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Ingrid Shears –
A Single Incision to Alleviate Gallbladder Pain

Documented: August 2013

At 59, Ingrid Shears is at a sweet spot in life. Healthy and fit, her children grown and her husband retired, Ingrid has both the freedom and the energy to make the most of her days doing what she enjoys. Gardening, exercising, traveling, and spending time with family and friends are all priorities, but golfing is a passion.

"Golf is an important pastime for me and my husband," says Ingrid. "We golf two or three times a week. It's a big part of our lives."

Ingrid ShearsFrom mid-April to mid-November, when Ingrid and her husband aren't on the golf course, they're busy tending the flower and vegetable gardens surrounding their home in the rolling countryside north of Kennett Square. In mid-November, they head to southern California, where they have spent winters since Ingrid's husband retired, have many friends, and enjoy superb golfing and hiking. At holiday time, they come home to be with their children and grandchildren and then head back to the California sun until mid-April.

"The weather is fantastic out there that time of year," says Ingrid. "Like today, only all the time." Her point is well taken. Today's weather -- sunny and 72 degrees -- is a delightful change from the typical hazy, hot, and humid days of summer in southeastern Pennsylvania.

But no one's life is sunny all the time. In Ingrid's case, unexplained symptoms began to pester her a few years ago. Nagging episodes of pain under her ribs and later in her back hampered her golf game, made exercise difficult, and kept her from engaging in many activities.

"I was uncomfortable and didn't feel well a lot of the time," says Ingrid. "My husband would ask whether I wanted to do this or that for the day, and I just wasn't up to it."

Nausea and feelings of indigestion after eating also made Ingrid wary of dining out with her husband and with friends. "For years I'd get terrible discomfort after a meal," she says. "I just assumed it was indigestion."

Over the years, Ingrid's pain and other symptoms prompted her to consult her primary doctor. "I would go to my GP [General Practitioner], but she could never find anything wrong," says Ingrid.

Because her pain almost always was on the left side, Ingrid also sought a heart doctor at one point. "I actually thought I might be having heart problems and went to a cardiologist," she says. "Tests were done, but nothing was there."

It took until early May of this year for Ingrid's problem to be correctly diagnosed. Several events led up to this, starting with an acute painful attack that occurred at the end of their winter stay in California. The pain was similar to what Ingrid had experienced before, but much worse.

"Since I don't have a doctor in California, I waited until we returned home to see my GP," says Ingrid. Her doctor prescribed medicine for a possible ulcer but also gave her a script for an abdominal CT scan if the medicine didn't help. Not long after, Ingrid had a second attack.

"It was terrible," she says. "Really, really bad pain. Insane pain. It lasted all night long." Ingrid says she was close to going to a hospital emergency department but then the pain subsided.

The next day, she made an appointment for the CT scan, which showed "sludge" in her gallbladder. Sludge forms when bile fluid in the gallbladder concentrates to the point that it cannot flow out properly. Tiny particles in the sludge can go on to form gallstones.

After the test, Ingrid's doctor called with the news. It was her gallbladder that was causing all the trouble, and it needed to come out as soon as possible. A surgeon was recommended, but Ingrid could not get an appointment for two to three weeks, which was a concern because she was now eager to have her gallbladder out. "I was constantly nauseated and just felt like...uggghhhh," she says. She decided to ask around for names of other surgeons.

"Once you know what your problem is, you start talking to people," says Ingrid. "My husband was playing golf with someone who said his wife had had gallbladder surgery two years earlier at The Chester County Hospital and had a great experience, so I phoned her up to get the name of the surgeon. Then, I learned that one of my daughter's friends, a much younger woman, also had had gallbladder surgery performed by a surgeon in the same group."

Demnicki and FukuchiWith two recommendations for the same surgical practice, Ingrid decided to contact the group and was able to get an appointment quickly with Pamela Demnicki, MD, an attending general surgeon at The Chester County Hospital. Dr. Demnicki performs hundreds of gallbladder removals each year at the Hospital. The operation, called a cholecystectomy, often is done using a minimally invasive (laparoscopic) approach. Early this year, Dr. Demnicki and her colleague, Steven Fukuchi, MD, began performing robotic-assisted laparoscopic cholecystectomies at The Chester County Hospital. In May, they started doing the robotic operation though a single one-inch incision in the belly button.

At the appointment, Dr. Demnicki reviewed Ingrid's CT scan and agreed that her gallbladder needed to come out, and the sooner the better. She then discussed the option of doing the surgery robotically through the belly button and provided Ingrid with information explaining the procedure.

