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Laparoscopic surgery is also called minimally invasive surgery (MIS), bandaid surgery, or keyhole surgery. It is a modern surgical technique in which operations are performed through 3 to 4 keyhole incisions (usually 0.5 - 1.5 cm) made into abdominal wall.
 
A tube is inserted through the incision, and carbon dioxide gas is pumped through the tube to inflate your tummy (abdomen). Inflating your abdomen allows the surgeon to see your organs more clearly and gives them more room to work. A laparoscope is then inserted through this tube. The laparoscope will relay images to a television monitor in the operating theatre, giving the surgeon a clear view of the whole area.
 
If the laparoscopy is used to carry out a surgical treatment, such as removing your appendix, further incisions will be made in your abdomen. Small, surgical instruments can be inserted through these incisions, and the surgeon can guide them to the right place using the view from the laparoscope. Once in place, the instruments can be used to carry out the required treatment.
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The “Keyhole surgeries” performed by Dr. Dinesh Jain are to :

  • Repair of all kinds of abdominal hernias (Inguinal, Femoral, Umbilical, ventral and incisional)
  • Removal of appendix (Appendicectomy)
  • Removal of gall bladder (Cholecystectomy)
  • Repair of hiatus hernia (Fundoplication)
  • Surgery for achalasia cardia.(Cardiomyotomy)
  • Removing the adhesions between abdominal wall, omentum and organs (Adhesiolysis)

Advantages of laparoscopic surgery over the open surgery :

  • Minimal cutting of the body tissues
  • Minimal Pain
  • Minimal time for healing
  • Minimal medication
  • Minimal hospital stay
  • Minimal scar
  • Early return to work 

Laparoscopic Appendix removal FAQs

What is Appendix?

The appendix produces a bacteria destroying protein called immunoglobulins which help fight infection in the body. Its function, however, is not essential. People who have had appendectomies do not have an increased risk toward infection. Other organs in the body take over this function once the appendix has been removed.

What is Laparoscopic Appendectomy?
Appendicitis is one of the most common surgical problems. One out of every 2,000 people has an appendectomy sometime during their lifetime. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall.
In most laparoscopic appendectomies, surgeons operate through 3 small incisions (each ¼ to ½ inch) while watching an enlarged image of the patient’s internal organs on a television monitor. In some cases, one of the small openings may be lengthened to 2 or 3 inches to complete the procedure.
Advantages of Laparoscopic Appendectomy
Results may vary depending upon the type of procedure and patient’s overall condition. Common advantages are:
  • Less postoperative pain
  • May shorten hospital stay
  • May result in a quicker return to bowel function
  • Quicker return to normal activity
  • Better cosmetic results
Are you a candidate for Laparoscopic Appendectomy?

Although laparoscopic appendectomy has many benefits, it may not be appropriate for some patients. Early, non-ruptured appendicitis usually can be removed laparoscopically. Laparoscopic appendectomy is more difficult to perform if there is advanced infection or the appendix has ruptured. A traditional, open procedure using a larger incision may be required to safely remove the infected appendix in these patients.

How is Laparoscopic Appendectomy performed?
The words “laparoscopic” and “open” appendectomy describes the techniques a surgeon uses to gain access to the internal surgery site.
 
Most laparoscopic appendectomies start the same way. Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through a cannula, giving the surgeon a magnified view of the patient’s internal organs on a television monitor. Several other cannulas are inserted to allow the surgeon to work inside and remove the appendix. The entire procedure may be completed through the cannulas or by lengthening one of the small cannula incisions. A drain may be placed during the procedure. This will be removed before you leave the hospital.
What happens if the operation cannot be performed or completed by Laparoscopic method?
In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. Factors that may increase the possibility of converting to the “open” procedure may include:
  • Extensive infection and/or abscess
  • A perforated appendix
  • Obesity
  • A history of prior abdominal surgery causing dense scar tissue
  • Inability to visualize organs
  • Bleeding problems during the operation
The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open procedure is strictly based on patient safety.
What should you expect after surgery?
After the operation, it is important to follow your doctor’s instructions. Although many people feel better in just a few days, remember that your body needs time to heal.
  • You are encouraged to be out of bed the day after surgery and to walk. This will help diminish the risk of blood clots in your legs and of soreness in your muscles.
  • You will probably be able to get back to most of your normal activities in one to two weeks time. These activities include showering, driving, walking up stairs, working and engaging in sexual intercourse.
  • If you have prolonged soreness or are getting no relief from the prescribed pain medication, you should notify your surgeon.
  • You should call your surgeon and schedule a follow up appointment for about 1-2 weeks following your operation.
What complications can occur?
As with any operation, there are risks including the risk of complications. However, the risk of one of these complications occurring is no higher than if the operation was done with the open technique.
  • Bleeding
  • Infection
  • Removal of a normal appendix
  • A leak at the edge of the colon where the appendix was removed
  • Injury to adjacent organs such as the small intestine, ureter, or bladder.
  • Blood clot to the lungs
It is important for you to recognize the early signs of possible complications. Contact your surgeon if you have severe abdominal pain, fever, chills or rectal bleeding.
When to call a doctor?
Be sure to call your physician or surgeon if you develop any of the following:
  • Persistent fever over 101 degrees F (39 C)
  • Bleeding
  • Increasing abdominal swelling
  • Pain that is not relieved by your medications
  • Persistent nausea or vomiting
  • Chills
  • Persistent cough or shortness of breath
  • Purulent drainage (pus) from any incision
  • Redness surrounding any of your incisions that is worsening or getting bigger
  • You are unable to eat or drink liquids

