Mini laparoscopic cholecystectomy.
The mini laparoscopic surgery has the characteristic of not changing the surgical technique but only changing the diameter of the instruments with which it is performed.
INFORMATION FOR THE PATIENT FROM HIS (HER) SURGEON AND SAGES
The cholecystectomy was introduced more than a century as treatment of the symptomatic cholelithiasis, being up to date, the best treatment of this disease.
At the end of XX century, with the support of the technology, the laparoscopic cholecystectomy was introduced which in many ways revolutionized surgery, allowing to perform the same procedure with less disconfort, since it is less invasive, giving better aesthetic results and less pain. When noticing the benefits of the minimal invasión, a series of studies began to obtain better results, until getting to the surgery by natural orifices, that pretend not to leave visible scars, but its use is still in discussion because its possible complications, the cost and the lack of adequate instruments to perform it.
An interesting alternative has been the use of instruments of less diameter (two or three milimeters) which has been attempted since more than 15 years. Finally, it has been achieved the developing of better instruments that allow to perform it with confidence, with the advantage of offering better aesthetic results and, above all, to cause less pain.
The laparoscopic cholecystectomy of fine insturments, known as mini laparoscopic surgery, has the quality of not changing the surgical technique but only to change the diameter of the instruments that are used, and so it keeps the same characteristics of security of those of the larparoscopic surgery alredy known by everybody, but includes the aforementioned benefits, less pain and smaller wounds without the main risks of the surgery by natural orífices.
LAPAROSCOPIC CHOLECYSTECTOMY – AN INNOVATIVE TECHNIQUE WITH GREAT ADVANTAGES
In the past… When your surgeon recommended a gallbladder surgery, you perhaps thought about an experience, of a relative or a friend, who have had this surgery years ago. These persons had a big incision and probably have had a lot of pain after the surgery. They were at the hospital for one week and did not come back to their regular activities until six weeks. You might be worried of having a similar experience. Maybe you cannot afford being absent from your work, and are worried of not being totally functional at home for one month or more.
Today… There is an innovative technique with great advantages. The extraction of the gallbladder is one of the most frequent surgeries performed in the United States. Today, the majority of gallbladder surgeries are performed in a laparoscopic way. The medical name for this proceeding is Laparoscopic Cholecystectomy.
Instead of an incision of five or seven inches (13 – 18 cm), the surgery only requires four small openings in the abdomen.
The patient usually has a minimum post surgery pain.
The patient usually experiments a faster recuperation than the patients that have been operated with the traditional surgery of gallbladder. Most of the patients returned to their home in one day, and enjoy a faster return to their normal activities.
WHAT IS THE GALLBLADDER?
The gallbladder is an organ with a pear shape that rests below the right side of the liver.
Its principal function is the collection of a digestive liquid (bile), produced by the liver. The bile is released by the gallbladder after eating, helping the digestion. The bile travels through slim tubes (biliary tract) towards the small intestine.
In most patients the extraction of the gallbladder is not associated to any damage of digestion.
WHICH ARE THE CAUSES FOR THE GALLBLADDER PROBLEMS?
The problems of the gallbladder problems are usually caused by the presence of stones, which are small stones principally composed by colesterol and bile salts, and they are formed in the gallbladder or in the biliary tract.
It is not known why some people make stones.
These stones can obstruct the releasing of the bile of the gallbladder, causing its inflammation and producing acute abdominal pain, vomits, indigestion, and occasionally, fever.
If the stone obstructs the bile duct it may cause jaundice (yellow color in the skin)
HOW TO FIND AND TREAT THESE PROBLEMS?
After the patient has symptoms…
The ultrasound (sonography) is the method most used to find the stones.
In few more complex cases other x-ray exams can be used to evaluate the gallbladder.
The stones are not expelled by themselves. Some may be temporally treated with drugs or with special diets, to quit the absorption of grease. This treatment has in a short time, a low percentage of success and the symptoms will continue until the gallbladder is removed.
The surgical removal of he gallbladder is the most recognized over time and secure for the patology of the gallbladder.
WHAT PREPARATION IS REQUIRED?
Before the surgery you should be in fast of liquids and solids since midnight of the prior day.
You must get a shower the prior night or in the morning of the surgery.
If you have difficulty for your bowel movements an enema or any similar preparation might be used, after consulting your surgeon.
Some preparation exam might be required in accordance to your medical condition.
If taking a daily medication talk with your surgeon if he wants you to take the medication in the morning of the surgery, with a sip of water. If you take aspirine, blood thinners or medication for arthritis, you need to talk with your surgeon for the appropriate time of stopping this drugs before the surgery.
HOW IS THE LAPAROSCOPIC REMOVAL OF THE GALLBLADDER CARRIED OUT?
By general anesthesia; the patient is going to be asleep during the surgery.
Using a cannula (thin tube) the surgeon enters into the abdomen in the navel area.
A laparoscope (a fine telescope) connected to a special camera is introduced through the cannula, giving the surgeon a magnified image of the internal organs of the patient through a television screen.
