra pounds. Besides the positive effects for the baby, breastfeeding burns approximately 500 extra calories each day.

Medical Treatment

Medical treatment of obesity focuses on lifestyle changes such as eating less and increasing activity level. There are medications that can promote weight loss, although they work only in conjunction with eating less and exercising more.

Most medications that promote weight loss work by suppressing the appetite. Some medications used in the past have been shown to be unsafe and are no longer available. The newer appetite-suppressing medications are thought to be safe, but they do have side effects and may interact with certain other drugs. They are used only under the supervision of a health care provider.

For more information about weight-loss medications, go to the article Medication in the Treatment of Obesity.

Some weight-loss products are known to be dangerous. The safety of others is in question. This includes certain prescription and over-the-counter drugs and herbal supplements. Avoid them.

• "Phen-fen" and Redux: These prescription drugs have been removed from the market in the United States and many other countries. They are linked to heart valve problems and pulmonary hypertension. Pulmonary hypertension affects the blood vessels in the lungs and is often fatal.
• Ephedra: This natural substance is essentially an herbal phen-fen. It is the active ingredient in MaHuang and is used as a stimulant and appetite suppressant. Ephedra resembles the amphetamines -- the popular "diet drugs" that were banned in the 1970s -- in that it is highly addictive. Ephedra is often combined with caffeine and aspirin ("the Stack"), which increases the thermogenic (fat-burning) effect of ephedra. Ephedra increases the risk of high blood pressure, irregular heartbeat, insomnia, seizures, heart attack, stroke, and death. The FDA has recently banned ephedra because it has been linked to more than 100 deaths.
• Phenylpropanolamine (PPA) is often found in appetite suppressants as well as over-the-counter cough and cold remedies. The FDA has recommended that products containing PPA be removed from the market. Studies have suggested that this product is associated with an increased risk of hemorrhagic (bleeding) stroke in women.
• Sibutramine is an oral anorexiant that was removed from the U.S. market in 2010 due to the risk of serious adverse cardiovascular events.

Some people have tried combining more than one weight-loss drug or combining a weight-loss drug with other drugs for the purposes of losing weight. The safety and effectiveness of such drug "cocktails" is not known.

Medications for Obesity

The following medications are available in the United States by prescription. If you have been unsuccessful losing weight through diet and exercise, ask your doctor about these medications. For more information about these drugs, see Medication in the Treatment of Obesity. These are not a substitute for dietary management. Over the long term, successful long-term weight loss requires changes in overall eating patterns.

• Orlistat (Xenical 120 mg by prescription or Alli 60 mg available over the counter) is a medication approved by the FDA in 1999. Your doctor may prescribe it if you weigh more than 30% over your healthy body weight or have a BMI greater than 30. Over one year, people who followed a weight-loss diet and took orlistat lost an average of 13.4 pounds, almost 8 pounds more than people who used diet alone to lose weight. It works by reducing the absorption of fat from the intestine. Diarrhea and incontinence of stool may be side effects of this medicine.

Surgery for Obesity

Surgery to correct obesity (known as bariatric surgery) is a solution for some obese people who cannot lose weight on their own or have severe obesity-related medical problems. Generally, surgery is recommended only for morbidly obese people (body mass index 40 or greater). This means men who are at least 100 pounds overweight and women who are at least 80 pounds overweight.

The two types of bariatric surgery are malabsorptive and restrictive.

• Malabsorptive procedures decrease intestinal absorption of food by bypassing part of the digestive system. A greater proportion of food than usual passes through without being absorbed.
• Restrictive procedures decrease the amount of food that a person can take in by decreasing the size of the stomach.

Both surgical strategies entail changes in how food is processed in the body. While they are successful in helping some people lose weight, they also may cause cramps, diarrhea, and other unpleasant effects. For more information, go to the article Surgery in the Treatment of Obesity.

Liposuction is purely a cosmetic procedure that removes fat cells but has no beneficial effects on health, such as heart disease and diabetes.

