As soon as the doctor recommends surgery, a flood of feelings rush in—fear of pain, worry about scars, anesthesia, costs, and ultimately the unavoidable issue of a long hospital stay. Since surgery usually requires hospitalization, you want to get better, but you can’t take many days off work. What should you do?
What if you could have surgery… without staying in the hospital? How great would that be? Today, we will get to know One Day Surgery (ODS) with Associate Professor Dr. Thanyadet Nimmanwutipong, Head of the Advanced Surgical Technology Center (ASIT) at Phyathai 3 Hospital.
Which diseases can be treated with surgery without hospital admission?
In Thailand, several conditions are accepted for one-day surgery treatment, such as hernia repair in the groin, hemorrhoids, gallstones, bile duct or esophageal stricture dilation, and colon polyp removal via endoscopy.
Most of these surgeries are low-risk with minimal side effects, suitable for patients in good overall health or those who have family members at home to assist with post-operative care. After surgery, patients who recover well and show no abnormal symptoms can continue recovery at home without hospital admission.
The medical staff will follow up closely by phone and provide advice. Today, we will focus on one of the most common conditions treated with outpatient surgery: “gallstones”.
How do gallstones form?
First, it’s important to understand that the liver produces about 800-1000 cc of bile daily, but we don’t use it all at once. The bile produced is gradually stored temporarily in the gallbladder, which concentrates the bile by absorbing excess water. To explain simply, bile is like soy sauce: the liver produces soy sauce, and the gallbladder concentrates it into dark soy sauce. The bile in the gallbladder becomes thicker. If the bile’s composition becomes unbalanced, such as having too much cholesterol, it can precipitate and form stones.
Does eating fried and fatty foods increase the risk?
Consuming excessive amounts of food, whether carbohydrates or sugar, leads to excess energy being stored as fat in various organs. This raises blood cholesterol and triglyceride levels. Since bile naturally contains fat, consuming more fat than needed is another risk factor.
However, not eating fried or fatty foods doesn’t mean you’re risk-free! Cholesterol in bile is synthesized by the liver, and each person produces different amounts. Genetics also play a role. If someone in your family has a history of gallstones, your risk increases. Additionally, lifestyle changes have led to a higher incidence of gallstones, even in younger people, with cases found from age 15 onwards.
Can gallstones dissolve on their own? Is surgery necessary?
Gallstones form when components in bile crystallize. It is quite difficult for these stones to dissolve on their own because bile composition is genetically determined. Medications to alter bile composition have been discontinued due to the need for long-term use, liver side effects, and recurrence after stopping treatment.
With innovations in minimally invasive surgery causing less pain and faster recovery, surgery is the most targeted treatment and can cure the disease. However, if gallstones are found during a routine health check and there are no symptoms, surgery is not always necessary. The chance of severe symptoms requiring emergency surgery is only 1 in 1000 cases. Doctors usually recommend monitoring symptoms and considering treatment only if symptoms develop. The key point is that symptoms can resemble gastritis or acid reflux, and treating those conditions without addressing gallstones leads to persistent symptoms.
Minimally invasive surgery, go home immediately, no hospital stay needed
The gallbladder is normally about the size of a chicken egg, located under the ribs, and resembles a small sac. Minimally invasive surgery reduces injury to unrelated areas. The surgery involves making a small incision near the navel, inserting instruments to suction bile from the gallbladder, and then removing the gallbladder along with the stones. The patient will have small wounds. The advantage is that after surgery, once the patient wakes up, they can eat immediately and rest for about 2 hours. If the doctor assesses no risk, mild pain manageable with medication, the patient can go home right away.
What symptoms suggest gallstones?
Symptoms that may indicate gallstones include bloating, indigestion, or what most people call “indigestion”, especially after heavy meals or fatty foods, particularly if there is continuous pain in the upper middle abdomen or right under the ribs for several hours.
Importantly, some people mistakenly think it’s gastritis and keep taking medication for that. However, gallstones with pain are like a ticking time bomb. You should consult a doctor to consider treatment before severe pain and fever develop, which usually means gallbladder inflammation requiring emergency surgery, increasing unnecessary risks.
Associate Professor Dr. Thanyadet Nimmanwutipong
Head of Advanced Surgical Technology Center (ASIT)
Advanced Surgical Technology Center
Phyathai 3 Hospital
