Laparoscopic Cholecystectomy Surgery In India

Today Laparoscopic Cholecystectomy Surgery in India has become the Gold Standard for surgical treatment of benign gall bladder disease, all over the world. In view of the prevalence of Gall stone disease especially in North India it is desirable to discuss the procedure in detail.

What is a Gall Bladder?

A gall bladder is a pear shaped organ attached to under surface of liver. Liver produces bile (necessary for digestion of food) and sends it to the gall bladder for storage and concentration. Whenever we take some food gall bladder contracts and releases bile in the intestines to aid in digestion.

What is it  like to have gallstones?

Once formed, these stones lead to repeated attacks of severe pain, fever, vomiting and even occasionally jaundice- features of acute cholecystitis. Repeated attacks of acute cholecystitis make the gall bladder thick and functionless so that it can no longer concentrate the bile. Even when the patient is not having acute cholecystitis he can continue to have mild pain, difficulty in digestion, feeling of heaviness after meals- features of chronic cholecystitis. Both these conditions warrant an early removal of gall bladder through Laparoscope.

What tests may be needed for Laparoscopic Cholecystectomy ?

Ultrasound: It is a simple, rapid, noninvasive and yet highly accurate investigation for detection of gall bladder stones. Ultrasound can detect gallstones with an accuracy of 95% and size as small as 2 millimeters in diameter. The ultrasound is done on a patient who is fasting for at least 6 hours and total time for this is around 15-20 minutes. Besides the gall bladder the radiologist also gives an accurate view of the surrounding organs viz., common bile duct, pancreas, liver, kidney etc.

How Serious are gallstones and gallbladder disease?

Besides pain, dyspepsia and flatulence etc., there are other complications that one sees with gallstones which are more serious and may prove to be fatal.

• Pancreatitis:

  It occurs if one of the stones slips from the gall bladder into the bile duct and leads to swelling of a nearby organ called pancreas. This disease has a very high death rate.

• Gall Bladder Cancer:

  Although not proven as a cause for gall bladder cancer, it has been seen that more than 80% of gall bladder cancer patients also have gallstones. People who have symptomatic gallstones, however, have four times the risk as those without symptoms.

• Pus Formation in Gall Bladder:

  This is a very common complication with gall stones and can even lead to rupture of gall bladder, another life threatening complication.

What happens once the gall bladder is removed ?

Actually speaking nothing significant!! Because, by the time patients come forward for surgery, mostly their gall bladders are already functionless. Gradually all the functions of the gall bladder are taken over by liver.

Can only the gall stones be removed leaving the gall bladder behind?

This question is asked by a majority of patients. Patients site the example of kidney stones where only the stones are removed and not the kidney. The answer is that it is not advisable to do so, because this is a diseased gall bladder and it will again form stones after some time leading to recurrence so the entire gall bladder is removed.

What about the procedure in Laparoscopic Cholecystectomy ?

Coming to the crux of the story ,that is the procedure of Gall bladder removal though tubes or Laparoscopic Cholecystectomy is a very safe procedure. For this surgeon makes 3 or 4 tiny holes in the abdomen and inflates the abdomen by putting CO₂ (carbon dioxide) gas to create room for movement of instruments. The first hole is made through the naval and a state of art telescope attached to camera is introduced through it. After having a general look in the whole of abdomen at one go (this is not possible in conventional surgery) gall bladder is removed using long fine instruments just like in open surgery. The time taken varies from case to case but on an average, operating time is 20-30 minutes. The procedure requires general anesthesia (just like the conventional surgery). Patient gets only a few stitches and is mobile by evening. In some patients there is slight feeling of nausea and some pain due to stretching of abdomen.

Diet:

Most of the patients are allowed oral sips after 4-5 hours of surgery. Normal diet is resumed in 99% cases by next day and patient may also be discharged at the same time after postoperative evaluation by the surgeon.

Resumption of Activity : Patients can resume work and other daily activities whenever they feel comfortable. Normally we have seen patients going to their office by 4^th or 5^th day.

Stitches : Stitches are usually removed after one week .

While the procedure seems very easy for the patient, it is still an abdominal surgery. And, even though infrequent, it still carries the same risks as general surgery. These complications may include:

What are the complications in Laparoscopic Cholecystectomy ?

• In about 5 to 10% of cases, the gallbladder cannot be safely removed by laparoscopy. Standard open abdominal surgery is then immediately performed. However, even then mostly the size of the incision is less than the conventional one.
• Injury to the bile ducts, blood vessels, or intestine can occur, requiring corrective surgery.
• Quite uncommonly, a diagnostic error or oversight may occur.

Who can’t have the procedure ?

Surgeons are finding that cases previously felt to be unsuitable for laparoscopy can now be done safely with this technique. Still, there are instances in which the surgeon will not recommend the procedure. At times, pregnancy or previous surgery in the upper abdomen (which may cause adhesions) may require conversion to the standard surgery requiring a skin incision. In each instance, the surgeon will weigh the benefit for the patient against the risks, always considering other medical problems and always making the recommendation that is in the patient’s best interest.

COMPARISON AT A GLANCE :