Other Therapy

Behavior modification is a fancy name for changing your attitude toward food and exercise. These changes promote new habits and attitudes that help you lose weight. Many people find they cannot lose weight or keep it off unless they change these attitudes. Behavior modification techniques are easy to learn and practice. Most involve increasing your awareness of situations in which you overeat so that you can stop overeating.

Obesity Prevention

Reversing obesity and its health risks requires changing the habits of a lifetime. Eating less over the long term means learning to think about your eating habits and patterns.

What makes you overeat? Coffee break at work? Going out with friends? Watching TV? Late afternoon energy lag? Late night sweet tooth? Are you the one who finishes the last serving of dinner just so there won't be any leftovers? Do you eat high-calorie fast foods or snacks because you don't have time or energy to cook? Having some insight into your overeating habits helps you to avoid your problem situations and reach your weight goal.

Likewise, increasing your activity level is largely a matter of changing your attitude. You don't have to be a marathon runner. Look for ways to increase your activity level doing things you enjoy.

For some strategies that may help you change your habits, go to the article Weight Loss and Control.

Prognosis of Obesity

Obesity increases your risk of many other diseases and health problems, including the following:

• Heart disease
• Diabetes
• High blood pressure
• Stroke
• Osteoarthritis (especially knee, hip, and lower back pain)
• Gallstones
• Lung disease and sleep apnea
• Colon cancer
• Endometrial cancer
• Depression
• Gout
• Dementia

Depression may be one of the most common effects of obesity. Many obese people suffer emotional distress. Because of the emphasis on physical appearance in our culture, which equates slimness with beauty, obese people may feel unattractive. They also are subjected to prejudice, ridicule, and discrimination, which may make them feel ashamed or rejected.

Obesity is also a major risk factor for the development of diabetes mellitus. The good news is that this may be preventable. In clinical studies, patients who were at a high risk of developing diabetes decreased their risk by almost 60% with less than 10% weight loss in three years.

HERNIA& IT'STREATMENT

Hernia Information

A hernia occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity. Hernias by themselves may be asymptomatic (produce no symptoms) or cause slight to severe pain. Nearly all have a potential risk of having their blood supply cut off (becoming strangulated). When the content of the hernia bulges out, the opening it bulges out through can apply enough pressure that blood vessels in the hernia are constricted and therefore the blood supply is cut off. If the blood supply is cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency as the tissue needs oxygen which is transported by the blood supply.

Different types of abdominal-wall hernias include the following:

• Inguinal (groin) hernia: Making up 75% of all abdominal-wall hernias and occurring up to 25 times more often in men than women, these hernias are divided into two different types, direct and indirect. Both occur in the groin area where the skin of the thigh joins the torso (the inguinal crease), but they have slightly different origins. Both of these types of hernias can similarly appear as a bulge in the inguinal area. Distinguishing between the direct and indirect hernia, however, is important as a clinical diagnosis.


• Indirect inguinal hernia: An indirect hernia follows the pathway that the testicles made during fetal development, descending from the abdomen into the scrotum. This pathway normally closes before birth but may remain a possible site for a hernia in later life. Sometimes the hernia sac may protrude into the scrotum. An indirect inguinal hernia may occur at any age.


• Direct inguinal hernia: The direct inguinal hernia occurs slightly to the inside of the site of the indirect hernia, in an area where the abdominal wall is naturally slightly thinner. It rarely will protrude into the scrotum. Unlike the indirect hernia, which can occur at any age, the direct hernia tends to occur in the middle-aged and elderly because their abdominal walls weaken as they age.


• Femoral hernia: The femoral canal is the path through which the femoral artery, vein, and nerve leave the abdominal cavity to enter the thigh. Although normally a tight space, sometimes it becomes large enough to allow abdominal contents (usually intestine) to protrude into the canal. A femoral hernia causes a bulge just below the inguinal crease in roughly the mid-thigh area. Usually occurring in women, femoral hernias are particularly at risk of becoming irreducible (not able to be pushed back into place) and strangulated. Not all hernias that are irreducible are strangulated (have their blood supply cut off ), but all hernias that are irreducible need to be evaluated by a health-care provider.


