Written by Dr. Olga Bednarek
Category: Procedures
Published: February 2, 2017
Laparoscopic Surgery
Laparoscopy (sometimes referred to as minimally invasive surgery) refers to abdominal procedures performed with the help of a camera. Your surgeon will make small cuts in your belly, insert a camera (laparoscope) and inflate your belly with carbon dioxide. Inflating your belly gives the surgeon more room to work and allows them to see your organs clearly. The location and number of the cuts will depend on the procedure being performed. Instruments will be inserted through these cuts to allow the surgeon to carry out the procedure. Procedures that are commonly done laparoscopically include taking out the appendix (appendectomy) and taking out the gallbladder (cholecystectomy).
Source: http://www.nhs.uk/Conditions/Laparoscopy/Pages/How-it-is-performed.aspx
Cholecystectomy
Cholecystectomy is the name of the surgery to remove your gall bladder. The gall bladder is a small organ located near your liver, and it’s job is to store the bile produced by the liver. Bile is a substance that helps you digest fats. Your doctor may talk to you about having a cholecystectomy if you have stones in your gall bladder which cause you pain (symptomatic cholelithiasis), or if your gall bladder becomes inflamed (cholecystitis). The procedure is most commonly performed under general anesthesia.
Laparoscopic cholecystectomy is performed by making four small incisions in your abdomen. A camera is inserted through one of the incisions; this allows the surgeon to see inside your abdomen. Your abdomen will be inflated with carbon dioxide gas, which will give the surgeon better visibility and more room to operate. Instruments are inserted through the other incisions, and these will allow your surgeon to separate the attachments that hold your gall bladder in place. Once your gall bladder is removed, the incisions will be closed with dissolving sutures.
Laparoscopic surgery is preferable to the open procedure because there is less pain, smaller scars, and a shorter hospital stay. However, there may be some circumstances where your surgeon cannot safely or effectively use laparoscopic techniques, and they will have to perform an open cholecystectomy, or convert from a laparoscopic procedure to an open one. This will involve an incision in the right upper quadrant of your abdomen. If you have an open procedure as opposed to laparoscopic, you may need to stay in hospital for an extra day or two to make sure that your pain is under control.
Sources:UpToDate: Laparoscopic cholecystectomy, Open cholecystectomy
http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/BILIARY%20SYSTEM/laparoscopic%20chole.html
Appendectomy
Your appendix is a small tube of tissue connected to the beginning of the large intestine (known as the cecum). Sometimes the appendix gets blocked off (obstructed) by something in the cecum (fecal matter, infection, etc) and becomes inflamed and infected; this is the condition known as appendicitis. The usual symptoms of appendicitis are severe belly pain (sometimes starting near the belly button and then moving to the right lower quadrant), fever, nausea, vomiting, and decreased appetite. Inflammation can lead to tissue death (necrosis) and perforation (the so-called “burst” appendix). Perforation is dangerous because this can lead to widespread infection throughout your abdomen.
With very few exceptions, an appendectomy (operation to remove your appendix) is the standard of care for the majority of patients who develop appendicitis. Appendectomies are typically performed laparascopically, although they are occasionally performed as open procedures (or converted from laparoscopic to open). With a laparoscopic appendectomy you will have three (sometimes four) small incisions on your abdomen. If you have an open procedure, you will have one large incision on the right lower quadrant of your abdomen. As with other laparoscopic procedures, your abdomen will be inflated with carbon dioxide and a camera is used to help the surgeon see inside. Once your appendix is removed, the incisions will be closed with dissolving sutures.
Sources:UpToDate: Management of acute appendicitis in adults; Acute appendicitis in adults: Clinical manifestations and differential diagnosis; Patient education: Appendicitis in adults (The Basics)
Large and Small Bowel Surgery
CThere are several reasons why you may require surgery of your large or small bowel (also known as your intestines). If you have cancer or certain medical conditions (such as diverticular disease or inflammatory bowel disease), you may need to have parts of your bowel resected, or removed. Resection may also be required if you have damage to your bowel as a result of trauma or ischemia (when the blood supply to your bowel is cut off, for example, by a clot). Depending on how much bowel is removed and the reason for resection, you may require an ostomy.
An ostomy is a hole created by a surgeon. In the case of bowel ostomies, the hole connects your bowel to the outside to allow waste from your body to drain, typically into a bag. An ostomy may have different names depending on the segment of bowel that is connected to the outside (for example, colostomy, ileostomy). Sometimes an ostomy is a temporary measure to allow part of your bowel to rest and heal. Sometimes it is permanent. Another term you may have heard to describe an ostomy is “stoma.”
You may also require bowel surgery if you have an obstruction. Many obstructions are managed without surgery, but sometimes it becomes necessary for a surgeon to intervene. Bowels can become obstructed in many different ways; sometimes the bowel doesn’t function properly and the flow of contents is interrupted and becomes backed up (functional obstructions). You may also have a mechanical obstruction (which may be partial or complete) if there is something physically stopping your bowel contents from moving along (such as a mass, or if the bowel twists on itself).
As with other general surgery procedures, surgery on your large and/or small bowels may be done laparoscopically or open, and this depends on many factors. Your surgeon will be able to discuss which option will be best for you.
Sources:UpToDate: Overview of mechanical colorectal obstruction, Overview of management of mechanical small bowel obstruction in adults.
http://www.ostomy.org/What_is_an_Ostomy.html