GALLBLADDER SURGERY
Gone are the days when gall bladder surgery meant a long , ugly scar that too on upper part of abdomen. Besides looking bad it meant the person had to wear covered dresses. Scared to even go for stuff like swimming. Recovery used to take weeks. Needless to say atleast 3-4 days hospital stay.
Today’s minimally invasive gallbladder surgery requires three or four separate tiny incisions the maximum being 1 cm length. Alternatively it can also be accomplished by 1 to 1.5 inch single incision at the navel.
The gallbladder resides behind the liver where it receives bile produced by the liver, which is released into the small intestine to aid in digestion. Gallbladder problems, the commonest being gallstones ,may need surgical removal of the gall bladder ( known as cholecystectomy). Dr. Kapil Kochhar is one of the pioneers in this surgery. He performed his first laparoscopic gall bladder surgery somewhere around 1995. And after that has done hundreds of such cases laparoscopically including the ones which were refused a laparoscopic procedure at most centres.
GALLBLADDER AILMENTS REQUIRING SURGERY
There are several common ailments of the gallbladder that require surgery.
1. The single most common gallbladder disorder is cholelithiasis, also known as gallstones. These gallstones are thought to be created by cholesterol combining with bile salts and bilirubin (dead red blood cells), creating a small stone-like particle that can block bile ducts and cause severe pain. It leads to unbearable pain often associated with intractable vomiting and mild derangement of liver functions.
2. Another common indication is slippage of stone in common bile duct leading to jaundice , fever and at times life threatening situation known as pancreatitis. Blockage of bile duct leads to build up of bile resulting in painful swelling that can lead to infection. Swelling can also be the result of injury to the gallbladder. Not only is fever often present, a little over one-third of the patients presenting have a palpable gallbladder and about 15 percent of patients will have jaundice, which is yellowing of the skin.
3. Sometimes, Intensive Care Unit patients in the hospital develop acute acalculous cholecystitis, also known as porcelain gallbladder, which is the creation of thickened walls caused by calcification. Not only does this ailment give the gallbladder a white or porcelain appearance, but it also surrounds the gallbladder that can become distended, resulting in a need for urgent surgery. This medical condition is also seen in late term HIV patients, diabetics, and patients on total parenteral nutrition (TPN) for three months or longer. Patients suffering acute acalculous are at greater risk for perforation and/or gangrene. If the patient does not respond to intensive IV antibiotics and supportive therapies, the patient will need an emergency cholecystectomy.
RISK FACTORS FOR GALL STONE DISEASE
Although the exact cause and clear risk factors are not known , the following groups are at a higher risk
• Women
• Women who have been pregnant
• Women over the age of 40
• Women who are overweight
Symptoms for Gallbladder Disease
Sometimes a patient does not experience any discomfort, but there are common signs and symptoms that indicates towards gallbladder disease, which include the following:
1. intermittent pain or a feeling of upper abdominal fullness particularly after eating, especially in centre or on the right side
2. sharp pain that occurs because of swelling, resulting in cholecystitis
3. heartburn, indigestion, and vomiting
4. jaundice which indicates a possible blockage of the bile duct
5. fever may be present
Diagnosis and Treatment
A physician will order several tests to assist in diagnosing and treating cholecystitis, acute acalculous cholecystitis, and cholelithiasis. These will include blood tests and ultrasound. CT scans or MRIs may be needed in complicated cases. If it’s a very acute attack then treatment with IV antibiotics and other medications is needed to bring the inflammation down a bit. However this is not the definitive treatment. The only effective way to treat these disorders is by doing a cholecystectomy or surgical removal of gall bladder.
WHAT TO EXPECT DURING A CHOLECYSTECTOMY
There are three surgical procedures used to remove the gallbladder: single wound open surgery, laparoscopic surgery or robotic surgery.
OPEN CHOLECYSTECTOMY
Although laparoscopic surgery is most commonly performed, there are surgeons who prefer the open single cut surgery approach to remove the organ using a single incision that can be as long as seven inches. The open method is also used when a patient presents with abnormalities that make laparoscopic surgical procedures impossible.
Surgeons who use this method make the single incision and then spread open the skin, clamping it back so the liver can be lifted and the organ accessed. The surgeon clips and cuts the cystic duct ( narrow tube that connects the gall bladder to main bile duct ), along with the blood vessels that feed the organ, then the surgeon is able to carefully remove it. Surgery may involve special x-rays called cholangiograms, using dye injected into the common bile duct to ensure there are no gallstones present in the bile duct or abdomen. Recovering from the removal of the gallbladder, which takes about one to two hours, normally means a five-day stay in the hospital and then weeks before patients can lift a considerable weight or resume his normal activities.
LAPAROSCOPIC SURGERY
This surgery uses three to four small incisions about 0.5 -1 cm in length. Alternatively there can be a single incision of 1-1.5 inches at the navel. During surgery, the patient’s abdomen is filled with gas to allow easier access to the organs and better visuals. The surgeon then completes the gallbladder surgery by clipping the cystic duct and feeding vessels. Then he detaches the organ and removes it through one of the ports. This surgery is completed in 15-20 minutes in case there are no complications. And patient can be discharged the same evening. Approximately 95 percent of my patients resume their offices in 5-6 days and most start work from after 48-72 hours. There’s no restriction on physical activity or lifting weight.
ADVANTAGES OF ROBOTIC / LAPAROSCOPIC GALLBLADDER SURGERY
There are many advantages of laparoscopic surgery over open surgery. For instance, patients having laparoscopic removal of their gallbladder experience much faster recovery time than those receiving an open cholecystectomy. Many patients are able to go home the same day while a few may need an overnight stay. Almost all patients are started liquid diet after 6 hours and most are able to tolerate soft diet by next day morning. As soon as the patient accepts diet he / she is discharged. This is much faster than with open surgery. In addition, patients are able to bathe the very next day, change their bandages themselves and resume regular activities in as little as five days to one week after laparoscopic surgery.
Infact laparoscopic cholecystectomy has become the gold standard for gallbladder surgery in todays world. It’s the first choice not only of the patients but surgeons as well. Needless to say that since hospital stay is less , amount of medicines used less and very early resumption of work , it is extremely more economical than conventional surgery