Cholecystectomy (Gallbladder removal)
Cholecystectomy is performed when the gallbladder needs to be removed—in most cases, due to gallstones. Laparoscopic cholecystectomy is the gold standard treatment; 90 percent of patients have their surgery performed this way.
The surgery is performed through four small incisions, or ports, used for laparoscopic procedures. The gallbladder can then be placed in a small bag and removed through one of the ports. Laparoscopic gallbladder surgery rarely requires a hospital stay.
Laparoscopic gallbladder surgery offers the patient several benefits:
– Quick recovery. Some patients experience very little pain. Most patients can return to normal daily activities within a few days or a week.
– No dietary restrictions following the surgery. The body adjusts rapidly to not having a gallbladder.
Hernia repair
Surgery to repair a hernia—a defect in the abdominal wall that results in a bulge or tear—has advanced steadily during the past decade. Many hernias require no treatment; surgical repair is usually recommended when they cause pain or a burning sensation.
Hernia repairs are now performed laparoscopically using mesh materials to patch the defect. There are two broad categories of hernia: inguinal and ventral.
– Inguinal hernias are located in the groin area, are more common in men and are often easily repaired. In this procedure, mesh is placed over the hernia. When scar tissue forms over the mesh, the hernia closes up. Patients experience less pain, need less pain medication and return to their normal activities, including work, fairly quickly. Most patients are able to return home a few hours after their surgery.
– Ventral hernias are more complex, as they often develop near the site of previous surgery; these are called incisional hernias. This procedure requires tacks and sutures to attach the mesh over the defect, which often results in more pain than inguinal hernia repairs. However, when ventral hernia repairs are performed laparoscopically, there is less chance of wound complications and a possible lower recurrence rate. Patients typically stay in the hospital for one day.
Surgery for diverticulitis and complex diverticular disease
Diverticulosis, the presence of small pouches in the lining of the colon, is quite common: by age 50, approximately 50 percent of Americans have the condition. It may or may not cause symptoms such as abdominal pain, bloating, constipation or diarrhea. When one or more diverticula become infected or inflamed, the condition is called diverticulitis, and the symptoms are much worse.
Most cases of diverticulitis can be treated with antibiotics and changes in diet, but individuals who have repeat episodes of diverticulitis often consider having surgery to remove the segment of colon that is the source of their problem. This is typically the sigmoid, the last segment of colon before it empties into the rectum.
Surgery for inflammatory bowel disease
Most individuals with inflammatory bowel disease—either Crohn’s disease or ulcerative colitis—are treated by a gastroenterologist who prescribes medication. However, surgery may be needed in cases where medication is not successful at controlling the condition or complications arise.
Crohn’s disease: This condition can lead to bowel perforation or obstruction, which are surgical emergencies. Crohn’s disease also can cause abscesses and fistulas to form; this also requires surgery. Surgery for Crohn’s disease often provides effective long-term relief of symptoms and may limit or eliminate the need for medication. Approximately 75 percent of those with Crohn’s disease will require surgery at some point in their lives. In some cases, the surgery can be performed laparoscopically.
Ulcerative colitis: For some individuals, the goal of surgery is to remove the colon and rectum, which can result in a cure of the disease and, thanks to advanced surgical technique, allows them to continue moving their bowels normally. Today, a “new” rectum—called a neo-rectum—can be constructed from the patient’s small intestine and attached to the anus. The surgery may be performed in a single operation or a series of staged operations.
Appendectomy
An appendectomy—surgical removal of an inflamed appendix—is the most common acute emergency procedure performed in the U.S. Fortunately, over the last 20 years, the surgery is increasingly performed laparoscopically, with more than 60 percent of cases done this way. There are many benefits:
– Fewer wound infections
– Less pain
– Shorter hospital stay, with many patients going home within 24 hours of having surgery
Abdominal wall repair
Advances in abdominal wall reconstruction have significantly improved the surgical success in repairing complex abdominal defects. This is especially true in patients who have failed previous repair attempts or those with complex wounds or a fistula—a narrow passage or duct that has formed in the gastrointestinal tract.