Other cannulas are inserted to let the surgeon separate delicately the gallbladder of its adhesions and remove it through one of the opennings.
Many surgeons make an x ray, called cholangiography to identify stones which can be located in the bile duct, or to ensure that the anatomical estructures have been identified.
If the surgeon finds one or more stones in the bile duct he can remove it (them) using a special endoscopy; he may decide to remove it (them) later, using other procedure minimally invasive or can turn it into an open surgery, with the purpose of removing all the stones in this surgery.
After the surgeon has removed the gallbladder the small incisions are closed with one stitch or two, or with a surgical tape.
WHAT HAPPENS IF THE SURGERY CANNOT BE PERFORMED BY MEANS OF A LAPAROSCOPY?
In a small number of patients the laparoscopic method is not possible due to the disability of visualizing or managing the organs effectively. When the surgeon decides that is safer to turn the laparoscopic surgery into an open surgery it is not a complication. This decision means good surgical judgement. Some factors, which increase the risk of turning it into an open surgery, include obesity, backgrounds of prior abdominal surgeries that cause dense scars, or bleeding during the surgery. The decision of performing an open procedure is a judgement decision, chosen by the surgeon before or during the surgery. The decision of turning it into an open procedure is strictly based on the safety of the patient.
HOW LONG WILL THE PATIENT STAY AT THE HOSPITAL?
Most of the patients return to their home the next day of the Laparoscopic Cholecistectomy. Some patients can even return the same day of the surgery, in comparison to a five day staying after an open traditional procedure.
WHEN CAN THE PATIENT GET BACK TO HIS (HER) WORK?
Most of the patients can get back to work within seven days after the laparoscopic procedure. Of course, this depends of the nature of his (her) job. Patients with an administrative jobs or a desk job usually returns in few days, while those who have manual jobs, or who lift heavy objects can delay a little bit more. Patients who suffer traditional procedures cannot get back to their normal activities for four or six weeks.
WILL YOU GET A BIG SCAR?
No. Using the laparoscopic techniques the surgeon can avoid a big incision, leaving the patient with only four little marks.
IS THE GALLBLADDER LAPAROSCOPIC SURGERY SAFE?
Many medical studies show that the rate of complications of the gallbladder laparoscopic surgery is comparable to the rate of complications of the traditional surgery of gallbladder, when performing it by a well trained surgeon.
ARE THERE RISKS RELATED TO A LAPAROSCOPIC CHOLECYSTECTOMY?
Exist risks related to any kind of surgery; Most of the patients of laparoscopic cholecystectomy experience few or none complications, and return rapidly to their normal activities. It is important to recall that, before getting any type of surgery (either laparoscopic or open), you should ask your surgeon about his experience and training. The risks of laparoscopic cholecystectomy are fewer than the risks of leaving a condition without treatment.
The complications of the laparoscopic cholecystectomy are not frequent, but they can include bleeding, infections, pneumonia, blood clot or cardiac problems. An unnoticed injury of an adjacent structure like the bile duct or the duodenum may occur and may require other procedure to fix it. Leaks of bile to the abdomen coming from the ducts that carry bile from the liver to the duodenum have been described.
WHAT HAPPENS AFTER THE SURGERY OF THE BILE DUCT?
The removal of the gallbladder is a major abdominal surgery and certain amount of pain can be sensed. Nauseas and the vomit are not infrequent.
Patients leave the hospital the same day or the next day of the laparoscopic surgery of the gallbladder, once liquids or diet are tolerated.
Turning into activities depends on how the patient is feeling. Walking is adviced. Patients can remove their bandages and can take a shower the next day after the surgery.
Patients probably will be able to return to their normal activities within a week, including, driving the car, climbing the stairs, lifting up lightweight objects and getting back to work.
In general, the recovery is progressive since the patient returns to his(her) home.
The presence of fever, yellow color in eyes or in skin, worsening of the abdominal pain, distension, nausea and persistent vomit, or leak from any wounds are indications that any complication might have occurred. In this circumstances you have to contact your surgeon.
You can request a control appointment within the two weeks after the surgery, even if your post operative period has passed without problems.
IS THE GALLBLADDER LAPAROSCOPIC REMOVAL THE INDICATED FOR YOU?
Although there are many advantages of the laparoscopy the procedure may not be appropriate for some patients who have had prior abdominal surgeries, or those who have any prior medical condition. It can be determined if the laparoscopic removal of the gallbladder is the appropriate one for you through an exam performed by your personal doctor, and the consulting of a general surgeon trainned in laparoscopy.
This brochure does not pretend to replace the conversation with your surgeon over the necessity of getting an appendicectomy. If you have any question reffered to your necessity of getting an cholecystectomy, its alternatives, the invoicing or the covering of the insurance, or about the training and experience of your surgeon, do not hesitate in asking such surgeon or the personnel of the clinic about it. If you have questions over the surgery or the subsequent control, we ask you to talk about such subjects with your surgeon before or after the surgery.
