Laparoscopic Cholecystectomy and Appendicectomy

What are gallstones and how are they formed?

Gallstones are solid clumps of cholesterol or pigment material that form in the gallbladder. When the concentration of bile components like cholesterol or bile pigments increases, they precipitate to form solid crystals. These crystals then stick together and form gallstones. Why some people form gallstones is not clearly known, and therefore there is nothing one can do or avoid in the diet to prevent the gallstones from forming.

What symptoms do patients with gallstones experience?

Patients with gallstones often get severe abdominal pain in the right upper side – particularly after eating fatty food. If a gallstone blocks the common bile duct, jaundice (yellowing of the skin) can develop. Patients with gallstones may also suffer complications such as infection and inflammation of the gallbladder (cholecystitis) or of the pancreas (pancreatitis). Some people who have gallstones have no symptoms and these people are said to have so-called “silent” gallstones.

How is laparoscopic cholecystectomy performed?

It is important to note that laparoscopic cholecystectomy is a major operation performed under general anaesthesia. The surgeon passes a cannula (a narrow tube) into the abdomen in the region of the umbilicus. A telescope connected to a camera is passed inside the abdomen through the cannula. The camera is connected to a television monitor so that a magnified view of the patient’s internal organs appears on the screen. The surgeon and his team conduct the operation by observing the television screen. The surgeon then inserts other cannulas and passes long, thin instruments inside the abdomen through them. Using these instruments the gallbladder is separated from its attachments and is removed through one of the openings. After removal of the gallbladder, the small incisions are closed with a few stitches.

What is the appendix?

The appendix is a narrow, small, finger-shaped portion of the large intestine that generally hangs down from the lower right side of the abdomen.

What are the symptoms of appendicitis?

• Abdominal pain -- pain may begin in the upper-middle abdomen then develop to sharp localized pain

• Abdominal pain may be worse when walking or coughing

• Fever usually occurs within several hours

• Loss of appetite

• Nausea

• Vomiting

• Constipation

• Rectal tenderness

• Chills and shaking

Appendicitis is a sudden inflammation of the appendix. Although the appendix does not seem to serve any purpose, it can become diseased and, if untreated, can burst, causing infection and even death.

The cause of appendicitis is usually unknown. Appendicitis may occur after a viral infection in the digestive tract or when the tube connecting the large intestine and appendix is blocked or trapped by stool. It is thought that blockage of the opening of the appendix into the bowel by a hard, small stool fragment causes inflammation and infection of the appendix. The inflammation can cause infection, a blood clot, or rupture of the appendix.

The infected appendix then must be surgically removed (emergency appendectomy) before a hole develops in the appendix and spreads the infection to the entire abdominal space.

Most cases of acute appendicitis can be treated laparoscopically. The main advantages are:

• Less post-operative pain

• Faster recovery and return to normal activity

• Shorter hospital stay

• Less post-operative complications

• Minimally sized incisions/scars

In most cases, patients can be discharged within 24 to 36 hours. By contrast, the hospital stay is typically two to five days for an open procedure.