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Laparoscopic Cholecystectomy and Appendicectomy

Laparoscopic cholecystectomy is the surgical removal of the gallbladder. Gallbladder collects and concentrates digestive fluid called bile produced by the liver. Gallbladder problems usually occur due to the presence of gallstones which is more common in older people or who have family history of gallstones. These gallstones block the flow of bile out of the gallbladder causing swelling, sudden and sharp abdominal pain, nausea, vomiting, Indigestion and sometimes jaundice.  When medications don’t dissolve these painful gallstones then Surgery is required to remove the gallbladder. There are mainly two methods of removing a gallbladder:

1. Laparoscopic cholecystectomy – in this, several tiny incisions are made in the stomach and special surgical instruments are used to remove the gallbladder.

2. Open cholecystectomy – in this method, a large single incision is made in the abdomen to reach and remove the gallbladder. 

Some of the benefits of laparoscopic cholecystectomy include:

Less post surgery discomfort
Small incisions
Less scarring
Faster recovery
Short stay at hospital

Doctor will perform some tests such as blood tests, medical evaluation, EKG etc to diagnose the problem and would ask patient to stop taking any medications like blood thinners or anti inflammatory drugs and quit smoking a week before surgery. 

During the surgery, patient will be given general anesthesia. Surgeon will access the abdomen through a cannula inserted near the belly button. Then a laparoscope (thin probe with a light and tiny camera at the end) is inserted through the cannula to allow the surgeon to have a magnified internal view of the patient’s abdomen on a monitor. Surgeon will delicately remove the gallbladder through one of the incision with the help of special instruments.  The incisions are closed with stitches and surgical tape. 

Mostly, patient can go back home in a day or two once the liquids are tolerated.  Patient can resume normal activities like driving, walking, light weight lifting or even job within 10 days. Post surgery follow ups should be fixed with doctor to check the progress of healing process. 
Some complications and risk of a laparoscopic cholecystectomy may include:

Excessive bleeding
Fluid/bile leakage in the stomach
Blood clots
Heart problems
Injury to blood vessels

Patient should immediately seek medical attention in case of:

High fever and chills
Persistent nausea and vomiting
Persistent cough
Pus in the wound
Unable to eat and drink liquids

Some symptoms of appendicitis may include:

Severe stomach pain
Swelling in the abdomen
Constipation  or diarrhea
Nausea or vomiting
Loss of appetite

Patient should inform the doctor in case of pregnancy (women), allergic or sensitive to certain medications or have a history of bleeding disorders. Doctor will perform some blood tests, physical examination, imaging tests or may require medical history of the patient.
During the surgery, patient will be given general anesthesia and medications or fluids through intravenous tube (IV).  In some cases, patient may need local anesthesia instead to numb the area even though the patient is awake during the surgery. There are two main ways to perform appendectomy:
1. Open appendectomy – surgeon will remove the appendix through one large incision made in the lower right side of the abdomen.  Incision will be closed with stitches after the removal of the appendix. This procedure is generally done if the appendix has ruptured and infection has spread to other organs.  

2. Laparoscopic appendectomy – during this procedure, surgeon will make few small incisions in the abdomen and a small, thin tube called cannula is inserted to inflate the stomach with carbon dioxide gas that allows the surgeon to see the appendix more clearly. Then a laparoscope (a thin long tube with light and tiny camera at the front) is inserted through the incision. Doctor can see the internal images of the abdomen on a screen and remove the appendix with the help of surgical instruments.  The opening will be closed with stitches and surgical tapes.  Laparoscopic surgery generally is the best option for older adults and obese people. 

Post surgery, patient can usually go back home in a day or two and will be given pain medication and some antibiotics to prevent infection. It is advised to limit heavy activities at least for a month.  

Although laparoscopic appendectomy is a less invasive procedure, it still involves few risks that include:

Excessive bleeding
Damage to surrounding organs
Blocked bowels
Pus in the abdomen

Patient should inform doctor in case of severe pain, redness or swelling around the incision, vomiting, loss of appetite, stomach cramps, high fever, and fluid leakage from the incision or constipation.

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