Frequently asked questions about general and bariatric surgery

Call (664) 108-6258, write to info@drarisalgado.com or fill in the form on this page. Consultations take place at Harmony Health Clinic, P.º de los Héroes 2509 C, Zona Urbana Río Tijuana, ZIP 22010, and also at New City Medical Plaza, Paseo del Centenario 9580, floor 25. Hours are Monday to Saturday, 9:00 AM to 8:00 PM.

Your complete studies — liver and biliary ultrasound, CT, endoscopy, colonoscopy or plain films — on disc, USB or printed, together with the report from whoever read them. Also the list of medications you take, recent labs, and summaries of any previous surgery. Without the original studies, the visit is only half a visit.

Yes. Surgical emergencies are attended 24 hours a day, 7 days a week at (662) 282-1787. If there is severe abdominal pain that does not let up, fever with pain in the right side of the abdomen, vomiting that prevents keeping fluids down, distension with no gas or bowel movements, a hernia that has turned hard and cannot be pushed back in, or vomiting or stool with blood, GO TO AN EMERGENCY DEPARTMENT IMMEDIATELY. Do not email an emergency.

Not always. Stones that have never caused symptoms and were found incidentally can often be watched. Surgery is indicated once there has been biliary colic, cholecystitis, gallstone pancreatitis or a stone in the bile duct, when the gallbladder is calcified or carries polyps above a certain size, and in a handful of particular situations assessed case by case. An ultrasound showing stones is not, on its own, an order for the operating room.

In most cases it means less pain, fewer days in hospital, smaller scars and an earlier return to activity. But it is not always possible: advanced inflammation, adhesions from previous operations, bleeding or an unstable patient can require converting to open surgery during the procedure. That is not a complication, it is a safety decision, and it is explained before the consent is signed.

Yes, and it is a good idea. Bring the studies and the surgical plan you were given. The visit reviews whether the indication holds up, whether less invasive alternatives exist, and what is gained or lost by waiting. A second opinion does not offend any serious colleague.

Yes. Consultations run in Spanish or in English and both offices are minutes from the San Ysidro crossing. For bariatric surgery there is a published package that includes ground transport to and from San Diego airport, hotel, hospital and follow-up. Bear in mind that most US insurance plans do not cover care in Mexico: confirm with your insurer before scheduling.

It depends on the procedure, the hospital, the operating time and any associated conditions. The only price published on this site is the gastric sleeve package for patients from the United States, with the list of what it includes and the note that airfare is not covered. For everything else the quote is issued in writing after the assessment, because a price quoted over the phone without seeing the patient is not a price, it is a guess.

The gastroenterologist studies and treats digestive disease with medication and endoscopy. The general surgeon is the one who operates when the condition needs an intervention: removing the gallbladder, repairing a hernia, taking out the appendix, resecting a segment of colon. Very often both look after the same patient, at different moments of the same illness.

Generally yes, and it is done frequently. What changes is not whether it is possible but how it is prepared: pre-operative assessment, glucose and blood-pressure control, adjustment of blood thinners and a clear conversation about individual risk. Age alone does not rule out an operation; poorly controlled associated disease can, until it is corrected.

Drugs exist that dissolve certain cholesterol stones, but their use is very limited: they require small stones of a particular type, a functioning gallbladder, treatment lasting months or years, and a high proportion of patients form stones again on stopping. They are not a realistic alternative to surgery in most cases.

It has been tried and it does not work. The problem is not the stones but the gallbladder that makes them: leave the organ and the stones return. That is why the standard treatment worldwide is to remove the whole gallbladder.

In many cases, watch. Surgery is considered where factors raise the risk of complication: very large stones, a calcified gallbladder, polyps, or certain associated conditions. That assessment is individual and is made in clinic with the ultrasound in view.

Reducing fat lowers the frequency of episodes in many patients, because it is fat that makes the gallbladder contract. But diet does not dissolve stones or remove the risk of complication: it is relief, not treatment.

