A Ventral Hernia or abdominal wall hernia is an abnormal protrusion of the contents of the abdominal cavity or of preperitoneal fat through a defect or weakness in the abdominal wall.  The abdominal wall is the musculofibrous covering of the contents of the abdominal cavity.

A ventral hernia is a hernia of the abdominal wall excluding the inguinal area, the diaphragm and the pelvic area.  Abdominal wall hernias can be of congenital or acquired variety.  The latter can occur either spontaneously or after surgery. When they occur after surgery, they are called incisional hernias.  3-20% of laparotomy incisions develop ventral hernia.

Types of Ventral Hernia

Umbilical Hernia – This occurs at the umbilicus or the belly button when the intestine pushes through the umbilical ring.  It can be seen as a bulge at the area of the belly button.

Lumbar Hernia –  Lumbar hernia occurs when the bowel, omentum or preperitoneal fat herniates through a defect in the lumbar triangles.  This can be Right Lumbar Hernia or Left Lumbar Hernia

Hypogastric Hernia – This occurs in the hypogastric region.

Epigastric Hernia – An epigastric hernia occurs when the intestines protrudes through the abdominal wall muscles between the umbilicus and the chest.

Spigelian Hernia – A Spigelian hernia is a ventral hernia where the abdominal contents or peritoneum through the Spigelian fascia that is comprised of the transversus abdominis and the internal oblique aponeuroses.

Strangulated Hernia

When the intestinal tissue gets tightly caught as a bulge in the abdominal wall, then the condition is termed as strangulated ventral hernia. In this case the intestinal tissue cannot be pushed back and cuts the blood flow to the area causing the hernia contents to become ischemic due to compromised blood supply.  This requires emergency surgery.

Causes of Ventral Hernia

There are several factors that lead to the formation of ventral hernia and these include:

• Pregnancy
• Obesity
• Record of previous hernias
• Previous abdominal surgery
• Injuries to the bowel area
• Frequently lifting and pushing  of heavy objects
• Week scar tissues from previous abdominal surgery

Symptoms

Symptoms may last for weeks or months and includes:

• pain and discomfort in the abdominal area during prolonged walking, standing or lifting heavy objects
• outward bulging of skin or tissues in the abdominal area
• nausea
• vomiting
• Swelling in the bulged area

Diagnosing Ventral Hernia

The doctor performs a physical exam and asks about the symptoms. The doctor suggests various imaging test including ultrasound scan, CT scan or a MRI scan.

Ventral Hernia Repair

Ventral hernia repair is the second most common type of abdominal hernia operation (25.6% of all hernia repairs). It includes incisional hernia, epigastric hernia, umbilical hernia, lumbar hernia and spigelian hernia.

Laparoscopic Ventral Hernia Repair

Laparoscopic surgery is performing the hernia repair through keyhole incisions using a laparoscope.  A laparoscope is a thin long tube that has a camera attached to its end and enables the surgeon to view enlarged images of the cavity and the organs with a monitor attached.

Laparoscopic Ventral Hernia Repair requires much smaller incisions than open surgery; minimal abdominal wall tissue trauma, less hematoma and seroma; wound infection is four-fold less likely to occur in patients with laparoscopic repair.  Cosmetic benefit varies from case to case (lack of long scar vs. correction of abdominal bulge and apron). Length of hospital stay after laparoscopic ventral hernia repair is found to be shorter in the majority of cases.

Laparoscopic surgery has several advantages with a faster recovery time and minimal scars. Advantages of laparoscopic hernia removal include:

• Few small incisions
• Lowers chance of infection
• Less postoperative pain
• Reduced hospital stay
• Minimal scars
• Faster recovery time

When approaching the hernia with the traditional open technique, the fascial defect is ideally repaired with a prosthetic mesh placed in an onlay/subfascial position. However, the appropriate positioning of the mesh usually involves a large incision and a fair amount of dissection, often complicated by the patient’s body habitus. The laparoscopic approach to ventral hernia repair offers a minimally invasive technique to repair these hernias.

The surgery is initiated by administering a dose of anesthesia to relax the patient and to reduce the pain and discomfort caused by the condition. The surgeon makes a small incision in the abdominal wall and inserts a laparoscope to view the internal abdominal cavity and associated organs. A laparoscope is a thin long tube that has a camera attached to its end and enables the surgeon to view enlarged images of the cavity and the organs with a monitor attached. After investigation, the surgeon makes few more incisions to insert hernia repair tools and the bulged tissues are pushed back and placed in position. Later a mesh is placed in the weak spot of the abdominal wall to prevent the possibility of reoccurrence of hernia. Later the incisions are closed and sutured.

