Ans: Once the diagnosis is made, the following facts should be kept in mind:
- It is better to undergo the procedure before any complication (acute cholecystitis, jaundice) has occurred. Presence of complications increases hospital stay and may require additional investigations and procedures thereby adding to discomfort, morbidity and cost. Presence of complications also increases the operating time, chances of conversion to open surgery and prolongs hospital stay and recovery.
- Small/multiple stones have higher potential of slipping out of the gallbladder through the cystic duct into the common bile duct and producing serious complications like jaundice or pancreatitis. They should be treated early.
- If you have diabetes, you live alone, travel frequently or have to travel abroad, it is better to get rid of the disease at the earliest.
- After cholecystectomy, there is no risk of recurrence of gallbladder stones since the organ at fault has been removed.
- Removal of the gallbladder generally leads to no permanent disability or deficiency of the digestive system since in majority of patients, the gallbladder was already non-functioning. In others, the digestion, including that of fatty food, returns back to normal in four-six weeks after which one can enjoy all kinds of food.
- In an otherwise healthy person, laparoscopic cholecystectomy is a safe and simple procedure. While most surgeons use 11 mm instruments for laparoscopic cholecystectomy, we use finer instruments with significantly smaller punctures of three to five mm for this procedure and no stitches are required (sutureless mini/micro laparoscopic cholecystectomy).
This saves you from apprehension and discomfort of suture / clip removal.
Evaluating your condition
Detailed history and physical examination may help in identifying gallbladder problem and ruling out other causes of pain. Ultrasound has high accuracy (98%) for diagnosing gallstones and associated acute cholecystitis. It may reveal information if stone has passed into the bile duct Blood tests may also suggest possibility of stone in the common bile duct. Occasionally MRCP, ERCP or CT scan may be required.
Your Surgical Experience
Conventionally, the surgery is performed through four tiny punctures. Through the navel, the surgeon inserts a laparoscope which is attached to a lightweight, medical grade video camera. The camera sends images to a monitor, allowing the surgeon and his team to see inside the body.
Through other punctures, specially designed instruments are inserted.
The gallbladder is disconnected from its attachments and removed through the highest incisions.
After treatment, the infection may resolve or lead to pus formation (Empyema). Empyema is more common in patients with diabetes, who are also prone to perforation of gallbladder and leakage of pus (pericholecystic abscess).
The procedure is performed under general anaesthesia. While each case has unique characteris-tics, It generally takes about 20 to 30 minutes for the procedure and only 24 hours hospital stay is required.
Because of our extensive experience in laparoscopic surgery, number of stones, size of the stones, size of the gallbladder, presence of acute cholecystitis etc. do not influence the decision against laparoscopic cholecystectomy. Even excessive obesity, in our hands, does not go against laparoscopic procedure. Our specialisations include surgery for weight loss (Laparoscopic Sleeve Gastrectomy and bypass).
In our hands, Laparoscopic cholecystectomy can be safely performed in a large number of patients despite previous (multiple) abdominal operations, second trimester of pregnancy and associated diabetes and heart conditions. With good hospital backup, today there are very few contraindications for laparoscopic surgery.
During laparoscopic cholecystectomy, if at any stage it is felt that it is not safe to continue, the. procedure may be converted to open surgery.
The conversion rate to open surgery varies from centre to centre and surgeon to surgeon. Im-portant factors influencing conversion rate are experience and skill of the surgeon and quality of the instruments.
Accepted conversion rate is about two or five percent. Conversion in hands of our team is less than 0.1 percent and is generally limited to patients having pus in the gallbladder, multiple previous surgeries or when lung/cardiac condition during surgery prompts conversion to open surgery. In case of conversion, gallbladder is removed through the smallest possible incision.
Risks and Complications
Any gallbladder surgery has risks and complications.
- Excessive bleeding
- Injury to abdominal organs
- Injury to common bile duct
- General anaesthesia carries little more risk in patients with diseases of the heart, lungs, kidneys and other systemic problems.
Each Center and each surgeon has a complication rate different from others.
Dr. Kriplani’s large experience of laparoscopic surgery and excellent infrastructure of anaesthesia make the procedure safer and simpler in our setup. In around 12,000 laparoscopic cholecystecto-mies, technical complications have been encountered in only 0.1% of our patients. There has been no technical complication in our last 5000 patients. We have even removed gallbladder laparo-scopically in patients on whom cholecystectomy was attempted else where earlier and part or whole of the gallbladder was left behind due to technical difficulties.