Laparoscopic Gallbladder removal FAQs

What Is The Gallbladder?
  • The gallbladder is a pear-shaped organ that rests beneath the right side of the liver.
  • Its main purpose is to collect and concentrate a digestive liquid (bile) produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through narrow tubular channels (bile ducts) into the small intestine.
  • Removal of the gallbladder is not associated with any impairment of digestion in most people.
What Causes Gallbladder Problems?
  • Gallbladder problems are usually caused by the presence of gallstones: small hard masses consisting primarily of cholesterol and bile salts that form in the gallbladder or in the bile duct.
  • It is uncertain why some people form gallstones.
  • There is no known means to prevent gallstones.
  • These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting, indigestion and, occasionally, fever.
  • If the gallstone blocks the common bile duct, jaundice (a yellowing of the skin) can occur.
What Are The Advantages of Performing Cholecystectomy Laparoscopically?
  • Rather than a five to seven inch incision, the operation requires only four small openings in the abdomen.
  • Patients usually have minimal post-operative pain.
  • Patients usually experience faster recovery than open gallbladder surgery patients.
  • Most patients go home within one day and enjoy a quicker return to normal activities.
Are You A Candidate For Laparoscopic Gallbladder Removal?

Although there are many advantages to laparoscopy, the procedure may not be appropriate for some patients who have had previous upper abdominal surgery or who have some pre-existing medical conditions. A thorough medical evaluation by your personal physician, in consultation with a surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal is an appropriate procedure for you.

What Preparation Is Required?
The following includes typical events that may occur prior to laparoscopic surgery; however, since each patient and surgeon is unique, what will actually occur may be different:
  • Preoperative preparation includes blood work, medical evaluation, chest x-ray and an ECG depending on your age and medical condition.
  • After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
  • It is recommended that you shower the night before or morning of the operation.
  • After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery..
  • Quit smoking and arrange for any help you may need at home.
How Is Laparoscopic Gallbladder Removal Performed?
  • Under general anesthesia, so the patient is asleep throughout the procedure.
  • Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen in the area of the belly-button.
  • A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient’s internal organs on a television screen.
  • Other cannulas are inserted which allow your surgeon to delicately separate the gallbladder from its attachments and then remove it through one of the openings.
  • Many surgeons perform an X-ray, called a cholangiogram, to identify stones, which may be located in the bile channels, or to insure that structures have been identified.
  • If the surgeon finds one or more stones in the common bile duct, (s)he may remove them with a special scope, may choose to have them removed later through a second minimally invasive procedure, or may convert to an open operation in order to remove all the stones during the operation.
  • After the surgeon removes the gallbladder, the small incisions are closed with a stitch or two or with surgical tape.
What Happens If The Operation Cannot Be Performed Or Completed By The Laparoscopic Method?
In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.
The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.
What Should you Expect After Laparoscopic Gallbladder Surgery?
  • Gallbladder removal is a major abdominal operation and a certain amount of postoperative pain occurs. Nausea and vomiting are not uncommon.
  • Once liquids or a diet is tolerated, patients leave the hospital the same day or day following the laparoscopic gallbladder surgery.
  • Activity is dependent on how the patient feels. Walking is encouraged. Patients can remove the dressings and shower the day after the operation.
  • Patients will probably be able to return to normal activities within a week’s time, including driving, walking up stairs, light lifting and working.
  • In general, recovery should be progressive, once the patient is at home.
  • The onset of fever, yellow skin or eyes, worsening abdominal pain, distention, persistent nausea or vomiting, or drainage from the incision are indications that a complication may have occurred. Your surgeon should be contacted in these instances.
  • Most patients who have a laparoscopic gallbladder removal go home from the hospital the day after surgery. Some may even go home the same day the operation is performed.
  • Most patients can return to work within seven days following the laparoscopic procedure depending on the nature of your job. Patients with administrative or desk jobs usually return in a few days while those involved in manual labor or heavy lifting may require a bit more time. Patients undergoing the open procedure usually resume normal activities in four to six weeks.
  • Make an appointment with your surgeon within 2 weeks following your operation.
What Complications Can Occur?
While there are risks associated with any kind of operation, the vast majority of laparoscopic gallbladder patients experience few or no complications and quickly return to normal activities. It is important to remember that before undergoing any type of surgery–whether laparoscopic or open you should ask your surgeon about his/her training and experience.
Complications of laparoscopic cholecystectomy are infrequent, but include bleeding, infection, pneumonia, blood clots, or heart problems. Unintended injury to adjacent structures such as the common bile duct or small bowel may occur and may require another surgical procedure to repair it. Bile leakage into the abdomen from the tubular channels leading from the liver to the intestine may rarely occur.
Numerous medical studies show that the complication rate for laparoscopic gallbladder surgery is comparable to the complication rate for open gallbladder surgery when performed by a properly trained surgeon.
When To Call Your Doctor?
Be sure to call your physician or surgeon if you develop any of the following:
Persistent fever over 101 degrees F (39 C)
Bleeding
Increasing abdominal swelling
Pain that is not relieved by your medications
Persistent nausea or vomiting
Chills
Persistent cough or shortness of breath
Purulent drainage (pus) from any incision
Redness surrounding any of your incisions that is worsening or getting bigger
You are unable to eat or drink liquids