After the surgery, meditations are administrated to reduce pain and discomfort from the surgery. The patient can leave the hospital in a day or two and are instructed not to do any heavy tasks like weight lifting. Diet rich in fiber content and adequate fluid intakes is instructed.

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Obturator Hernia – Symptoms

Symptoms of Obturator hernia include:

• Bowel obstruction
• Abdominal bloating
• Pain
• Constipation
• Nausea
• Vomiting

Causes of Obturator Hernia

Aging can cause loosening of muscle mass and fatty tissue and the intestine enters the obturator canal. Multiple child birth and obesity can also cause obturator hernia. It can be diagnosed by imaging tests like CT scan, ultrasound scan or MRI scan of the abdomen.

Treatment

Obturator hernia can be treated with Laparoscopic surgery. The surgery is initiated by administering a dose of anesthesia to relax the patient and to reduce the pain and discomfort. The surgeon then makes a small incision in the abdominal wall and inserts a laparoscope to view inside of the abdominal cavity and associated organs. The surgeon makes few more incisions to insert two more instruments and the bulged tissues are pushed back and placed in position. Later a mesh is placed in the weak spot of the abdominal wall to prevent the possibility of reoccurrence of hernia. Later the incisions are closed with self dissolving sutures.

After the surgery, medications are administrated to reduce pain and discomfort of the surgery. The patient can leave the hospital in a day or two and resume normal life in a week’s time.

Advantages of laparoscopic hernia surgery include:

• Small incisions
• Lowers chance of infection
• Less postoperative pain
• Reduced hospital stay
• Minimal scars
• Faster recovery time

Hernia – Other Types

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Spleen is an organ that functions to remove unwanted materials such as old and damaged blood cells from the blood stream and plays an important role in the body’s defense system. They contain particular white bloods cells that have the ability to destroy the bacteria that invade the body and prevents from bacterial attack. It also acts as a filter to the blood stream to keep it clean.  

Laparoscpoic splenectomy is recommended when following conditions persist in the organ:

• Ruptured spleen: multiple abdominal injuries leading to ruptured spleen. Ruptured spleen leads to internal bleeding.
• Enlarged spleen: An enlarged spleen condition (splenomegaly), can cause severe pain and discomfort.
• Blood disorder: Several blood disorders are successfully treated by laparoscpoic spelenectomy.
• Cancer: Laparoscopic Splenectomy is used to treat various cancers including chronic lymphocytic leukemia, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma and hairy cell leukemia.
• Infection: An infected spleen develops pus and has to be removed by laparoscopic spelenectomy.
• Cyst or tumor:  Formation of cysts and tumors inside the spleen are removed by laparoscopic splenectomy.  

Diagnosis and treatment

Before undergoing a laparoscopic splenectomy patients are required to undergo various treatments and precautions such as:

• Blood transfusion: to ensure sufficient blood cells are present in the body.
• Vaccinations:  to prevent development of any infection after spleen removal
• Temporarily discontinue other meditations if any.
• Controlled diet

Laparoscopic splenectomy procedure

During laparoscopic splenectomy, the surgeon initiates the procedure by administering a dose of general anesthetic and monitors the blood pressure and oxygen levels during the surgery. The surgeon makes a small incision in the abdomen and inserts a laparoscope (a small tube connected with a camera) through the incision. The laparoscope enables the surgeon to view an enlarged image of the abdomen and internal organs captured by the camera attached to the end of the laparoscope and is connected to the monitor. Later more incisions are made and other surgical tools are inserted to remove the affected spleen and incisions are closed with surgical tapes. After laparoscopic splenectomy, the patients can leave the hospital in a day or two. As spleen plays a major role in defense system to fight infections and bacterial attacks, doctors recommend taking several immunizations to help improve the functioning of immune system of the body in the absence of spleen.

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Tumor in the stomach may grow and occupy major portion of the cavity and block food from leaving the stomach. Laparoscopic Gastrojejunostomy helps to prevent this condition and is performed by attaching the jejunum to the upper part of the stomach. This allows the food to leave the stomach through the new bypass route.

