Laparoscopic Surgery

Gall bladder & Hernias

Laparoscopic Surgery
infoLaparoscopic Surgery

Laparoscopy has found its place quite rightfully among the surgeons. Most of the common general surgical procedures are now done laparoscopically. Some people call it ‘MICROSURGERY’. Though technically it is not correct, it conveys the essence of the concept – it is done with minimum injury to human body and therefore is relatively painless. Surgeons prefer to call it MINIMAL INVASIVE SURGERY – MIS. So, all these – MICROSURGERY, KEY-HOLE SURGERY, MINIMAL INVASIVE SURGERY and LAPAROSCOPIC SURGERY mean the same. I would list down the surgeries I perform laparoscopically below.

    Basic Laparoscopic Procedures:
  1. Gall bladder stones
  2. Appendicitis
  3. Hernia surgery
    Advanced Laparoscopic Procedures:
  1. Colorectal surgery
  2. Upper GI Surgical procedures like Hiatus Hernia, anti-reflux surgeries, and Gastrectomy
  3. Laparoscopic surgery of Liver and Spleen and Pancreas
  4. Laparoscopic surgery of adrenal gland, and intestinal surgeries

Frequently Asked Questions

Gall bladder Surgery

  • Why only the Gall bladder stones are not removed?

    A gall bladder containing stones is a diseased gall bladder and isn’t performing its function. If only stones are removed new stones will form quickly. Therefore, the gall bladder must be removed.

  • Is it possible to get only the stones removed?

    Theoretically possible but logically it is stupidity! Moreover, taking out the stones only isn’t regarded as the standard of care. A surgeon might be held negligent in his job if he does so.

  • Can’t you crush the stones with laser and can`t I pass it in urine?

    No. crushing of stones is done in kidney stones and you can perfectly flush out the sand in urine if you take lot of water. But gall bladder isn’t a part of urinary system. It is a part of digestive system where flushing by excess water doesn’t work.

  • I think laparoscopy is done under local anaesthesia, am I right doctor?

    No, laparoscopy is generally performed under general anaesthesia and never under local anaesthesia. Rarely is it done under epidural anaesthesia too.

  • My elderly father who is also a heart patient has stones in gall bladder. Don`t you think laparoscopy will be the best option?

    Decision of laparoscopy is joined taken by surgeon, anaesthetist and cardiologist if the patient has significant cardiac ailment. Most doctors advice open surgery because it has been proved open surgery put less stress on the heart. Therefore, contrary to the common belief.

  • Are all gall bladder stone surgeries possible through laparoscopy?

    Almost all, if not all; but depends on anatomy of the gall bladder, complications present, and controversially, skill of the surgeon.

  • What is difficult anatomy you mean?

    It will call for a knowledge of anatomy of the gall bladder and the relationship of the cystic duct to the bile duct. Suffice it to say here that any abnormality which endangers operative injury to the bile duct is regarded as difficult anatomy.

  • What will you do in that situation?

    Any sensible and mature surgeon will abandon laparoscopy and complete the surgery by open surgery.

  • Will conversion to open surgery make me weak or infirm?

    No, absolutely not. In fact open surgery had been the gold standard in eighties and nineties, but as laparoscopy became popular, open surgery has lost its preferred place, but still retains its position as the salvage procedure when the surgeon faces a difficult situation. Except a bigger scar, and more pain open surgery doesn’t make one weak or infirm. Incidence of Postoperative Hernia is slightly more in open surgery, but with due care this complication can be avoided also.

  • My uncle told me during his laparoscopic surgery the surgeon couldn`t remove all the stones. So, I am scared to choose laparoscopy!

    To answer to this question I`d say that the comment is wrong and the person wasn’t probably explained about the procedure. In laparoscopic gall bladder surgery a surgeon removes the gall bladder itself, not the stones. Now you can well realize why the comment above is wrong!

  • But I heard about patients who needed some extra procedures after laparoscopy. Why do they need so and what exactly is done?

    In a patient with gall bladder stones, tiny stones can come out of the gall bladder and lodge in the bile duct. This condition is generally indicated by raised liver enzymes – SGOT, SGPT, and Alkaline Phosphatase with raised conjugated Bilirubin some times. An MRCP can confirm it. If confirmed before laparoscopy, an ERCP – an endoscopic procedure to extract stones from the bile duct, with or without stent placement in the bile duct is done by gastroenterologists. Generally ERCP is done before laparoscopy, but if unfortunately Bile duct stones weren`t suspected pre-operatively because of normal LFT, sometime ERCP is done after laparoscopy too.

  • Why some patients have a tube after surgery?

    This is called a drain in surgical language. During surgery the surgeon dissects tissue, cuts some, burns some and finally leaves the field dry. If he thinks the field isn’t unquestionably satisfying, most surgeons will leave a drain near the gall bladder area so that if there is any collection of blood or serum and in rare cases bile forms it can come out. Otherwise, trapped inside, the fluid can turn into an abscess.

  • Is it true that after gall bladder surgery a patient cannot eat normal food? Is it a fact that all life he/she will have to take boiled diet?

    No, this is not true. Most patients take normal diet from first week.

  • Stones have been detected in my gall bladder during USG for a different reason. Do I need to undergo surgery immediately?

    Not necessarily. But a subgroup of population, such as Diabetes, young age at diagnosis, sickle cell anaemia, big sized stone, concomitant polyps etc. are recommended to undergo surgery.

  • My USG report says I have polyps in the gall bladder. Do I need to get it removed?

    Gall bladder polyps if they are more than 10 mm in size should undergo surgery.

Hernia Surgery

  • What is hernia?

    Any abnormal protrusion of abdominal content through a natural or unnatural orifice is a hernia.

  • How many types?

    For patients it could be groin hernias, umbilical, and post operative hernias, which can occur through or around any scar.

  • Is surgery a must? Or can it be treated with medicine?

    Hernia warrants surgery almost all the time.

  • Can the surgery be done laparoscopically?

    Of course! Nowadays all hernias are repaired laparoscopically unless the patient is very obese.

  • Is it done under local anaesthesia?

    All laparoscopic surgeries, including hernias are done under general anaesthesia, not local anaesthesia. However, they can be done under local or regional anaesthesia but in that case the surgeon has to do an open surgery. Laparoscopic surgery can not be done under local anaesthesia. Contd.

  • How do you repair a hernia?

    The basic principle is to mend the defect using a mesh, which is a porous synthetic material through which tissues grow and finally incorporated in tge body making an impenetrable barrier.

  • Is it costly?

    Depends on many factors. Varies from cheap to expensive. As a rule meshes for open surgery are cheaper than mesh used in laparoscopic surgery.

  • When can one resume normal activity after laparoscopic repair?

    Much earlier than an open hernia.