Lap Chole Surgery
Listed below is the step by step procedure of lap chole surgery:
- What is Lap Chole Surgery?
- Why is Lap Chole Surgery Required?
- Pre-operative Preparation
- Day Before Surgery
- Procedure Day
- Methods/Techniques of Lap Chole Surgery
- Post Procedure
- Risks and Complications
What is Lap Chole Surgery?
Laparoscopic cholecystectomy, referred to as a lap chole, is a surgical process which involves removal of gallbladder using laparoscopy. The gallbladder is responsible for storage of bile formed in the liver prior to the digestion process. Gallstones get formed in the gallbladder which need to be treated in time to avoid complications.
Laparoscopic cholecystectomy is a new technique which has advantages over traditional open surgery method. It does not need incision to be made in the abdominal muscles and is less painful compared with conventional surgical process. Along with this, it also has shown quicker recovery results and improved cosmetic appearance.
An open surgery has more risk of infection which is not the case in lap chole surgery. Being a less invasive method, it is safer process.
Why is Lap Chole Surgery Required?
In general, cholecystectomy is recommended to the patients suffering from cholecystitis of acute or chronic type. It may or may not involve gallstones. Cholecystectomy is also helpful in prevention of pancreatitis caused by gall stones which results in blocking of common bile duct.
Prior to the lap chole surgery, patient needs to follow instructions given by the surgeon. Surgeon gives basic details about the surgery and post surgery possibilities to the the patient and his/her close relatives. This helps in making patient relaxed since some feel more anxious prior to the surgery. Depending on medical condition and age of patient, blood rests and other medical evaluations are done. These help surgeons with regards to surgery. ECG (Electrocardiogram) is also done. Doctors also advice patients to stop certain medication and follow a recommended diet before surgery. Patients need to quit smoking several days before surgery.
All the records of the tests need to be kept handy prior to the surgical process. This helps in prevention of complications during and after the surgery.
Day Before Surgery
Doctors recommend not to drink or eat anything post midnight a day before surgery. Any medication that has been prescribed by your doctor needs to be taken with just sips of water. Taking a shower a night before surgery, or early morning on your operation day is recommended. Using a prescribed antibiotic soap is important.
Patient will need to provide consent for the surgical procedure. Before this, potential risks along with benefits of the surgery will be discussed with patients and their relatives.
On the day of surgery, patients need to make sure that they have taken all essentials with them for hospitalization. Close relatives or friends need to be informed about the surgery so that they can be available during and post surgery whenever required. This helps in recovery of the patients as they get moral support while going through the surgical process.
Methods/Techniques of Lap Chole Surgery
Laparoscopic cholecystectomy, known as â€œlap cholyâ€ or â€œlap chole,â€ is an advanced surgical process used all over the world. The procedure is usually carried under general anesthesia. During lap chole surgery, tiny incisions (less than half an inch each) are made by the surgeon in the belly button, on the right side below ribcage and in the upper part below sternum (breastbone). Insertion of a tube is done through one of the slits. Carbon dioxide gas is filled in the abdominal cavity so that upon inflation, surgeon can get better access. In the other slit, a laparoscope is inserted. A laparoscope is a long tube having a small camera and light at one end. For clear view while surgery, this camera helps when connected to the monitor in an operation room. For accurate surgery it is very important to get the better view.
For removal of gall bladder and insertion of different instruments, other incisions can be used. The gallbladder removal is carried out using a grasper tool inserted via one of the incisions. Once the removal of gallbladder is completed, removal of carbon dioxide gas is carried out. After this, all incisions are closed with the help of sutures or can be closed with tape strips. The entire process can be completed within 1-2 hours.
In case of severe gallbladder damage cases, an open cholecystectomy is preferred over laparoscopic cholecystectomy. In such cases, a laparoscopic cholecystectomy gets converted into an open cholecystectomy as a result of complications. Given below are the cases for which such conversion from surgical processes is required to be done.
- Patients of age more than 65 years
- Male patients
- Patients with history of acute cholecystitis
- Previous abdominal surgery
- High fever
- Frequent gallbladder attacks
- High bilirubin content
Post surgery, patients are moved to the recovery room. Special attentions is given to the patients. Monitoring of blood pressure, breathing rate and temperature is done at regular interval for checking the health of patients post surgery. Any unusual symptoms can be treated as soon as reported by the patients.
After completion of laparoscopic cholecystectomy, the gallbladder needs to be tested for diagnosis of cholelithiasis or cholecystitis. It also helps in diagnosis of cancer. If cancer is detected, the patient needs to undergo another surgery where removal of part of liver or lymph node is carried out.
Deep breathing and movements help the patient in prevention of fluid entry into the lungs which prevents pneumonia. Deep breathing can be done by taking a deep breath and holding it for minimum 5 seconds. While patients are awake, it is advised that they perform deep breathing every hour. As a result of anesthesia and lack of movements, chances of blood clot formation increase. Use of compression stockings is done during surgery to prevent formation of blood loss. Patients are motivated to get up as soon as possible post surgery so that further blood clots can be prevented. Usually tiredness is observed post surgery. More sleep is required during this phase for the patients. Driving and strenuous activities are not recommended.
- Post Surgery Medication
Pain killers are given for reducing pain after the surgical process. There can be nausea and vomiting along with severe pain. Patients need to report all the troubles post surgery to their surgeons in time so that further complications can be avoided. This also helps in early recovery process. Medicines for the treatment of the nausea can be given from the hospital along with pain medications.
