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Gall Bladder Surgery


Laparoscopic cholecystectomy or gall bladder surgery aims at treating symptomatic gall bladder stones. It is considered as the gold standard procedure for gall bladder removal. The choice is due to the several advantages of laparoscopic surgery, which includes reduced postoperative pain, early post operative recovery, early return to work, improved cosmesis and minimal intake of pain killer medicines.

Gallbladder Stone Removal Treatment In Kerala

There are several indications for gallbladder surgery:

Symptomatic Gall Stone Disease

Sonography (ultrasound scan) indicates the presence of identifiable gallbladder stones. Laparoscopic surgery is done for acute cholecystitis diagnosed within 72 hours of the onset of the symptoms. Beyond that period, open surgery may be required or the patient is treated with antibiotics and after recovery, an interval gallbladder removal is done. Another indication of a laparoscopic procedure is recording an ejection fraction of < 35% at 20 minutes if the patient has typical gallbladder related symptoms.

Asymptomatic Gallstones

Silent gallstones are asymptomatic and can go on to become symptomatic. A diagnostic abdominal ultrasonography leads to the detection of unsuspected gallstones. In such a case, the patient needs to be under close follow up and gallbladder removal is done if he or she develops symptoms.

Complex Gall Bladder Disease

Gallstone pancreatitis, incidental gallbladder cancer, calculous cholecystitis, Mirizzi syndrome, cholecystoduodenal fistula, and choledocholithiasis are all complex gallbladder diseases which require a laparoscopic cholecystectomy.

Technique

  • A pneumoperitoneum is a necessity for a laparoscopic cholecystectomy
  • Patient is administered general anaesthesia
  • After placing the patient in a supine position, peripheral intravenous lines are inserted
  • Blood pressure monitors are placed along with pulse oximetry and electrocardiography
  • The procedure can be converted into an open, if any complications arise during the laparoscopic procedure, or if the anatomy is unclear and proceeding laparoscopically would cause damages to the nearby structures.
    • Conventional laparoscopic cholecystectomy: In this approach, four small wounds are made in the abdomen, with the help of camera, telescope and delicate instruments, the gallbladder is dissected and removed through one of the wounds.
    • Minilaparoscopic cholecystectomy: As an aim to reduce invasiveness, this procedure is performed electively using 5 mm epigastric, 2 mm lateral, 2 mm subcostal and 10 mm umbilical ports.
    • Single-site cholecystectomy: A single port access or SPA is also known as single-port cholecystectomy or single-incision laparoscopic cholecystectomy (SILC) or even a single-incision laparoscopic surgery (SILS). A distinct and single entry point is made at the patient s umbilicus. In some cases, three discrete mini incisions are performed at a single site. This improves cosmesis considerably.

Our team of surgeons review each case and prepare a preliminary treatment plan best suited to the patient s disposition. The patient is also advised a post-operative course of treatment inclusive of monitoring and follow-up schedules before the operation itself.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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