Laparoscopic Gastrojejunostomy procedure

The surgeon initiates the procedure by administering a dose of general anesthesia to relax the pain and reduce the pain and discomfort during the procedure.

During the laparoscopic gastrojejunostomy, the surgeon makes 4 small incisions in the abdomen. A laparoscope is inserted through an incision to view enlarged clear images of the internal organs and abdominal cavity.  More surgical tools are inserted through more incisions and the passage is rerouted.  A main advantage of laparoscopic gastrojejunostomy is that it enables the patient to have shorter hospital stay and a faster recovery from the surgery. The patient experience less pain and discomfort and have minimal scars and low risk for rise of infections.  The surgery takes around 2 to 4 hours. After the laparoscopic gastrojejunostomy, the patient has to follow diet instruction provided by the doctor. This includes consuming oral fluids for few days post-surgery. When the gut adapts to the new connection, mild regular meals can be consumed in small quantity.

Dr. R. Padmakumar performs various cancer surgeries. Cancer surgery is essential to prevent metastasis (that is to prevent the spread of cancer to other parts of the body). Dr. R. Padmakumar is an expert laparoscopic surgeon and many of these surgeries are performed laparoscopically (that is through keyhole incisions). Laparoscopic Gastrectomy is another procedure to remove part of the stomach that is affected by cancer.

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Appendectomy is a surgical procedure performed to remove an inflamed appendix.  The procedure is performed laparoscpically, which is a minimal invasive surgical procedure through few small incisions made in the abdomen.  A laparoscope is a thin elongated tube like structure that has a camera attached to its end. The camera captures images of the internal organs and cavity and enables the surgeon to view the abnormalities enlarged through a connected monitor.

Is appendix surgery minor or major?

Appendectomy is a major surgery as it has to be done under General Anesthesia and it is laparoscopy.

Is Laparoscopic appendectomy a day surgery?

Laparoscopic appendectomy can be done as a day procedure, but generally patients get admitted for 24 hours.  Getting admitted may be necessary for insurance purpose as well.

How much does laparoscopic appendectomy cost?

All together the cost of undergoing appendectomy laparoscopically may be around one lakh.

What is the recovery time for a appendectomy?

The recovery time after appendectomy is usually one day in the hospital and a few days off work.

How many days should I rest after a laparoscopic appendectomy?

No bed rest is required after undergoing appendectomy laparoscopically.  One can resume office type of activities in 2-3 days.  However, strenuous activities may be done after 2-3 weeks.

According to studies, laparoscopic approach is considered the best option for removal of appendix as it has fewer complications, reduced hospital stay, and faster recovery compared to open surgery.

Dr. R. Padmakumar is one of the Best Laparoscopic Surgeons in India and has trained many surgeons all over India in Laparoscopic Surgeries.

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Colostomy procedure reroutes the normal method of waste elimination. The procedure is performed alone or in combination with other surgical procedure that requires rerouting the waste elimination system in the body. This procedure is performed in individuals who had undergone large intestine repair surgery and not able to reconnect the intestine or colon to the rectum or anus. The procedure does not cause pain as there are no nerve endings in the stoma and there is no storage of stool as the connection between the colon and rectum is terminated and redirected to the colostomy bag attached to the abdomen.

Why is a Colostomy performed?

A Colostomy is done to correct and redirect the bowel movements. This procedure can be temporary or permanent to divert the stool from the intestine. A permanent colostomy is performed when the intestine is affected by colon cancer and not able to reconnect the healthy portion of the intestine and the rectum to form a passage after removing affected segments of the intestine.

A permanent colostomy is performed when following conditions occur:

• a blockage or injury in the intestine
• inflammatory bowel disease
• colorectal cancer and colonic polyps
• diverticulitis
• imperforate anus or other birth defects
• irritable bowel syndrome
• ulcerative colitis

Colostomy procedure

At Kims hospital, we perform the minimally invasive laparoscopic colostomy surgery. The surgery is performed as a single process or in combination with other surgery performed in the intestine. The surgeon initiates the procedure by administering a dose of general anesthesia to relax the muscles and to reduce the pain and discomfort during the surgery. The surgeon makes an incision in the abdomen and inserts a laparoscope (an instrument with a camera attached at the end) to view enlarged images of the abdominal cavity and intestine. After the investigation and repair of the intestine an ideal location of the intestine is figured to form a stoma. Next a ring is implanted to hold the intestine in place to hold the stoma in the abdomen. This ring can be temporary or permanent. After creating the stoma, the incisions are closed and sutured.