It is allowed to have liquids within 6 to 8 hours of surgery with the consultation of the surgeon. Solid food is allowed to be consumed a day after the surgery. There can be constipation after having pain medications in most of the patients. This needs to be treated with the help of high fiber diet consumption and use of stool softeners with the advice of surgeon. Foods with high fiber content, such as beans, fruits and grains are recommended in such cases. For any abdominal pain, medications are given after the surgery.
- Recovery At Home
In healthy conditions, patients are allowed to recover at home after the discharge, if no unusual symptoms are observed. They can return to normal activities based on their overall health and recovery process.
Risks And Complications
Laparoscopic cholecystectomy has shown very less rate of complications. As it is a well-documented process, in most of the cases, patients can recover fast and go back to their activities soon. Adjacent organs in the body get affected rarely. There is a need of second surgical process if adjacent organs get affected while performing laparoscopic cholecystectomy. Described below are the complications post laparoscopic cholecystectomy.
- Common Bile Duct Injury
A potentially serious complication in the common bile duct is observed after laparoscopic cholecystectomy in some patients. This bile duct helps in connecting common hepatic ducts to the duodenum. Bile can leak from an injured bile duct. This results in painful experience and can lead to severe infection. In most of the cases, this problem can be solved without surgical process. However, major damage to the bile duct needs to be treated by corrective surgery. An experienced biliary surgeon needs to treat such conditions.
In rare cases, bleeding may occur after laparoscopic cholecystectomy. This needs to be treated by a surgical method.
Post gallbladder removal, an internal infection or wound can be developed in some patients. Infection can be experienced in the form of pain, pus, swelling and redness. For treating infections, patient need to follow an antibiotic course.
- Bile Leakage
Special types of clips are used for sealing the tube which connects the gallbladder with the main bile duct. Even after this, bile fluid gets leaked into abdomen after the removal of gallbladder in some cases. Bile leak can be indicated by the symptoms, such as sickness, swollen tummy and pain in abdomen. It is necessary to drain the fluid from the abdomen of these patients. This is carried by a surgical process. It has been reported that only 1% cases show signs of bile leakage.
- Bile Duct Injury
In rare cases, damage to the bile duct while removing the gallbladder has been reported. If bile duct injury takes place during surgical process, it can be repaired at the same time. Further surgery is recommended in some patients after original operation i.e., laparoscopic cholecystectomy.
- Bowel, Intestine and Blood Vessel Injury
While removing gallbladder, surgical instruments are used which can injure nearby organs. These organs include small intestine, bowel and blood vessels. Such type of injuries are rare and can be repaired during the main operation. In cases where injuries are noticed after surgery, a further surgery is recommended.
- Deep Vein Thrombosis
Post laparoscopic cholecystectomy, chances of blood clot formation are high in some patients. This blood clotting is known as deep vein thrombosis which mostly happens in a leg vein. This is a serious complication since the clot of blood can move around the body and may result in pulmonary embolism which is blockage of blood flow into the lungs. Special compression stockings are given to the patients for preventing blood clot formation post operation.
- General Anesthesia Complications
In rare cases, severe complications can be observed due to general anesthesia. Allergic reactions and death can occur in some cases due to general anesthesia. It is recommended to remain healthy prior to the surgery which helps in reducing future complications.
- Post-cholecystectomy Syndrome (PCS)
Experience of symptoms similar to that of gallbladder symptoms can be seen in the patients post laparoscopic cholecystectomy. These symptoms include diarrhea, indigestion, abdominal pain, high fever and yellowing of eyes and skin. This is known as post-cholecystectomy syndrome (PCS). This happens as a result of bile leaking into stomach as well due to gallstones left in the bile ducts. In cases of persistent symptoms, patients need consult their surgeon as soon as possible.
- What is Single Incision Laparoscopic Cholecystectomy (SILS) ?
A. Single incision laparoscopic cholecystectomy is an advanced technique in laparoscopic surgery which involves making of a single incision in the belly button (umbilicus) instead of more incisions on the abdomen. Patients having cosmetic concerns can opt for this exciting alternative. In case of some patients, this method is not suitable.
- What kind of diet restrictions are advised after laparoscopic cholecystectomy?
A. After removal of gallbladder via laparoscopic cholecystectomy, no special diet instructions are given to the patients. In some patients bowel function problems and digestion changes can be seen which will get reduced after some days. In general, plain food is suggested for these patients. Water intake needs to be sufficient to prevent dehydration. Recommended water intake is 1.5 to 2.0 liters per day.
- How soon the patient can take bath or shower after laparoscopic cholecystectomy?
A. Post operation, it is very essential to let the stitches dry completely. It helps in recovery process and prevents infection. For this purpose, patients need to take bath or shower 3 days after surgery. While taking bath or shower, patients need to protect themselves with band-aids. After every bath, these band-aids need to be replaced. This helps in maintaining cleanliness and ensures faster recovery as well
- Is it harmful to expose the wound of surgery to sun?
A. Initial days after laparoscopic cholecystectomy are very important since neglecting important things can cause troubles. It is advised not to expose the wounds to sun as it can damage final scars. Healing wounds need to be protected from sun with the help of band-aids as well as with the use of sun-block creams. This care needs to be taken from 6 to 12 months post surgery. Exposing the wounds to sun in the early post-operative stage may worsen the appearance of the final scar. It is recommended to protect the healing wounds from sun with band-aids or total block sunscreen for a full 6 to 12 months after surgery.