Smaller incisions, bigger results, faster recovery.
Surgery to remove the gallbladder (cholecyslectomy) is the only way to treat gallstones and is a “Gold Standard” This can be done by conventional open method or a well established endosscopic (Laparoscopic) method which is now the gold standard.
The surgery is called laparoscopic cholecyslectomy (Lab,chole). For this operation the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature telescope with mounted video camera into the abdomen. The camera sends a magninfied image from inside the body to a video monitor giving the surgeon a close-up views of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully seperate the gall bladder from the liver ducts, and other structures. Then the Cystic duct is cut andthe gall bladder removed through one of the small incisions, Recovery usually occurs which in a day in the hospital, followed by few days of rest at home.
Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fever wound complications.
If the surgeon discovers any obstacles to the laparoscopic procedure, the operating team may have to switch to open surgery. It is called “open” surgery because the surgeon has to make a 5 to 8 inch incision in the abdomen to remove the gallbladder. Open surgery is now required in less than 0.1 percent gallbladder operations, in our cenre.
CAN THE SURGERY BE PERFOMED AS DAY CARE PROCEDURE?
Yes, day care surgery may be performed in young and selected patients. The patient would be called to the operating theatre in the morning fasting, the operation performed and the patient would be observed for 4-6 hours post operatively in our day care facility near the operation theatre. The patient would normally be discharged the same afternoon. However,if the need arises, he/she could be admited overnight as well.
WHAT HAPPENS AFTER ADMISSION FOR LAPAROSCOPIC SURGERY?
The patient is normally admitted to hospital a day prior to the surgery or on the day of surgery. After admission the patient is examined and investigations reviewed by one of the members of the MAS team, Also a member of the anaesthesia team would conduct the pre anesthetic check-up. Any pre operative investigations are performed if needed. The patient would need to be fasting overnight or for 8 hrs for the surgery but can take his regular dose of medicines with sip of water (Please follow instruction given by the attending staff).
Next morning, the patient is shifted to the operating theatre about an hour or so prior to surgery. After surgery, the patient is shifted to the recovery ward under the care and supervision of our Anaesthesia team. The patient is observed in the recovery ward normally for 2-4 hours after surgery and then shifted back to the room. Hence the patient may come back to the room after about 5 – 8 hours since he/she has left the room Oral diet is started with sips of water on return to the room and progresses to drinking all liquids on the same day of surgery. The patent is encouraged to sit up, visit the toilet and removed around the same day. In fact movements are encouraged because this causes dramatic reduction in pain and increases the sense of well being.
The patient is given a normal breakfast next morning and will be discharged from hospital after a visit by one of the MAS team members. On discharge, a discharge summery with a medication advised will be handed over to the patient with date for next appointment.
WHAT IF STONE HAS SLIPPED IN CBD?
Slippage of stones in CBD may cause pain or jaundice or both. This situation requires en endoscopy (ERCP) for removing the sontes. This should preferably be done before surgery.
HOW DO WE CONFIRM IF STONE IS IN THE CBD.
Sometimes a stone in the CBD may not show on ultrasound however patient may have symptoms which are suspicious of the same. In this event the patient requires magnetic resonance cholangiopancreatography (MRCP – an MRI scan) which shows the presence of stones in the common bile duct.
WHAT IS ERCP?
The surgeon may use endoscopy in removing CBD stones before gallbladder surgery. Once the endoscope is in the small intesline, the surgeon locates the affected bile duct. An instrument on tbe endoscope is used to cut the duct and the stone is captured in a tiny basket and removed with the endoscope. This two-stpe procedure is called ERCP and EPT.