Dr Stephen Chang

The current recommendation is to repeat another 3 doses of the vaccine.

Hi there, It is not necessary. However, the patient will need to have lifetime follow ups for liver cancer screening. *Dr Stephen Chang*Medical Director, GLAD ClinicAdj Assoc Professor, NUSFounding President, Hepatopancreatobiliary Association (Singapore)www. GLADClinic. com.

Gallbladder polyp is a common finding on abdominal imaging such as ultrasonography. Most of these polyps are not cancerous and only a small proportion of these polyps will progress to cancer. Unfortunately, it is rarely curable and prognosis is poor with less than 5% of patients with confirmed gallbladder cancer surviving more than 5 years [1]. Thus it is important to decide which gallbladder polyps should be treated. The most accepted guideline now is for gallbladder polyps that are more than 10mm to be removed.

Up to now, there are no tests to conclusively diagnose IBS. Instead, tests are done to rule out other conditions. If a colonoscopy and CT scan have not yet been done, they should be done to make sure you are not suffering from other more serious conditions. *Dr Stephen Chang*Medical Director, GLAD ClinicAdj Assoc Professor, NUSFounding President, Hepatopancreatobiliary Association (Singapore)www. GLADClinic. com.

A colon surgery can be done either through an open incision or in trained hands, via the laparoscopic approach. Depending on the indication of the surgery, the 'radicality' of the procedure will vary. It is best to consult a specialist to discuss the details of the surgery. *Dr Stephen Chang*Medical Director, GLAD ClinicAdj Assoc Professor, NUSFounding President, Hepatopancreatobiliary Association (Singapore)www. GLADClinic. com.

Both open surgery and keyhole surgery have their own risks. For open surgery, as the wound is much larger, there is a greater risk of wound infection and wound healing failures such as hernia development. For keyhole surgery, traditionally there is a greater risk of bile duct injury. But with increasing experience, this risk is approximating that of open surgery. Surgeon's experience is probably the main determinant of this risk. In addition, for keyhole surgery, traditionally there is increased risk in patients with heart function insufficiency.

Gallstone formation is found to be 2 to 3 times more common in females as compared to males [1]. This difference is observed starting puberty and throughout childbearing age. This is because females have higher levels of estrogen which promotes gallstones formation. Gallstones are caused by hardened digestive fluid deposits. In most cases, they are primarily composed of cholesterol. Estrogen level is a risk factor because estrogen increases biliary cholesterol secretion causing cholesterol supersaturation of bile [2]. References: 1. Novacek G. Gender and gallstone disease.

The symptoms of 'gallbladder attacks' can be very varied. The most common symptom is just an upper abdominal vague discomfort of which you may just feel 'bloated' or have 'gas' in your belly. It usually happens after a meal even though the amount consumed may not be a lot. Occasionally, when there is acute inflammation of the gallbladder, then you will feel a more severe pain in the right side of the upper abdomen.

As per all cancers, the earlier the stage of the cancer, the higher the chance of cure. In stomach cancer, it is no different. If stomach cancer is in the early stages where there is no spread of cancer to the surrounding tissues or to distant sites, surgery offers the best chance of cure. An exception is when the cancer is detected in the very early stages where the cancer involvement is very shallow. In such very early stages, a curative option will include an endoscopic resection of the cancer.

In general, as per all abdominal surgeries, laparoscopic approach has less pain compared to open incisional hernia repair during the recovery period. In incisional hernia repair, with the laparoscopic approach, it may be possible to identify other subclinical hernia defects in the old incision and they can then be repaired at the same time. Of course, some incisional hernias are so big that it may be impossible to perform the repair laparoscopically.

Laparoscopic hernia surgery works by covering the defect of the hernia with a prosthetic mesh introduced via the laparoscopic ports. The mesh will eventually be incorporated into the patient's abdominal wall and prevent the intra-abdominal contents from protruding through the defect.

In general, gallbladder removal (cholecystectomy) should not affect your bowel habits. Very occasionally, some patients may have softer stools which may give rise to the sensation of urge to defecate. Various studies have also found that to be true [1]. Some patients reported less constipation and slightly more frequent defecations but short term recordings show no consistent change in bowel function. Only very rarely, patients experience clinical diarrhoea. 1. Hearing SD, Thomas LA, Heaton KW, Hunt L. Effect of cholecystectomy on bowel function: a prospective, controlled study. Gut.

In the majority of the situations, a perforated ulcer presents itself in an acute emergency situation with severe abdominal pain. The treatment is surgery to either seal the perforation or to resection the portion of bowel that has perforated. This may be done via laparoscopic (keyhole) approach. In a very small proportion of patients, the presentation may be delayed for whatever reasons and the patient may no longer experience severe pain and it is possible that nature has taken its course to seal the perforation.

Cholecystitis or inflammation of the gallbladder is best treated with early removal of the gallbladder (cholecystectomy). In Singapore, it is usually performed as a key-hole procedure (laparoscopic approach) and in expert hands [1], a single key-hole may only be needed (Single-port laparoscopic cholecystectomy) which leaves no obvious scar and has been proven to be more acceptable by patients and has less pain [2][3]. The only exception is when the patient is not fit for surgery, i. e. the patient has other medical conditions with prohibitive risks of general anaesthesia.