Cirugía de la Obesidad - Dr. Alberto Daccach Plaza - Guayaquil

SURGICAL PROCEDURES:

COLECISTECTOMY LAPARASCOPY

GALL BLADDER AND BILIARY DUCT LAPARASCOPYC SURGERY

* The gall bladder is a dilation, a pouch of the external biliary duct. It is located in the inferior face of the liver. It is divided in three parts. The vacinete, body and neck. Through a fine duct, the cystic is joined to the main duct or coledocum. The gall bladder, when it contracts expels bile to the main duct and to the duodenum. The gall bladder has a capacity of about 50cc. and allows the bile to accumulate between meals.

1. - WHAT IS COLELITIASIS?

It is the formation of biliary stones in the gall bladder or its ducts; this is called "colelitiasis"

The stones are formed from the elements that compose the bile; mainly cholesterol and biliary salts. This illness, colelitiasis, is one of the most frequent illnesses in women that multiple pregnancies and are over nourished. Generally, the illness appears from after the age of 40. In developed countries and better-nourished population it is calculated that about 20% of the women over 50 have stones in the gall bladder. The stones remain during many years without symptoms. Once the symptoms appear, the natural history of the illness evolves presenting complications some of them very serious.

2. - WHAT SYNTOMS CAUSE COLELITIASIS?

Much of the colelitiasis have no symptoms (the patient does not know it has them) on other occasions the symptoms are not specific (heart burn, abdominal distress, bad digestion, head aches)

· The main symptom is the biliary colic, also called liver colic or hepatic colic. In these cases the patient notices a severe pain in the right part of the abdomen, it is accompanied by a general distress, nausea and vomiting. If the process continues an infection to the biliary gall bladder can appear, this is called acute colelitiasis. This circumstance has a severe complication that needs urgent treatment, there is a risk that the gall bladder might become perforated and peritonitis can originate.

3. - HOW TO DIAGNOSE COLELITIASIS AND OR COLECICTITS?

The most common manner is with an abdominal echo sonogram. This test allows us to identify the biliary stones and its possible complications. In complicated cases it might be necessary to perform an axial tomography or CAT SCAN.

4. - WHEN TO OPERATE

The moment symptoms appear, if we wait it is very possible that complications might arise (colecistitis, peritonitis, pancreatitis..)

5. - WHAT DOES A BILIARY GALL BLADDER LAPAROSCOPIC SURGERY ENTAIL?

It consists in operating without opening the abdomen, working through small openings of about 5 to 12 mm, in which we insert a camera and the necessary instruments to operate; all this will permit us to visualize everything that we do through the monitor. During the intervention the damaged biliary gall bladder and the stones are removed. This type of surgery requires a highly technical expertise from the surgeon (precise professional formation) and special technology from technical center. (Automatic sutures, harmonic scapel, and technical instruments etc.)

6. - WHAT ADVANTAGES DOES LAPAROSCOPIC SURGERY HAS?

When small incisions are made, the pain is less. Consequently, the recovery is much faster, improving movement and the general state and behavior of the patient preventing or decreasing potential complications (thrombosis, embolism, pneumonia and respiratory complications, etc) Since the incisions are so small the possibility of infection barely exists, the same goes for hernias in the operated wound. In a normal operation these might have an incidence of 40% or more, therefore they disappear in laparoscopic surgery. The delicate handling of the intestine with thongs allows fast recovery and the patient will be able to eat and tolerate food faster. In summary:

LESS PAIN, LES VOMITING AND LESS FASTING PERIOD AFTER SURGEY.

FEWER COMPLICATIONS OF TROMBOSIS

LESS WOUND INFECTIONS

LESS EVENTRATIONS

LESS SCARING, BETTER ESTHETIC RESULTS

LESS ADHESIONS, BETTER RECOVERY PERIOD

FASTER RETURN TO NORMAL ACTIVITY

7. - WHAT STEP SHOULD I TAKE TO OPERATE MY BILIARY GALL BLADDER?

1.- Pre-op: You must be examined by a doctor, who will perform a complete clinical history. The test previous to the operation will be: Ecosonogram, conventional pre-op (analytical x-ray of the thorax and an electrocardiogram) If you are taking medication on a habitual manner, your doctor will tell you if you should continue taking them or stop before the surgery.

2.- Intervention. You will inter the hospital 2 hours prior to the operation in order to be prepared. The operation has a variable duration of 20 minutes to 2 hours depending on the patient. Nonetheless, the correct insertion and preparation of the patient in the operating room as well as the anesthetic and stabilization of the patient take time. Family members must not worry if the stay at the operating room takes longer. Such surgery must be done step by step without any hurry. Six hours after the surgery, the patient begins to ingest liquids, if no complications arise, the patient may leave the hospital 12 to 48 hours after the post op period.

3.- Leaving the hospital: If no complications arise the patient can leave the hospital after 12 to 48 hours after the surgery.

8.-WHAT HAPPENS AFTER LEAVING THE HOSPITAL?

When you arrive home you rest, it is advisable to take short walks around the house. There are few complications; therefore we do not prescribe analgesics after leaving the hospital. You can take a bath the day after arriving home.

· Ten day after the surgery you must return to your surgeon, who will remove the sutures from your skin. You will probably return to your normal activities within a week, even go back to work if there is no physical activity entailed, (otherwise we advise to slowly increase your working hours). The presence of abdominal pain, fever, nausea and/or persistent vomiting or oozing from the wound might indicate a complication. In this case you must contact your surgeon immediately.

9.- ARE THERE ANY RISKS RELATED TO THE LAPAROSCOPIC SURGERY?

Any operation as simple as it might be has a certain level of risk, the majority of patients operated by laparoscopic procedures experiment few or no complications and quickly return to their normal activities.

· Complications after laparoscopic surgery might include: subcutaneous emphysema,

Hemorrhaging, wound infection, post-op pneumonia, deep vein thrombosis and/or pulmonary embolism etc. The percentage of complications does not add up to 1% in laparoscopic surgery.

· Among the most specific complications of this type of surgery we can cite a biliary fistula (oozing of bile from the biliary ducts) and injuries to the biliary ducts. We must consider that when the surgeon indicates the need for this procedure, it is because the risk of the operation is less than a non-treated pathology.