• Umbilical hernia: These common hernias (10%-30%) are often noted at birth as a protrusion at the bellybutton (the umbilicus). This is caused when an opening in the abdominal wall, which normally closes before birth, doesn't close completely. If small (less than half an inch), this type of hernia usually closes gradually by age 2. Larger hernias and those that do not close by themselves usually require surgery at age 2-4 years. Even if the area is closed at birth, umbilical hernias can appear later in life because this spot may remain a weaker place in the abdominal wall. Umbilical hernias can appear later in life or in women who are pregnant or who have given birth (due to the added stress on the area).


• Incisional hernia: Abdominal surgery causes a flaw in the abdominal wall. This flaw can create an area of weakness in which a hernia may develop. This occurs after 2%-10% of all abdominal surgeries, although some people are more at risk. Even after surgical repair, incisional hernias may return.


• Spigelian hernia: This rare hernia occurs along the edge of the rectus abdominus muscle through the spigelian fascia, which is several inches to the side of the middle of the abdomen.


• Obturator hernia: This extremely rare abdominal hernia develops mostly in women. This hernia protrudes from the pelvic cavity through an opening in the pelvic bone (obturator foramen). This will not show any bulge but can act like a bowel obstruction and cause nausea and vomiting. Because of the lack of visible bulging, this hernia is very difficult to diagnose.


• Epigastric hernia: Occurring between the navel and the lower part of the rib cage in the midline of the abdomen, epigastric hernias are composed usually of fatty tissue and rarely contain intestine. Formed in an area of relative weakness of the abdominal wall, these hernias are often painless and unable to be pushed back into the abdomen when first discovered.

Hernia Causes

Although abdominal hernias can be present at birth, others develop later in life. Some involve pathways formed during fetal development, existing openings in the abdominal cavity, or areas of abdominal-wall weakness.

• Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia. Examples include


• obesity,


• heavy lifting,


• coughing,


• straining during a bowel movement or urination,


• chronic lung disease, and


• fluid in the abdominal cavity.


• A family history of hernias can make you more likely to develop a hernia.

Hernia Symptoms and Signs

The signs and symptoms of a hernia can range from noticing a painless lump to the severely painful, tender, swollen protrusion of tissue that you are unable to push back into the abdomen (an incarcerated strangulated hernia).

• Reducible hernia


• It may appear as a new lump in the groin or other abdominal area.


• It may ache but is not tender when touched.


• Sometimes pain precedes the discovery of the lump.


• The lump increases in size when standing or when abdominal pressure is increased (such as coughing).


• It may be reduced (pushed back into the abdomen) unless very large.


• Irreducible hernia


• It may be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it.


• Some may be chronic (occur over a long term) without pain.


• An irreducible hernia is also known as an incarcerated hernia.


• It can lead to strangulation (blood supply being cut off to tissue in the hernia).


• Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting.


• Strangulated hernia


• This is an irreducible hernia in which the entrapped intestine has its blood supply cut off.


• Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting).


• The affected person may appear ill with or without fever.


• This condition is a surgical emergency.

When to Seek Medical Care

All newly discovered hernias or symptoms that suggest you might have a hernia should prompt a visit to the doctor. Hernias, even those that ache, if they are not tender and easy to reduce (push back into the abdomen), are not necessarily surgical emergencies, but all have the potential to become serious. Referral to a surgeon should generally be made so that the need for surgery can be established and the procedure can be performed as an elective surgery and avoid the risk of emergency surgery should your hernia become irreducible or strangulated.

If you find a new, painful, tender, and irreducible lump, it's possible you may have an irreducible hernia, and you should have it checked in an emergency setting. If you already have a hernia and it suddenly becomes painful, tender, and irreducible, you should also go to the emergency department. Strangulation (cut off blood supply) of intestine within the hernia sac can lead to gangrenous (dead) bowel in as little as six hours. Not all irreducible hernias are strangulated, but they need to be evaluated.