Be careful with that moment. In some cases the pain eases exactly when the appendix perforates and internal pressure falls, and the patient believes they have improved. Hours later the pain returns, now generalised, with a rigid abdomen. Sudden relief after hours of severe pain is not reassuring: it needs assessing.

There is no established way of preventing it and its hereditary component is marginal. No diet or habit demonstrably avoids it. The only thing in your hands is not to delay assessment when the picture appears.

Gastroenteritis usually begins with abundant vomiting and diarrhoea and diffuse pain that moves around. In appendicitis the pain comes first, settles in the lower right and stays there, and loss of appetite is very characteristic. When in doubt, get assessed: the cost of a consultation is incomparably lower than that of peritonitis.

Yes, and it is the commonest non-obstetric surgical emergency during pregnancy. Presentation can be atypical because the uterus displaces the appendix, and the imaging of choice is usually ultrasound. It is treated surgically, adapting the technique to the trimester.

Waiting is reasonable in selected cases: small hernias, without symptoms, in patients at high surgical risk. But the bargain is worth understanding: the hernia will not close, it will grow over time, and while it exists there is a risk of it becoming trapped. Most of those who wait end up operated on anyway, only with a larger hernia and sometimes as an emergency.

Physical activity does not cause hernias on its own, though it can make an existing one more obvious. With a diagnosed hernia it is sensible to avoid maximal-load exercises and straining with held breath, and to consider repair if it limits your activity.

It can recur, although current mesh techniques have greatly reduced that possibility. The factors that most increase recurrence are smoking, obesity, premature exertion after surgery and uncontrolled chronic cough.

No. In small children many umbilical hernias close on their own during the first years and watchful waiting is usual. Infant inguinal hernia, by contrast, is operated on, and its management belongs to paediatric surgery.

It is a concern raised with reason and it deserves a nuanced answer. Proton-pump inhibitors are safe and highly effective medicines, and for many patients the benefit clearly outweighs the risks of prolonged use. That said, taking them for decades is not trivial and it is one of the legitimate reasons a young patient may prefer surgery. That decision is discussed, not imposed.

No. It is an anatomical defect of the diaphragm and no exercise closes it. What does help control the symptom is losing weight, because it reduces the intra-abdominal pressure pushing the stomach upwards.

It is a change in the lining of the lower oesophagus from chronic acid exposure. It is diagnosed only with endoscopy and biopsies, not from symptoms, and it implies scheduled endoscopic surveillance. Its presence changes the conversation about treatment.

The best-supported ones: losing weight where there is overweight, eating dinner at least three hours before bed, raising the head of the bed — not using more pillows, raising the bed head — stopping tobacco and reducing alcohol. Lists of forbidden foods are far less useful than commonly believed and vary greatly from person to person.

No. It is a medical treatment of obesity and of the diseases that accompany it. Cosmetic surgery acts on the shape of the body; bariatric surgery acts on metabolism and on health. They are different things with different indications, although they are sometimes combined at different moments of the process.

It can happen, and that is exactly why follow-up is not optional. Long-term weight regain is associated above all with abandoning the eating plan, returning to large portions and losing contact with the team. Patients who sustain follow-up are the ones who best keep the result.

In many cases type 2 diabetes strengthens the indication rather than preventing it, because bariatric procedures — especially the bypass — have a favourable metabolic effect on glucose control. What is required is careful preparation and prior control.

After substantial weight loss, excess skin can remain, especially on the abdomen, arms and thighs. Its management belongs to plastic surgery and is considered once weight has stabilised, usually more than a year after the bariatric operation.

Acute episodes usually settle with conservative measures, and many patients spend years with occasional, well-controlled symptoms. What does not disappear on its own is established prolapse in the advanced grades: there, correction is surgical.