After a colostomy, the colon and rectum are diverted to the colostomy bag and feces are removed from the stoma attached.

Laparoscopic colostomy procedure is gaining popularity because of the many advantages of this technique and these include:

• Few small wounds
• Shorter hospital stay
• Less pain and discomfort after the surgery
• Faster recovery to normal activity
• Lower incidence of  infections and complications
• Minimal scarring

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• Less postoperative pain and discomfort
• Shorter hospital stay
• Faster recovery and return to normal activity
• Improved cosmetic result with minimal scars
• Reduced risk of wound separation

What are Adrenal Glands?

Adrenal glands also called suprarenal glands are endocrine glands which are located above the kidneys on both sides and has got the major function of secreting a variety of hormones. The adrenal glands are responsible for releasing different hormones.

Adrenal Diseases / Adrenal Gland Disorders

Adrenal gland disorders can be caused by variation in the production of hormones. Depletion of hormones produced by other organs also affects the function of adrenal glands.  The adrenal glands produce various hormones that control many important functions in the body. These hormones include:

• Cortisol
• Aldosterone
• Adrenaline
• Noradrenaline

Various functions controlled by the adrenal hormones include:

• Maintaining metabolic processes
• Manage blood sugar levels
• Regulating inflammation
• Regulating the balance of salt and water
• Controlling the response to stress
• Maintaining pregnancy
• Initiating and controlling sexual maturation
• Important source of sex steroids (estrogen and
  testosterone)

Conditions associated with adrenal gland

Conditions associated with abnormal adrenal gland include pheochromocytomas, aldosterone-producing tumors, and cortisol-producing tumors.

• Pheochromocytomas: the condition is caused by excess hormones produced by the gland and leads to high blood pressure, headaches, excessive sweating, anxiety, and rapid heart rate. Pheochromocytoma is a neuroendocrine tumor which affects the inner layer of the gland that can lead to uncontrolled secretion of Adrenalin and nor-adrenalin which cause dangerous levels of blood pressure.
• Aldosterone producing tumors: the condition causes high blood pressure and low potassium levels.
• Cortisol producing tumors: the condition causes Cushing’s syndrome and is associated with symptoms including obesity, high blood sugar and blood pressure, menstrual irregularities and prominent stretch marks.

The doctor diagnoses the condition and presence of tumors by performing special X-ray tests, CT scan, nuclear medicine scan, an MRI or selective venous sampling to locate the adrenal tumor.

Causes of adrenal gland disorders

Improper functioning and production of hormone cause adrenal diseases. Adrenal gland disorders occur when too much hormone is produced or when too little hormone is produced and include:

• Genetic mutations
• Tumors
• Infections
• Malfunction of pituitary gland that helps regulate the
  adrenal gland
• Certain medications
• Hormones from external source( outside the body)

Treatments for adrenal gland disorders

Laparoscopic Adrenalectomy is a minimally invasive surgical method to remove the affected adrenal gland along with the tumor. The surgeon initiates the procedure by administering a dose of anesthetic and makes few small incisions and inserts a laparoscope. A laparoscope is a long thin tube that has a camera attached to its end to view the internal organs as enlarged images through a monitor connected. After investigation few more incisions are made and other surgical tools are inserted to remove the malfunctioning adrenal gland from the body. The incisions are closed and sutured.

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Laparoscopy: As the name suggests ‘Laparo’ means abdomen, ‘Scopy’ means vision. The surgeon visualizes the inner parts of the patients body through the laparoscope which is a small cut (incision 5-10 mm) on the abdomen. The magnified (up to 20 times larger) vision of the interior parts through the telescope is quite different from the traditional open surgery. Due to the small incision inflicted on the patients, it is also known as Minimally Invasive Surgery (MIS), Band – aid surgery and rarely pin hole surgery.

Doctors, patients and their bystanders can now relax. The conventional methods of open surgery by cutting and stitching body parts are soon going to be extinct. Thanks to the advancement of Science and Technology in the medical field.