"I thought, why not? The other way involved four incisions, whereas this way was just one," says Ingrid. "Also, I trusted Dr. Demnicki. She had done several of the new operations already. I was fine with it. I just wanted to get the gallbladder out!"

Before moving ahead with surgery, Dr. Demnicki said she wanted Ingrid to have an abdominal ultrasound, to get more information about her gallbladder.

"The best way to evaluate a gallbladder is with an ultrasound," says Dr. Demnicki. "Even if we see stones or sludge on a CT scan, it's important to have a clear picture of the ducts that transport bile before we go in for surgery, to make sure there are no issues that would prevent a straightforward gallbladder removal," see explains.

On May 29, a few days after the ultrasound, Ingrid was admitted to The Chester County Hospital for her scheduled single-incision robotic cholecystectomy. When she slipped into the cloud of anesthesia that afternoon, she had no idea that she would emerge from surgery with more than her troublesome gallbladder problem solved. Unbeknownst to Ingrid, a small hernia was lurking just below her belly button. The hernia was also a surprise to Dr. Demnicki.

"Ingrid had a small umbilical hernia that was not apparent on her physical examination," says Dr. Demnicki. "Since the incision for single-incision robotic cholecystectomy is located at the umbilicus -- the belly button -- we discovered it right away."

An umbilical hernia is an abnormal protrusion of abdominal tissue or an abdominal organ through the area around the belly button. In Ingrid's case, a small amount of fat from inside the abdomen had herniated through.

"A hernia often gets larger, and as it does, larger things can start to herniate through, such as intestine," says Dr. Demnicki. If that happens, surgery is needed to avoid complications. She says that since Ingrid's hernia was discovered at the start of the operation and was easily fixable, she took care of it after completing the cholecystectomy.

Dr. Demnicki explains that to correct the hernia, the fatty tissue was pushed back into the abdomen. Then, the hernia defect was closed along with the cholecystectomy incision.

"We fixed two problems -- one that clearly needed surgery and another that may have needed surgery in the future -- all with just one little incision that is hidden in the belly button," Dr. Demnicki says enthusiastically. "It's wonderful to be able to offer patients such minimally invasive solutions to their problems."

Ingrid says that when Dr. Demnicki visited the morning after her surgery, she told her that the gallbladder operation had gone very well. Then, she told her about finding and fixing the hernia. Although the hernia was a surprise, Ingrid is glad it won't be a potential problem down the road.

Ingrid went home from the Hospital that day and one week later saw Dr. Demnicki in her office for a check-up. Ingrid was feeling better* and Dr. Demnicki was pleased with how the incision looked.

"She was very happy with how everything turned out," says Ingrid. "She also took a picture of my belly," she adds, laughing.

A few weeks later, Ingrid was completely recovered from her surgery. By the end of July, she was feeling great.

"I have no pain whatsoever, no nausea, no heartburn," says Ingrid. "And the incision -- you can barely see it any more. It's amazing. I'm very pleased."

Since her surgery, Ingrid says she also has more energy and in general just feels better. Having no pain has made a world of difference. Even her golf game is better.

"I think I've increased my drive at least 15 yards," she says, laughing. "I didn't realize how much the pain was affecting me. Now it's gone."

Also gone is the uncomfortable, ill feeling she had after going out to dinner or dining with friends. "All that is gone," says Ingrid. "I'm happy -- I can enjoy meals again!"

That Pesky Gallbladder Can Be a Master of Disguise
According to Pamela Demnicki, MD, general surgeon at The Chester County Hospital, Ingrid Shears' story is not uncommon. Gallbladder symptoms often are misinterpreted, leading to delays in correctly diagnosing and treating the problem. Depending on their location, gallbladder symptoms can be mistaken as heartburn or indigestion, back pain, or even a heart attack, if the pain is sudden, severe, and on the left side. The "classic" symptom of gallbladder disease is pain in the upper right side of the abdomen, which typically comes on after eating and may extend to the right shoulder or the right upper back.

Dr. Demnicki says that people may find this "classic" description on the Internet, and because their symptoms don't match up, brush them off as indigestion or something else, without getting them checked out. Without evaluation, gallbladder problems can fester and become more serious. Upper abdominal discomfort anywhere -- on the right side, in the middle, or even on the left side -- may be caused by an underlying gallbladder problem and should be properly investigated.

By Debra Dreger

* Immediately after the surgery, Ingrid did experience abdominal pain associated with the gas required to perform the surgery. The expected pain subsided a few days after discharge from the Hospital.

Last Updated: 2/20/2015