Surgery Updates for PCPs

Ursodiol

For patients hesitant to undergo cholecystectomy, there is often little downside to initiating ursodiol therapy. There are many dosage ranges, I often use 300mg bid or tid, and continue it for at least 3-6 months, sometimes opting to follow the patient symptomatically versus repeating an ultrasound at that time. Remember the best results are when ursodiol is combined with a healthy low-fat diet, and when the stones are not very large (e.g. > 1 cm). Ursodiol is fairly safe, there are some reports of it increasing one’s chances of enteroliths, so it should be used cautiously in Crohns patients who may have strictures.

Hernias and Mesh

Though mesh hernia repairs are still the most common technique employed in the US, in non-overweight patients, the results of Shouldice and Desarda repairs are very close to, if not statistically comparable, to standard mesh repairs. Though most patients with mesh do not have long-term issues, there are undeniably some patients with mesh reactions. We recall a patient who had a red rash that persisted for months precisely in the inguinal region overlying the area of the repair, and when it was finally removed, the rash faded by the time the patient was in recovery!

More Options for Hemorrhoids

We have started using Hemwell to treat hemorrhoids, and it is a very simple and effective technique comparable to other techniques like HET and IRC. In others’ data and our initial experience, it seems more effective, comparable to surgical hemorrhoidectomy but it is relatively painless, similar to banding.