Origin and History

The first laparoscopic surgery was performed in dogs in 1902 by George Kelling of Dresden Germany. The first laparoscopic surgery in humans was conducted by Hans Christian Jacobaeus of Sweden in 1910. The first laparoscopic Cholecystectomy (removal of gallbladder) in humans was done in 1987 in France. The introduction of high definition camera, medical monitor and good electro surgical units made the procedure easier. In India the procedure is in practice for the past 20 years and is getting popular due to its very high advantages over conventional surgery.

How it works

The laparoscope, a telescopic rod lens system, is put through the small incision made around the umbilicus of the patient. The system is connected to a video camera (single chip or three chip). A fiber optic cable system connected to a ‘cold light source (halogen or xenon)’ is used to illuminate the operative field. The patient’s abdomen is distended with carbon dioxide gas to create a working and viewing space for the surgeon. Carbon dioxide is used as it is familiar to the human body and gets removed by the respiratory system if it gets absorbed through tissue. The surgical equipments are introduced into the abdomen through two 3mm incisions (punctures) made near the earlier entry. The skilled surgeon, by looking at the monitor can perform surgery with precision and perfection.

Advantages of Laparoscopic Surgery

Since only two or three tiny incisions are made in the abdomen the patient feels less pain. It reduces blood loss, compared to traditional open surgery. There is less need for blood transfusion, hence less chance for acquiring infection like Hepatitis B, HIV, Malaria etc. There is significant reduction in scar and wound infection. Scant use of antibiotics and painkillers is possible unlike in open surgery. Hospital stay for patients is limited to one or two days. Shorter hospital stay means less burden for the patient and relatives. Unlike open surgery, fast recovery through laparoscopic method saves money and consumption of medicines. The patients can return to normal work and profession within a shorter period. As external snitching is completely avoided, Laparoscopic method provides excellent cosmetic outcome. The diseased organ is tackled inside the abdomen and intestines are not brought out to be in contact with outside environment as in open surgery. Hence chance of adhesion (sticking together of intestines) is minimized in laparoscopy to the least.

Laparoscopy enables doctors for better diagnosis. Since the organs are seen in magnified form, the surgeon performs with high precision. There is less chance of contact with blood and tissue fluids. Hence less chance for surgeon and staff to contract dreaded infections.

The surgeon can visualize the entire abdominal cavity of the patients, by just turning the telescope in all directions. Laparoscopic method helps in detecting alternate pathology than one which is entertained pre operatively; which is not possible in open surgery due to limited access and vision. As one can start feeding the patient early in laparoscopy, the gastrointestinal problems are also minimized and nutrition is well maintained. Finally patients is highly benefitted. Use of advanced energy sources like harmonic scalpel reduces tissue damage and hence the resultant recovery time and tiredness.

Laparoscopy – Prospective fields

Laparoscopic treatment and surgery are ideal in the case of removal of gallbladder (laparoscopic cholecystectomy) , appendix, ovary, uterus etc. It is very good for, hernia repair, bowel surgery and surgery on kidney and for surgery for weight reduction. The term Arthroscopy refers to the keyhole procedure for treatment of bone and joint problems and thoracoscopy for the procedure in chest.

How can the diseased organs be taken out through small opening ?

Usually the organs or affected parts removed are not too big. An appendix, gall bladder, cyst wall etc. are of small size which can come out through the one 10mm Incision made earlier. For females, specimen like uterus comes out through the vagina without any need for abdominal incisions. If necessary, using instruments like morcellator the specimen can be sucked out in smaller pieces completely.

Is cancer treatment possible?

Laparoscopic treatment has many advantages in detecting and removing tumors. Eight major scientific studies have proved that laparoscopic surgery is better than open surgery for surgically treating cancer. Postoperative complications in lungs, veins, intestines etc are significantly reduced by the fact that patients are not confined to bed after laparoscopy. As wounds are less, patients need not wait for the wounds to heal and early initiation of chemotherapy is possible. Waiting for wound healing makes the microscopic reminant Cancer to grow before chemo tackles it. Cancers of uterus, intestine, kidney etc. are tackled laparoscopically all over the world. Laparoscopy avoid major negative laparotomies which increase the tiredness, sickness of patients when the tumour is not surgically removable.

