Caitlin Whyte (Host): This is Hello Healthy, a Dignity Health Podcast. I'm your host, Caitlin Whyte, and today we are welcoming Dr. Kevin Rodriguez to the show. He is a general surgeon specializing in minimally invasive surgery at the Dignity Health Surgical Specialty Center. In this episode, we delve into the benefits of minimally invasive gallbladder surgery.

Well, Doctor, we are so happy to have you on the program here today. To start us off, can you tell us a bit about your background?

Kevin Rodriguez, MD: Yes, of course. I am happy to be here. Caitlyn, thank you for, for calling me in. I'm originally from a small town in Peru, like a little fishing community up in the northern coast. My family and I immigrated to the US when I was around 10 years old. At that time, just like any other immigrant family, we were working extremely hard just to get by and, I'd always hear my dad talk about, him wanting to be a doctor in Peru.

Just they didn't have the means. And it's very hard to, you know, if you don't have money in Peru, it's very hard go to school and, do that kind of kind of thing. So when I went to high school, I, I, someone gave me a shot, gave me an opportunity to do an internship at the hospital. I just fell in love.

 I went to school at the University of Utah School of Medicine and, did a training and residency in Denver. My family and I, we, we were looking into where to settle, where to set down some roots, and we absolutely fell in love with the central coast and we decided to come here.

Host: Wonderful. We are so happy to have you. To get into the meat of our topic here today, now everyone knows someone who's had their gallbladder removed, it seems. What are some symptoms of gallstones and when should we see a doctor about them? When does it get to that point?

Kevin Rodriguez, MD: I

love how you, how you ask that question because, many patients who have gallstones actually will never know it. And, don't actually have to do anything about it. Like you and I could have gallstones and if we don't have any symptoms associated with it, we, we don't have to do anything about it.

It's okay not to have surgery. But when you do have symptomatic cholelithiasis or, or biliary colic or symptoms associated with gallstones, they often classically report as, epigastric, uh, I mean, just pain right under your, your sternum and radiating to the right side under your rib cage, maybe 30 minutes to an hour after eating, and especially after eating a greasy meal, a burger and french fries, some pizza.

Many patients describe it after eating some dairy type products, which have carry a little bit more, uh, increased fatty contents. And so the gallbladder activates, and creating, recreating this kind of pain right under your right rib cage. Patients will often say it radiates to my back, onto my shoulders.

And it lasts, you know, anywhere from maybe 30, 40 minutes to a few hours. Some of them, it lasts much longer, and that's where I see them in the emergency department, that's where we have to do more urgent surgery.

Host: All right. Well, why has this procedure of removing the gallbladder become so common?

Kevin Rodriguez, MD: Yeah, it's, and it's definitely become more and more common in the last, I would say, 20 years. There are five big risk factors that we always think about when forming gallstones. And only one of them really has to do with diet. But the, the big five that, that I always think about is unfortunately, being a female, having the different hormones, fluctuations, to a month to month harbors increased, cholesterol deposits in your gallbladder, increasing your frequency of forming more gallstones.

So unfortunately there's nothing you can change. The second more c ommon thing that would cause someone to form gallstones is, being a female around the age of 40. So anywhere between 30 to 50 years of age, that's a prime time to start forming gallstones. Um, additionally, if you've had children, if you have any, any children. During pregnancy, again, the hormone fluctuations causes a little bit of a more cholesterol deposit into your gallbladder increasing the frequency of gallstones. Fourth, is being of a Native American or Hispanic descent, we see a genetic factor amongst these populations that just being a Hispanic or a Native American descent increases your, your frequency of forming gallstones. And finally, the last one that we always think about is a little bit of your diet.

Having a slightly higher cholesterol diet or fatty diet, and being maybe a little bit more overweight, does increase your risk of having gallstones. But notice this is only one out of the five most common, risk factors. So with the increase in maybe, larger population becoming slightly more obese or, our diets maybe not, being the greatest, that has overall increased what we've seen, the frequency of gallstone disease.

Host: So what are the advantages of the minimally invasive approach to surgically removing the gallbladder?

