Laparoscopic Cholecystectomy in India :
Minimally Invasive Surgery
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The gallbladder is a pear-shaped organ that sits beneath the liver in the right-upper abdomen. It's function is to store bile. It is attached to the bile ducts that come from the liver. These ducts carry bile from the liver to the gallbladder and intestine where the bile helps digest food. The gallbladder is not necessary to maintain good health.
Gallstones usually form in the gallbladder because of excessive cholesterol in bile. They are a very common medical problem. When they cause pain or other problems, treatment is usually needed. The removal of the gallbladder is one of the most common types of surgery done in this country. In the past, open abdominal surgery was the standard treatment. This procedure required a 3 to 7 day stay in the hospital and a 3 to 7 inch incision and scar on the abdomen.
Most females have heard of laparoscopy, also known as "bellybutton" or "Band-Aid" surgery. Gynecologists have long used this technique to tie the Fallopian tubes and to inspect the female reproductive organs. Now the use of laparoscopy has been expanded to include removing a diseased gallbladder. With new video technology, the laparoscope has become a miniature television camera. Powerful magnification is now possible, showing the intestinal organs in great detail.
What is laparoscopic cholecystectomy?
The surgery to remove the gallbladder is called a cholecystectomy. The gallbladder is removed through a 5 to 8 inch long incision, or cut, in your abdomen. The cut is made just below your ribs on the right side and goes to just below your waist. This is called open cholecystectomy.
A less invasive way to remove the gallbladder is called laparoscopic cholecystectomy. This surgery uses a laparoscope (an instrument used to see the inside of your body) to remove the gallbladder. It is performed through several small incisions rather than through one large incision.
What is a laparoscope and how is it used to remove the gallbladder?
A laparoscope is a small, thin tube that is put into your body through a tiny cut made just below your navel. Your surgeon can then see your gallbladder on a television screen and do the surgery with tools inserted in three other small cuts made in the right upper part of your abdomen. Your gallbladder is then taken out through one of the incisions.
When is it done?
This procedure is performed when you have stones or inflammation in your gallbladder, causing pain. The gallbladder is shaped like a small balloon. It is attached to the liver and holds bile. Bile is produced in the liver and helps with digestion of fatty foods. Small particles of bile can form a sediment in the gallbladder that can turn into gallstones. These stones may remain loose in your gallbladder or they may block the gallbladder outlet causing pain when the gallbladder contracts. In that case the gallbladder may also become swollen, inflamed, and/or rarely start to decompose (become "gangrenous").
There are no alternatives to surgically removing the gallbladder when it is causing pain.
How do I prepare for a laparoscopic cholecystectomy?
Follow the instructions provided by the doctor. The night before the procedure eat a light meal. Do not eat or drink anything after midnight and on the morning before the procedure. Do not even drink coffee or tea. You may be able to take some or all of your normal medicines with a sip of water. Ask your surgeon about this before the operation.
What happens during the procedure?
A general anesthetic is given to put you to sleep in the operating room. A general anesthetic will relax your muscles and keep you from feeling pain during the operation.
For the surgeon to see inside you with the camera, your abdomen must be inflated with carbon dioxide gas. This lifts the abdominal wall and helps the doctor see your gallbladder. The doctor makes three or four small incisions in your abdomen, puts in special instruments to remove your gallbladder.
The gall bladder as first seen
|Cystic duct and artery stripped of tissue
||Duct and artery clipped
What happens after the procedure?
|Gall bladder being cleared from liver
Most laparoscopic gallbladder removals are done as outpatient operations, without admission to the hospital. If you are admitted to the hospital after the operation, you may be able to leave the hospital the next morning, depending on your condition. Most patients have some incisional discomfort, nausea and sometimes shoulder pain for 1-3 days after surgery, but most return to full, normal activities within 5 to 10 days. There are usually no restrictions on lifting or exercising.
Ask your doctor what steps you should take and when you should come back for a checkup.
Are there any benefits of laparoscopic cholecystectomy compared with open cholecystectomy?
With laparoscopic cholecystectomy, you may return to work sooner, have less pain after surgery, and have a shorter hospital stay and a shorter recovery time. Surgery to remove the gallbladder with a laparoscope does not require that the muscles of your abdomen be cut, as they are in open surgery. The incision is much smaller, which makes recovery go quicker.
With laparoscopic cholecystectomy, you probably will only have to stay in the hospital overnight. With open cholecystectomy, you would have to stay in the hospital for about five days. Because the incisions are smaller with laparoscopic cholecystectomy, there isn't as much pain after this operation as after open cholecystectomy.
Is there any reason why I wouldn't be able to have a laparoscopic cholecystectomy?
If you have previously had surgery in the area of your gallbladder, if you tend to bleed a lot or if you have any problem that would make it hard for your doctor to see your gallbladder, an open surgery may be better for you. Your doctor will decide which type of surgery is best for you.
What are the complications of laparoscopic cholecystectomy?
Complications may include bleeding, infection and injury to the duct (tube) that carries bile from your gallbladder to your stomach. Also, during laparoscopic cholecystectomy, the intestines or major blood vessels may be injured when the instruments are inserted into the abdomen. All of these complications are rare.
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