Hernia Diagnosis

If you have an obvious hernia, the doctor may not require any other tests (if you are healthy otherwise). If you have symptoms of a hernia (dull ache in groin or other body area with lifting or straining but without an obvious lump), the doctor may feel the area while increasing abdominal pressure (having you stand or cough). This action may make the hernia able to be felt. If you have an inguinal hernia, the doctor will feel for the potential pathway and look for a hernia by inverting the skin of the scrotum with his or her finger.

Hernia Treatment

Self-Care at Home

In general, all hernias should be repaired unless severe preexisting medical conditions make surgery unsafe. The possible exception to this is a hernia with a large opening. Trusses and surgical belts or bindings may be helpful in holding back the protrusion of selected hernias when surgery is not possible or must be delayed. However, they should never be used in the case of femoral hernias.

Avoid activities that increase intra-abdominal pressure (lifting, coughing, or straining) that may cause the hernia to increase in size.

Medical Treatment

Treatment of a hernia depends on whether it is reducible or irreducible and possibly strangulated.

• Reducible hernia


• In general, all hernias should be repaired to avoid the possibility of future intestinal strangulation.


• If you have preexisting medical conditions that would make surgery unsafe, your doctor may not repair your hernia but will watch it closely.


• Rarely, your doctor may advise against surgery because of the special condition of your hernia.


• Some hernias have or develop very large openings in the abdominal wall, and closing the opening is complicated because of their large size.


• These kinds of hernias may be treated without surgery, perhaps using abdominal binders.


• Some doctors feel that the hernias with large openings have a very low risk of strangulation.


• The treatment of every hernia is individualized, and a discussion of the risks and benefits of surgical versus nonsurgical management needs to take place between the doctor and patient.


• Irreducible hernia


• All acutely irreducible hernias need emergency treatment because of the risk of strangulation.


• An attempt to reduce (push back) the hernia will generally be made, often after giving medicine for pain and muscle relaxation.


• If unsuccessful, emergency surgery is needed.


• If successful, however, treatment depends on the length of the time that the hernia was irreducible.


• If the intestinal contents of the hernia had the blood supply cut off, the development of dead (gangrenous) bowel is possible in as little as six hours.


• In cases in which the hernia has been strangulated for an extended time, surgery is performed to check whether the intestinal tissue has died and to repair the hernia.


• In cases in which the length of time that the hernia was irreducible was short and gangrenous bowel is not suspected, you may be discharged from the hospital.


o Because a hernia that was irreducible and is reduced has a dramatically increased risk of doing so again, you should therefore have surgical correction sooner rather than later.

o Occasionally, the long-term irreducible hernia is not a surgical emergency. These hernias, having passed the test of time without signs of strangulation, may be repaired electively.

Follow-up

To lower the risk of a hernia becoming irreducible or strangulated, the sooner a reducible hernia is repaired the better.

Hernia Prevention

You can do little to prevent areas of the abdominal wall from being or becoming weak, which can potentially become a site for a hernia.

Hernia Prognosis

• Risk of strangulation: In considering when to have a reducible hernia surgically repaired, it is important to know the risk of strangulation.


• The risk varies with the location and size of the hernia and the length of time it has been present.


• In general, hernias with large sac contents with a relatively small opening are more likely to become strangulated.


• Hernias that have been present for many years may become irreducible.


• Operative complications: Approximately 7% of people undergoing surgical hernia repair will have complications.


• These are short-term and usually treatable.


• The hernia that comes back after initial surgical repair can be repaired by the same or an alternate method.


• Complications include the following:


• recurrence (most common),


• urinary retention,


• wound infection,


• fluid build-up in scrotum (called hydrocele formation),


• scrotal hematoma (bruise), and


• testicular damage on the affected side (rare).