Kevin Rodriguez, MD: In the past, we'd have to do a, a big incision before laparoscopic surgery and minimally invasive surgery was invented and patients would spend, you know, four days to a week in the hospital just recovering from having their gallbladder taken out. Now, we've, near perfected this laparoscopic approach or a minimally invasive approach.

It can also be done robotically. It's basically the same incisions. They are these one centimeter incisions, maybe 1.5 centimeter incisions. They're very tiny. Uh, usually four of those incisions are across your belly where we, um, place a small camera and some instruments and are able to dissect the gallbladder out and we take out the gallbladder through one of those incisions.

Obviously a big factor into, wanting to do laparoscopic surgery is the patient experience. Way less pain after a minimally invasive approach. We see that the vast majority of these patients go home the same day after surgery. They have decreased opiate intake.

Most of my patients don't even take any and, or maybe just a few of the opiate prescription medication that they find they don't even need, them anymore after surgery. They're walking around the same day after surgery. They're going up and down stairs, and they get their lives back.

They're able to eat a regular diet without the fear of having that pain come back.

Host: Well, that brings me to my next question, Doctor. Can people live a normal, healthy life without a gallbladder?

Kevin Rodriguez, MD: Yeah, excellent question. And, and the answer is absolutely. The gallbladder acts as a reserve into bile and bile secretion. So your liver will still make all the bile it needs to digest any type of food and secrets the enzymes it needs to digest, especially fatty meals. Your gallbladder is just an extra reservoir of that.

You know, in the past if you decide to eat a few cheeseburgers and a slice of pizza, there's your gallbladder activating excreting an extra amount of bile, but without your gallbladder, your liver picks up what your gallbladder lacks. It'll produce just a little bit more bile every time you, you have a, a large bolus of food.

Maybe initially I've, I noticed very few patients after this type of surgery experience a little bit of GI upset, maybe a little bit of diarrhea that is very short-lived, and self results.

Host: So it sounds like an accurate diagnosis is the key, would you say, and talking to your doctor is just as important.

Kevin Rodriguez, MD: Yeah, absolutely. I would say if you're experiencing these types of symptoms, that we spoke about in the beginning, talking to your PCP, maybe getting a, right upper or quadrant ultrasound, to see if you have gallstones would be one of the first steps.

Host: And for the Spanish speaking community, is there any added risks or fears that you've seen when it comes to gallbladder disease or surgeries?

Kevin Rodriguez, MD: Yeah. And this is a, a whole topic onto itself. I think over the course of many years our Hispanic population has, uh, I think lost trust in the medical community and in some of those instances, I think it's, it's appropriate. And we're, we're gaining that trust back. You know, myself being of Hispanic descent, being Hispanic, I've seen many times where I, I go into the doctor's office with my mom when I was a child, just translating for her, and medical providers not necessarily taking the time that she deserves or the time that she needs. And so I'm, I'm trying to gain that confidence back in our Hispanic community. There's additional risk of many times them associating, or, our culture associating the medical profession with government association as well, which creates a whole other fear, as well. But, truly we're just here to help.

Host: Of course. And as we wrap up here today, Doctor, is there anything else you would like to add to our conversation on removing a gallbladder?

Kevin Rodriguez, MD: I think we've been, uh, getting better and better at this surgery. We're down to, you know, 99% of the time we're able to stay in a laparoscopic fashion, meaning very minimally invasive. And the 1% of patients who we can't do minimally invasive surgery on are generally patients who are a little bit sicker, have a lot more comorbidities, are in the hospital, in the ICU, those types of patients.

But generally for the general population, we're able to stay with very small incisions. They do extremely well after surgery. Although there are risks to every single incision that we do, the risks to having a major complication in this type of surgery is less than 1%.

Host: Thank you for your time today, Doctor. That was Dr. Kevin Rodriguez offering invaluable insights into minimally invasive gallbladder surgery. To learn more about our general surgery team on the central coast, you can visit Dignityhealth.org/phc and click on general surgery under the services tab.

If you enjoyed this podcast, please share it on your social networks and explore our entire library for more health topics of interest. I'm Caitlin Whyte, and this is Hello Healthy, a Dignity Health Podcast. Thanks for listening.