WHAT IS A LAPAROSCOPIC CHOLECYSTECTOMY?
Laparoscopic cholecystectomy is a procedure in which the gallbladder is removed by laparoscopic techniques.
WHAT IS GALLBLADDER?
The gallbladder is a pear-shaped organ that rests beneath the right side of the liver. Its main purpose is to collect and concentrate a digestive liquid (bile) produced by the liver. Bile is released from the gallbladder after eating, aiding digestion.
WHY DO YOU NEED TO GET THE GALL BLADDER REMOVED?
Gallbladder problems are usually caused by the presence of gallstones which are small hard masses consisting primarily of cholesterol and bile salts that form in the gallbladder or in the bile .These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting, indigestion and, occasionally, fever. If the gallstone blocks the common bile duct, jaundice (a yellowing of the skin) can occur.
HOW ARE GALL STONES DIAGNOSED?
Gall stones are most commonly diagnosed by Ultrasound method. In a few more complex cases, other X-ray tests may be used to evaluate gallbladder disease.
CAN GALLSTONES BE TREATED BY OTHER METHODS OTHER THAN SURGERY?
Some gallstones can be temporarily managed with drugs and/ by making dietary adjustments like reducing fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue unless the gallbladder is removed.
Surgical removal of the gallbladder is the time honoured and safest treatment of gallbladder disease.
HOW SAFE IS LAPAROSCOPIC GALLBLADDER SURGERY?
Laparoscopic cholecystectomy is a very safe operation. The overall complication rate is less than 2%. The complication rate for laparoscopic gallbladder surgery is similar to the complication rate for traditional open gallbladder surgery when performed by a properly trained surgeon.
HOW IS LAPAROSCOPIC CHOLECYSTECTOMY PERFORMED?
Some of the important steps in the operation are as follows:
General anesthesia is utilized, so the patient is asleep throughout the procedure.
An incision that is approximately half an inch is made around the umbilicus, three other quarter to half inch incisions are made for a total of four incisions. Four narrow tubes called laparoscopic ports are placed through the tiny incisions for the laparoscopic camera and instruments.
A laparoscope (which is a long thin round instrument with a video lens at its tip) is inserted through the umbilical port and connected to a special camera. The laparoscope provides the surgeon with a magnified view of the patient’s internal organs on a television screen.
Long specially designed instruments are inserted through the other three ports that allow your surgeon to delicately separate the gallbladder from its attachments to the liver and the bile duct and then remove it through one of the ports from the abdomen.
Your surgeon may occasionally perform an X-ray, called a cholangiogram, to check for stones in the bile duct.
After the gallbladder is removed from the abdomen then the small incisions are closed.
WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED OR COMPLETED BY THE LAPAROSCOPIC METHOD?
In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.
The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation.
WHAT ARE THE RISKS OF GALL BLADDER SURGERY?
Complications of laparoscopic cholecystectomy are infrequent, but include bleeding, infection, pneumonia, blood clots, or heart problems. If the gallbladder is accidentally opened during the procedure stones may fall out of the gallbladder and in to the abdomen that may give rise to later scarring. Unintended injury to adjacent structures such as the common bile duct or small bowel may occur rarely and may require another surgical procedure to repair it. Bile leakage into the abdomen from the tubular channels leading from the liver to the intestine can also rarely occur..
HOW LONG WILL YOU BE IN THE HOSPITAL AFTER THE SURGERY?
Once a diet is tolerated, patients leave the hospital. Most patients go home the next day after a laparoscopic cholecystectomy. Some may even go home the same day the operation is performed (Laparoscopic cholecystectomy can be performed as a day care surgery wherein the patient can go home the same day!)
WHAT ARE THE ADVANTAGES OF PERFORMING THE PROCEDURE LAPAROSCOPICALLY?
Rather than a five to seven inch incision, the operation requires only four small openings in the abdomen.
Patients usually have minimal post-operative pain.
Patients usually experience faster recovery than open gallbladder surgery patients.
Most patients go home within one day and enjoy a quicker return to normal activities.
WHAT IS THE RECOVERY PERIOD AND HOW SOON CAN YOU GO BACK TO WORK?
Patients will probably be able to get back to normal activities within a week’s time, including driving, walking up stairs, light lifting and work. Activity is dependent on how the patient feels. Walking is encouraged. In general, recovery should be progressive, once the patient is at home.
Most patients are fully recovered and may go back to work after seven to ten days.
Often, this depends on the nature of your job since patients who perform manual labour or heavy lifting may require two to four weeks of recovery.
WHAT SHOULD YOU BE CONCERNED ABOUT ONCE YOU GO HOME?
The development of fever, yellow skin or eyes, worsening abdominal pain, distension, persistent nausea or vomiting, or drainage from the incision are indications that a complication may have occurred. You should contact your surgeon under these circumstances.
Ref : 1. http://www.sages.org/publications