Laparoscopic surgery is the minimally invasive approach to an abdominal surgical procedure performed with multiple small skin incisions. People very commonly term it as “microsurgery” or “key-hole surgery”. Laparoscopic surgery is performed for the operations of the abdomen with 6 to 12 inch long cuts. This process has a laparoscope, a lean slender shaped tool with tiny video camera and light on the tip. With few millimeters long multiple small incisions, the surgeon inserts different instruments and performs the surgery by visualizing it on a video screen. Laparoscopic surgery is used for many surgeries. It has the advantages of less pain, less cutting of skin and tissue, fewer wound complications, quicker post-operative recovery, and shorter duration of hospital stay. The surgeons can perform laparoscopic procedures in many illnesses, including:
- Abdominal surgeries to treat appendicitis, Crohn’s disease, duodenal perforation, ulcerative colitis, diverticulitis, cancer, rectal prolapse, and chronic constipation.
- Gallbladder procedures
- Gynecologic surgeries such as hysterectomies
- Hernia surgeries
What is Laparoscopic Cholecystectomy (Gallbladder removal):
Laparoscopic cholecystectomy is a procedure to treat diseases related to gallbladder e.g. gallstones, gallbladder polyps, etc. In this surgery, the doctor removes the gallbladder. The gallbladder is a pear-shaped internal organ that is just below the liver and on the upper right side of the abdomen. A laparoscope is a narrow tube with a camera inserted through one cut. It helps the surgeon to see the gallbladder of the patient on screen and then remove it from another incision.
In some cases gall bladder may be removed by one large incision, it is known as open cholecystectomy.
When is Laparoscopic Cholecystectomy used?
Laparoscopic cholecystectomy is used most commonly when a patient has stones in the gallbladder. Gallbladder’s prime feature is to store bile juice/fluid. Bile fluid is manufactured by the liver; it helps digest fats in the food we eat. These stones like substance in the gallbladder can block the flow of bile juice in the digestive system. This blockage can cause bloating, nausea, vomiting, and pain in the abdomen, shoulder, chest, and back. These gallstones can block the ducts which channel the bile from the liver and gallbladder to the intestine. These gallstones can infect the gallbladder. Irritation in the pancreas and jaundice (yellowing of skin or eyes) can occur due to blockage in the bile duct.
Why Laparoscopic Cholecystectomy?
Cholecystectomy recommended by the doctor in the following conditions:
- Large gallbladder polyps
- Cholelithiasis (Gallstones in the gallbladder)
- Choledocholithiasis (Gallstones in the bile duct)
- Cholecystitis (Gall bladder inflammation)
- Biliary Pancreatitis (Pancreas inflammation) due to gallstones
The potential risk of Laparoscopic Cholecystectomy:
Although the potential risk and complication chances are very low, few of them are as follows:
- Bleeding
- Infection
- Injury of common bile duct
- Injury to the nearby organs such as the liver and small intestine
- Risk of general anaesthesia, such as blood clots and pneumonia
- Minor shoulder pain due to carbon dioxide
- Bile leakage
Preparation of Laparoscopic Cholecystectomy
A few things must be considered for Laparoscopic cholecystectomy:
Food and medications:
As a preparation, the surgeon may suggest the following to the patient.
- A patient may have little water with the medications but should avoid eating and drinking nothing a night before surgery or at least six hours before surgery.
- Before laparoscopic cholecystectomy, share all medicinal details of the patient to the surgeon/doctor, as he may make some amendments in it or may suggest to temporarily stop some medicines on or before the day of surgery.
- A pre-anaesthetic check-up (PAC) by an anaesthetist is required before surgery.
Personal belongings:
Many patients can go home on the same day to their Laparoscopic Cholecystectomy (Day-Care Surgery), but in the case of complications, patients may be suggested to stay for one night or more in the hospital. This means a patient can go home when he can eat and drink without pain and walk on his own. For maintaining general hygiene, take the personal belongings of the patient such as hand towel, toothbrush, comfortable clothing (may be required after discharge), etc.
Other Precautions:
Do not drive for a week or as advised by your surgeon. Do not stay all alone, after Laparoscopic Cholecystectomy, for 1 or 2 nights.
The patient can have a bath after 2-3 days. Wound management is also not difficult and does not require any special dressing. A simple bandaid/hansaplast/spot bandages will do the job.
Dr. Pranay Gourav, Consultant – General Surgery, Narayana Multispeciality Hospital, Barasat