Laparoscopy and Hernia surgery

Hernia is protrusion of contents of abdomen through defect in abdominal wall. The treatment is to repair these defects by supporting with a mesh. In conventional surgery one has to cut all layers of the abdominal wall to place this mesh; obviously causing major wound, pain and sometimes weakening of tissues. In laparoscopy the procedure is done through 1 cm incision much away from the defect and a much larger mesh can be placed right at the place of starting of hernia. Being more physiological, the outcome is superior with very very less chance of recurrence compared to open surgery. No need for 3-6 months rest as in open surgery. Even multiple hernias can be tackled through the single 1 cm incision plus two 3 mm punctures rather than cutting long at each place.

Obesity & Diabetic Surgery

Laparoscopic method may be the only safe option in bariatric surgery. Bariatric surgery is considered when the body mass index (BMI) is more than 35. It is really difficult to perform open surgery in obese patients and they go in for respiratory and wound complications. Highly desirable results are obtained by a laparoscopic approach which gives a very good access to the stomach.

Laparoscopic bariatric surgery brings back obese patients to normalcy by getting rid of the extra fat which was causing various medical illness like diabetes, high blood pressure, high cholesterol, cardiac illness , breathing difficulty , joint pain, cancers , infertility etc. Keyhole surgery gives excellent result in attaining long term resolution of Diabetes Type II.

Laparoscopy in Gynecology & infertility

All gynaec procedures can be performed very successfully by laparoscopy and gives much better results in infertility. Taking out baby (Cesarean) may be the only procedure which may necessitate a wound. Opening abdomen for the removing uterus or cyst of any size is unnecessary as the laparoscopic surgery accomplish better outcome.

Thyroid surgery (Endoscopic Thyroidectomy)

The surgical solution available in most of the places is open thyroidectomy which involves a large transverse cut across the lower part of the neck. This definitely leads to an unsighty scar which is not acceptable, especially for women. The endoscopic thyroidectomy – the keyhole or minimally invasive technique is a very good alternative to other methods. It gives excellent cosmetic outcome especially when done by an axillary approach. It gives equal or even a better surgical outcome as far as the actual thyroid nodule management is considered.

The earlier belief was that the endoscopic no neck scar option for thyroid swellings are applicable to lesions of less than 4 cm size. But we have observed that swellings of size of even 12 – 15 cm can be tackled very successfully through this method. The only pre-requisite will be a surgeon with good experience, in both laparoscopic surgeries and thyroid surgeries. Any kind of pathologies like benign or cancerous nodules, thyoiditis can be safely tackled by endoscopic thyroidectomy.

Thoracoscopy

Keyhole surgery is an excellent method for treating disease in the chest. Lung cancers, & recurrent pneumathorax (air leak) , chest wall tumors and infection can be tackled through 1 cm cut using telescopic system. In conventional surgery (Thoracotomy) the 30-40 cm incision with rib cutting-mainly for access and vision cause extreme discomfort to patient at every breath for at least six months. The procedures can be performed with high precision and perfection with out these troubles when performed by the thoracoscopic method.

Previous Surgery & Associated medical Illness

Previous open surgery or laparoscopy in not a contra indication for laparoscopy. Medical illness like diabetes, Hypertension, asthma, cardiac illness though increase risk for anaesthesia the laparoscopic surgery can be performed comfortably without increasing the risk . Less need for confinement to bed in laparoscopy actually reduces the post op complications in these patients with comorbid illness. Laparoscopic surgeries can be performed under regional anaesthesia (spinal / epidural) when general anaesthesia cannot be given.

What are the risks in Laparoscopy?

Laparoscopic procedures do not carry any additional risks, as nothing which can harm the body is used . Surgery related risks are very minimum compared to open surgery. The safety of the patient and the precision in treatment have increased manifold with the availability of ultrasonic and radio frequency instruments. Keeping blood in reserve is mostly not needed unlike in open surgery. Pain and infection after surgery is extremely rare for the patients in laparoscopy. The diseased organ is removed completely and no chance of recurrence of the problem, only because procedure was done laparoscopically.

There is no need for physical rest for the patient and can resume normal diet in twelve hours. No special preparation is required prior to laparoscopy. Four to six hours of fasting which mandates anaesthesia requirements is sufficient.

Training

A good hand, eye coordination is required for laparoscopy. Lack of trained surgeons in laparoscopy is a major problem in India like other parts of the world. After sustained training to surgeons with easy availability of sophisticated instruments; major hospitals are now getting fully equipped to handle laparoscopic surgery. Surgeons should not give a prolonged illness & discomfort by a wound when patient comes for an illness which can be cured by surgery in 24hrs. Every surgeon should learn Laparoscopy and practice it. Lap surgery has taken away the fear of surgery-the pain. It is very pleasing to see patients walking around even on the 1st day after undergoing major surgery laparoscopically . But open surgery patient is confined to bed and require many persons to help, even to move.

