Other Surgeries

LAPAROSCOPIC SURGERY means performing an operation using very small cuts. It has considerable advantages – 1. Less pain 2. Quick recovery 3. Lesser time to go back to activities 4. Extremely low incidence of incisional hernias 5. Good vision and magnification of the operating site 6. Better cosmesis. All of these surgeries should be performed by persons very experienced in this type of surgery to mitigate the risks.

LAPAROCOPIC CHOLECYSTECTOMY: Using 3-4 small incisions in the abdomen, the gall bladder is removed – if you suffer from Biliary Colic or other complications of gallstones like acute cholecystitis, cholangitis, pancreatitis, gangrene/perforation of gallbladder. Main Risk: Bile duct injury,bile leak. Not all people with gallstones do need removal of gall bladder. Discuss with your surgeon.

LAPAROSCOPIC REMOVAL OF STONES FROM DUCT: This is removal of gall stones which have fallen into the Bile duct from the gall bladder causing recurrent biliary colic, jaundice, cholangitis, or pancreatitis. Small stones could be removed by a camera passed through mouth (ERCP).

LAPAROSCOPIC HERINA REPAIR: Hernia is an abnormal defect through which bowel or other important viscera can come through; this can cause pain or strangulation resulting in serious condition warranting an urgent operation. Hernia is common in the groin area commonly called as ‘rupture’ or inguinal hernia. This could be repaired by a cut (Open repair) on the hernial site itself which is generally done under local anaesthetic for older people who cannot tolerate general anaesthesia. In fit people this could be repaired Laparosopically under General Anaesthetic; this is especially advantageous if you have hernias on either side (bilateral hernia) or it comes back (recurrence) after an open surgery. You can go back to work pretty quickly usually after 10 days.

LAPAROSCOPIC REPAIR OF HIATUS HERNIA: Hiatus Hernia is a condition in which the whole or part of the stomach can come through the hiatus or hole (which normally allows the gullet) in the diaphragm. This can cause dysphagia (difficulty in swallowing), Vomiting, Volvulus (where the stomach is twisted and can strangulate) or breathing difficulties (by occupying the chest cavity compressing on the lung). This is repaired only if it is causing problems. The stomach is pulled down into the abdomen and the ‘crus’ of the diaphragm is repaired so that the stomach doesn’t go back into the chest again. A mesh may be used.

LAP INCISIONAL HERNIA REPAIR: Major problem with an ‘open’ operation is the wound may not properly heal resulting in a hernia; the ‘incisional’ Hernia is unsightly and increases in size causing pain/discomfort and occasionally strangulation. This used to be repaired by ‘Open’ operation from which one takes a while to recover. Now it is generally repaired Laparosopically. The results are extremely good as it repairs all the defects under vision; risk of injury to viscera remains

LAP FUNDOPLICATION (ANTI-REFLUX PROCEDURE): Gastro-oesophageal reflux Disease (GORD) is a condition where the stomach contents reflux into the gullet and reach up to the mouth. Most of us might have experienced this at one time or other but for some it is frequent and distressing even causing respiratory (recurrent chest infections or recurrent cough) and dental problems (teeth get destroyed). Majority of the times this can be treated with medication (Antacids, H2 Blockers, Proton Pump Inhibitors). But a minority of these people cannot tolerate the drug, need very high dose or become resistant to drug or may have a volume reflux when they need surgery. The weak ‘valve’ (between the gullet and the stomach) is tightened by wrapping the top part (fundus) of the stomach around the lower part of the gullet; the hiatus is narrowed by approximating the crus (muscle) of the diaphragm close to the gullet. In appropriately selected patients the results are good giving relief in 95% of patients with extremely low complication rate. Most of these people have endoscopy, barium swallow, and Oesophageal physiology studies before they contemplate on surgery.

LAPAROSCOPIC CARDIOMYOTOMY (for Achalasia Cardia): The lower end of the gullet (‘valve’) doesn’t open/relax when the food goes down the gullet because of the nerve deficiency; the food gets stuck in the gullet and can cause severe pain in the chest. The valve could be stretched endoscopically (may have to be repeated or operation may be required: problem: perforation of gullet) or by operation where the muscle of the valve is cut to make the inside lining (mucosa) to pout for easy passage of food. An anti-reflux procedure is generally added to prevent ‘reflux’.

LAPAROSCOPIC OESOPHAGO-GASTRECTOMY: Removal of Oesophagus and part of the stomach for cancer or pre-malignant conditions. This is a major surgey performed until recently by a large incision in the chest (thoracotomy) and abdomen (laparotomy) with a gastric pull up (joining the stomach in the neck or chest). Totally performed minimally invasive oesophago-gastrectomy involves Thoracoscopic (3 -4 small holes in the chest) mobilization of the oesophagus followed by Laparoscopic (4 – 5 small holes in the abdomen) mobilization of stomach and formation of a stomach tube; The oesophagus (gullet) along with the tumour (cancer) and part of the stomach is removed and the stomach tube is joined to the small left over oesophagus in the neck. The clearance of the tumour is at least as good as open surgery, but one would not hesitate to convert into an open operation if there is any doubt.

LAPAROSCOPIC GASTRECTOMY: Removal of stomach for cancer or other tumours (Stromal tumours). The stomach is removed entirely or almost completely as required to the stomach tumour; the gullet (oesophagus) or the left over stomach is joined to the small bowel. Instead of a large cut in the abdomen, 5 small cuts are made in the laparoscopic method.

LAPAROSCOPIC ANTERIOR RESECTION AND COLECTOMY: Removal of Rectum and large bowel either for cancer or benign conditions like Diverticular disease. Instead of using a large cut sometimes opening the whole stomach from the xiphisternum (below the breast bone) to the pubis, 5 small cuts are made; there is no difference in the operation performed. Patients recovery is quick though the inside healing of the bowel join takes the same time.