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Minimally invasive surgery for Gall bladder removal is referred to as Laparoscopic Cholecystectomy surgery in medical parlance. It is considered as the treatment of choice for patients with symptomatic gall bladder stones. Gall bladder is a pear shaped organ that lies beneath the liver on the upper right side of the abdomen. It collects and store the digestive fluid(Bile) secreted by the liver and releases it into the small intestine in order to facilitate the fat digestion.
Cholecystectomy is commonly carried out due to the symptoms or the complications produced as the result of blockage caused by the gall stones. Under such circumstances, the patient usually presents with excruciating pain in the right upper part of the abdomen. Patient is discharged from the hospital the very same day of the surgery. It is a very common surgical procedure with very few complications, if at all.
There are different ways of carrying out the surgery. One with the use of video camera and specialized surgical tools inserted through four small key hole incisions in the abdomen, is referred to as Laparoscopic Cholecystectomy and the other that is carried out with one large incision in the abdomen, is referred to as Open Cholecystectomy.
Q1 What are the benefits of Laparoscopic Cholecystectomy over conventional Open cholecystectomy surgery?
A1 Laparoscopic Cholecystectomy surgery offers several advantages over conventional cholecystectomy surgery as mentioned below:
Shorter hospital stay
Minimal blood loss
Early resumption of activities
Aesthetically sound, minimal scarring
Q2 What type of anesthesia is required for this surgery?
A2 Laparoscopic Cholecystectomy is done under general anesthesia.
Q3 How long is the hospital stay in case of Laparoscopic Cholecystectomy surgery?
A3 The patient can go home the same day of the surgery or may stay overnight in the hospital. The general rule of thumb is once the patient is able to eat or drink without any discomfort and can walk without help, the patient may go. However, in case of Open cholecystectomy, the usual hospital stay is of 2 to 3 days.
Q4 How much time does it take to fully recover after cholecystectomy surgery?
A4 In case of laparoscopic cholecystectomy surgery, the usual time taken by the patient to fully recover is around 1 week. However, it may 4 to 6 weeks for the patient to fully recover in case of Open cholecystectomy.
Q5 How long does it take for the surgery to take place?
A5 It takes 1 to 2 hrs for carrying out the surgery.
Q6 What are the indications for cholecystectomy surgery?
A6 You may require Cholecystectomy surgery if you have evidence of
Gall stones causing symptoms or complications-Most common indication.
Gall stones in the gall bladder(Cholelithiasis)
Gall stones in the bile duct(Choledocholithiasis)
Gall bladder inflammation (Cholecystitis)
Pancreas inflammation due to gall stones(Pancreatitis)
Biliary dyskinesia, a medical condition in which gall bladder fails to function properly.
Q7 What are the symptoms of Gall bladder stones?
A7 Patient with gall bladder stones may present with:
Intermittent pain in right upper abdomen.
Q8 What is done during Laparoscopic Cholecystectomy surgery?
A8 Laparoscopic Cholecystectomy surgery involves few small keyhole incisions in the abdomen, referred to as ports. In order to access gall bladder the surgeon will put in tubes called trocars through these ports. One port is usually situated at the navel or umbilicus. Carbon-di-oxide is pumped through this port to inflate the abdomen so that the organs inside can be viewed clearly.
Subsequently,laparoscope is inserted through the port at the navel. Laparoscope is a small, thin, flexible tube with video camera at one of its end. Images of the surgical site are transmitted through the video camera at its end to the TV monitor in the operating room. Specialzed surgical instruments are passed through other incisions in the right upper abdomen, gall bladder is held and its duct and artery are clipped and gall bladder is removed through one of the incision.
Laparoscope is removed, Carbon- di-oxide is allowed to escape from the abdomen by leaving the port valve in place for a short while. the incisions will be sutured or stapled.
Q9 What may be the complications of the surgery?
A9 Bleeding, infection, injury to the bile duct, intestines and major blood vessels may occur, though rare and significantly small to justify Laparoscopic cholecystectomy as safe and effective treatment for symptomatic gall stones. It not only decreases pain and disability associated with it , but also decrease chances of mortality and morbidity. Moreover, the clinical outcome of the surgery is also influenced by the training, experience and skill of the surgeon.
Q10 What are the treatment options for Gall bladder stones?
A10 There are following two treatment options in case of Gall bladder stones that produce symptoms:
Surgery that removes the Gall bladder(Cholecystectomy)
Medicines that dissolve Gall bladder stones
Surgery is often recommended due to the fair possibility of recurrence of Gall bladder stones. Also, Gall bladder is not must for survival. People can do well without it as well. Other than transient diarrhea, it does not affect digestion of food. In case of Gall bladder removal surgery, since there is no place left for bile storage now, the bile is secreted by the liver directly into the small intestine for digestion of fats.
Medicines are only recommended in case surgery is not feasible for the patient due to some reason. Medicines work by dissolving the stones which may take months or even years. Above all, there is always a risk of their recurrence.
Gall bladder stones that do not cause any symptoms are left alone. However, your specialist is the best person to determine the best treatment protocol for you after evaluation of your medical reports and your clinical condition. Any symptom or sign in future that points to Gall bladder stone related complications which may present itself as excruciating pain in the right upper abdomen, may warrant treatment.
Q11. What are Gall stones?
A11 Hardened accumulated mass or sediments of digestive fluid is referred to as Gall stones. They may vary in shape, size and number and are of various types. Gall stones may or may not produce symptoms.
Q12 What are the complications associated with Gall stones?
A12 The complications of the Gall stones may be listed as follows:
Inflammation of the Gall Bladder caused when the neck of the gall bladder gets obstructed by the gall stones. In medical terminology, it is referred to as Cholecystitis which may present as severe pain in the right upper abdomen and fever.
Blockage of the CBD(Common Bile Duct)
Blockage of the Pancreatic Duct
Gall bladder Cancer, though rare, yet Gall stones makes the patient vulnerable to the development of the Gall bladder cancer.
Q13 Can by any chance doctor advise against Laparoscopic Gall bladder removal surgery and recommend or change it to Open Cholecystectomy during the operation?
A13 Yes, there are chances in few patients wherein the doctor may convert the Laproscopic approach towards cholecystectomy to Open Cholecystectomy during the surgery or recommend Open Cholecystectomy in the first place. The situations that determine the final judgement of better approach or change of approach during the surgery itself, may be summarized as follows:
Highly inflamed and scarred Gall bladder
History of previous abdominal surgery resulting in dense scar tissue
Bleeding issues during the surgery
Poor visualization of the organs
Patient's safety is the topmost priority in the specialist's mind while making the judgement. It is not a complication but the need of the hour and the right approach adopted by your specialist keeping your safety in mind.
Q-14 How are Gall bladder problems diagnosed?
A14 Gall bladder problems are diagnosed through the following tests or procedures:
Physical examination by the specialist
Blood tests values pointing towards inflammation and/or obstruction and to rule out other pathological conditions.
USG- Ultrasound abdomen
MRCP(Magnetic Resonance Cholangiopancreatography)
HIDA scan (Cholescintigraphy)
ERCP (Endoscopic Retrograde Cholangio Pancreatography)
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