Financial advantage

Through laparoscopic surgery costs higher than open surgery, it has its own advantages financially. For laparoscopic surgery, a patient need not stay in the hospital for more than two days. It will be week long stay in the hospital for open surgery. Prolonged stay in hospital incurs expenses for accommodation, food, medicine etc. The patient after laparoscopic surgery can join work much sooner than those undergoing open surgery. This will have an impact on the income of family. The expenses incurred for bystanders and their availability are minimized in the case of laparoscopy. These indirect expenses definitely over weighs the apparent direct cost for laparoscopy.

The wound related problem like infection, adhesion and hernia leads to further expenses in open surgery group even later.

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Gallbladder

The gallbladder is a small pear shaped organ that aids in the digestion process. The organ stores a fluid made by the liver called bile. Bile is a dark yellow fluid that helps digests fats in the gut. Gallbladder lies just beneath the liver and transports bile to the small intestine through narrow channels known as bile ducts.

Cholelithiasis / Gallbladder Stones

Gallstones or gallbladder stones is the most common cause of gallbladder disease. Gallstones are crystals that form inside the gallbladder. The gallbladder stone crystals are formed when too much cholesterol or too much bilirubin gets accumulated in the organ or in the duct. As a result, it prevents the flow of digestive enzymes.

Cholelithiasis is the term used to describe the condition of having gallstones. “Chole” means bile and “lithiasis” means forming of stones.

Gallstones that move out of the gallbladder can pass into the stomach. But sometimes the stone can become lodged in the bile duct due to the size of the stone. Thus, gallbladder stones that have become lodged in the bile duct are bile duct stones.

Presence of gallstones in the bladder or duct results in swelling, pain, indigestion and vomiting as they block the flow of enzymes through bile duct to the small intestine. If gallbladder stones or bile stones are left untreated, it can cause severe medical condition and leads to jaundice. Therefore, it is important to treat Cholelithiasis.

Cholecystitis

Cholecystitis is the term used to describe inflammation of the gallbladder. In most cases, gallstones is the main cause for cholecystitis. It is important to treat cholecystitis as it can lead to severe and life-threatening complications such as rupture of the gallbladder. Cholecystectomy or gallbladder removal is performed in such cases.

Diagnosing Cholelithiasis / Gallstones

Ultrasound scanning is used to diagnose gallstones. Nuclear Medicine Scans are performed for complex cases.

Picture showing Gallbladder stones

Treatment for gallbladder disorders

Laparoscopic cholecystectomy is the most commonly used treatment method for removal of gallbladder along with gallstones. Laparoscopic Surgeries are also known as Minimally Invasive Surgeries (MIS) as it uses keyhole incisions. The surgeon initiates the procedure by administering general anesthesia and the patient is put to sleep. Once anesthesia is achieved, the surgeon makes an incision in the navel area of the abdomen. The surgeon inserts a cannula through which a laparoscope is inserted.

A laparoscope is an instrument that has a telescope attached to a video camera. This helps to capture enlarged images of the organs enabling the surgeon to view in detail the condition of the organ and the surrounding internal cavity.

After inspection of the organ, few more incisions are made to insert specially designed instruments and other surgical tools to remove the bladder. During the operation cholangiogram may be performed to identify stones that could be lodged in the bile ducts. If gallstones are detected in the ducts, they are also removed.

The incisions are then closed by surgical clips or stitches. The surgery generally last for one or two hours.

Most patients can leave the hospital on the same day itself. However, proper care should be taken with proper medications and self care. If any symptoms like fever, pain in the abdomen area, frequent vomiting, or pus discharge from the incisions are noticed, immediately consult the doctor. Patients can engage in day to day activities within a week.

Laparoscopic Cholecystectomy vs. Open Cholecystectomy

Laparoscopic cholecystectomy is a minimal invasive procedure with faster recovery and less pain. As a result, most patients can be discharged same day itself. After laparoscopic cholecystectomy, patients experience lesser postoperative pain when compared to open surgery and have a fast recovery. Therefore, laparoscopy is preferred to open surgery.

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