They relieve the symptom — burning, itching, inflammation — and are useful in acute episodes. They do not correct prolapse or eliminate the haemorrhoidal column. In other words: they help, but they do not cure.

It is the commonest reason a simple problem becomes a complicated one. Proctological examination is brief, carried out with respect and privacy, and it is the only way to know the grade and to rule out other causes of bleeding. Delaying it does not change the diagnosis, only postpones it.

With rectal bleeding after 45, with any bleeding accompanied by a change in bowel habit, weight loss or anaemia, and where there is a family history of colorectal cancer or polyps. Also as screening according to the current recommendation for your age.

Generally no. Current practice is to individualise: planned surgery is considered when there are repeated episodes eroding quality of life, when there has been a complication, when a fistula or stricture remains, or in patients with particular conditions. A first uncomplicated episode, resolved medically, is not on its own a surgical indication.

That classic recommendation is not supported by current evidence; studies have not found that seeds, nuts or popcorn increase the risk of diverticulitis. What is supported is a high-fibre diet, keeping good bowel transit, physical activity and avoiding tobacco.

Because an episode of diverticulitis can resemble, on imaging and in symptoms, other causes — including a colonic tumour. Colonoscopy is done weeks after the acute episode, not during, and serves to confirm that what was there were diverticula and nothing more.

Not individually. When surgery is indicated, what is done is to resect the affected segment of colon — usually the sigmoid — and join the ends. The diverticula are not «cleaned out» one by one.

Only if you have had the study that corresponds to your age and clinical features. Having haemorrhoids is very common and does not protect you from also having something else. Attributing all rectal bleeding to haemorrhoids without investigating is, by some distance, the costliest error in this field.

The usual screening recommendation starts around 45 to 50 in people without risk factors. It is brought forward with a family history of colorectal cancer or polyps, with inflammatory bowel disease, or with red-flag symptoms at any age.

Most cases are sporadic, but a family history in first-degree relatives clearly increases risk and brings forward the screening age. There are also less common hereditary syndromes requiring specific surveillance and family study.

In many colonic resections, no. It may be needed temporarily to protect a low rectal join, and it can be permanent in some very low tumours. It is a conversation held before surgery, with the expected and the possible scenario explained clearly.

Most likely not: the great majority of thyroid nodules are benign. But that is not decided by probability, it is decided by investigation. Ultrasound assigns a level of suspicion and, where that justifies it, fine-needle biopsy gives the answer.

It is a brief procedure, with a very thin needle and ultrasound guidance. The discomfort is comparable to a blood draw and it requires neither general anaesthesia nor fasting. It is done in clinic and the patient walks out.

Generally it is not done that way. Removal is by lobe — hemithyroidectomy — or of the whole gland, because removing only the nodule compromises the quality of the histopathological study and leaves tissue with the same problem. The extent is defined by the diagnosis.

No. Many goitres are monitored or treated medically. Surgery follows compressive symptoms — difficulty swallowing or breathing — extension into the chest, suspicion of malignancy, or associated hyperthyroidism that is not controlled.

Practically never. Gastritis is treated with medication, eradicating Helicobacter pylori where present, stopping anti-inflammatories and correcting habits. If someone proposes operating on simple gastritis, seek a second opinion before agreeing.

The popular idea overstates its role: most ulcers are due to Helicobacter pylori or to anti-inflammatory drugs. That said, severe physiological stress — a critically ill patient, an extensive burn, major surgery — does produce stress ulcers, which are a different picture from everyday stress.

It depends on the finding. A gastric ulcer usually requires a control endoscopy to confirm healing and rule out malignancy. Other findings, such as mild gastritis without red flags, do not require routine repetition. The interval is set according to your report.

Because non-steroidal anti-inflammatory drugs damage the protective barrier of the gastric lining and are one of the two main causes of ulcer. If you need an analgesic on a sustained basis, alternatives can be prescribed; what does not work is continuing the anti-inflammatory while treating the ulcer.