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LAPAROSCOPIC SURGERY
Laparoscopic Surgery refers to surgery performed through very
small incisions on the abdomen. The incisions usually are one or two
centimeters in length. Many operations that once required large
incisions are now being done routinely using a laparoscope. Many
laparoscopic operations, including appendectomy and removal of the
gall bladder (cholecystectomy), are routinely done on an outpatient
basis, that ism without admission to the hospital. Other more
complex operations are being done with only a one or two day stay in
the hospital.
Patients are benefiting from less postoperative pain, earlier
returns to full activity, and much less scarring. Some operations,
such as colon resections, are being done as laparoscopic-assisted
procedures which means that most of the operation is done with a
laparoscope. A small incision, usually two or three inches long, is
used for part of the operation and to remove an organ.
LAPAROSCOPIC CHOLECYSTECTOMY
Laparoscopic cholecystectomy means removal of the gallbladder using
a laparoscopic technique. The gallbladder is smaller than a hen's
egg. It is adjacent to the liver in the right upper part of the
abdomen. Most cholecystectomies are done for gallstones which are
causing symptoms. The formation of gallstones in the gallbladder is
and indication that the gallbladder is not functioning properly.
Gallstones often lead to episodes of upper abdominal pain, sometimes
associated with nausea and vomiting. These episodes may even be
mistaken for a heart attack and often lead to emergency room visits.
The pain may resolve in 3-4 hours or may be persistent. The pain
tends to be recurrent. Some people, especially older people, present
with pain, fever, and malaise and require treatment more
expeditiously. Gallstones can cause many other problems including
pancreatitis, yellow jaundice, and severe infection.
In some patients with abdominal pain, testing will demonstrate a
malfunctioning gallbladder in the absence of gallstones. These
patients also benefit very often from laparoscopic cholecystectomy.
Laparoscopic cholecystectomy is done with general anesthesia and
usually does not require a hospital stay. Generally, four small
incisions are used. The largest is usually hidden by the umbilicus
(belly button). The incisions allow placement of a laparoscope and
long narrow instruments for operating. A camera on the laparoscope
allows the anatomy to be visualized on a large television monitor.
The gallbladder is dissected free from its attachments to the liver,
the bile duct, and its blood supple, and is removed through the
umbilical incision. The surgeon is always prepared to convert to an
open operation in difficult cases, but this conversion is needed
only rarely in uncomplicated situations.
Patients may require prescription pain medication for a day or two
after surgery. Most patients are able to resume all of their usual
activities in 5 to 7 days. Exceptions are very heavy manual work,
aerobics, jogging, and weight lifting. These types of activities may
require a longer recovery period
LAPAROSCOPIC ANTI-REFLUX PROCEDURES
The laparoscopic Nissen fundoplication is the most common
laparoscopic anti-reflux procedure. Other anti-reflux procedures are
done in special situations.
Gastroesophageal reflux disease (often called GERD) is a very common
problem in Americans. GERD leads to heartburn and indigestion. In
some people it leads to hoarseness, cough, recurrent lung
infections, asthma, persistent throat clearing, and sleeping
difficulties. People with GERD often lessen their symptoms with
lifestyle modifications and medications. More information on this
topic is available on an excellent web site called
HeartBurnHelp.com
Many cases if GERD are well managed with lifestyle changes and
medications; however many other GERD sufferers are not adequately
treated with the non-surgical approach. Others do not want to comply
with the lifestyle changes and medication regimens for the rest of
their lives. For these individuals laparoscopic surgery may be
appropriate.
Before laparoscopic surgery is recommended for GERD, a number of
tests must be done to prove the diagnosis and to be sure that the
individual has suitable anatomy and physiology to have the
operation.
The laparoscopic Nissen fundoplication is done with general
anesthesia. Usually six small incisions are required for placement
of the laparoscope and the long narrow operating instruments. The
operation involves creating a one-way valve on the distal esophagus
where it connects to the stomach. (The problem in people with GERD
is that the "natural one-way valve" in their esophagus is no longer
working properly.) The one-way valve effect is created by using a
redundant (excess) portion of the stomach to wrap around the lower
esophagus. For this reason, some doctors refer to the operation as a
"wrap". The valve prevents acid, food, and liquids from refluxing
back into the esophagus. Most patients can abandon their lifestyle
modifications and stop taking medications for GERD after the
operation.
Most patients stay one night in the hospital and are eating solid
food on the morning after surgery. One can return to work in 7-10
days except in unusual cases. More information concerning the
operation is available at www.heartburnhelp.com.
LAPAROSCOPIC APPENDECTOMY
Sometimes appendectomy is best accomplished using a laparoscope, but
not always. The laparoscopic technique allows the surgeon better
visualization of other abdominal structures which is especially
useful when the diagnosis is in doubt. For uncomplicated
appendicitis, the recovery is usually faster and the scarring less
with laparoscopic technique. Some cases of appendicitis are better
managed with an open operation.
LAPAROSCOPIC SURGERY
Many other procedures are being done using a laparoscope by the
surgeons at Surgical Associates of South Carolina. Some of these may
be included when this web site is updated.
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