Laparoscopic Procedures

Nissen Fundoplication (Anti-Reflux Procedure)

SAGES (Society of American Gastrointestinal Endoscopic Surgeons) position statement on Laparoscopic training states:
(1) Basic laparoscopic surgery is comprised of: diagnostic laparoscopy, laparoscopic cholecystectomy, and laparoscopic appendectomy.
(2) Advanced laparoscopic surgery consists of all other laparoscopic operations.

Laparoscopic Cholecystectomy:

Indications: Most gallbladder surgery is done for people who have symptomatic gallstones. Symptoms typically involve right-sided abdominal pain, commonly occurring after eating fatty or greasy foods. The pain can be associated with nausea and vomiting, and a bloating sensation. The pain can also radiate into the back. A small percentage of people has these same symptoms without gallstones, but can be shown to have gallbladder dysfunction.
Procedure: Laparoscopic surgery involves four small incisions, less than one-half inch in length. A camera is inserted into the abdomen through one of these holes. The other holes are used for the insertion of instruments that the surgeon uses to remove the gallbladder, instead of making a large incision as was commonly done in the past.

Pre-Op Prep: Little preoperative preparation is needed. Routine studies are ordered prior to surgery based on the patient’s age and the presence of any existing medical problems. An empty stomach is required and instructions are given to every patient concerning this and the appropriate medications to take on the day of surgery. For example, blood thinners are commonly discontinued, heart medicines are continued and adjustments are made in insulin dosing.
Inpatient vs. Outpatient: In healthy patients, most of this surgery can be done as an outpatient. Some will require extended observation, with discharge later in the day or the next morning. This occasionally is required in elderly patients, those with many other medical problems, or in patients who may be nauseated or uncomfortable postoperatively.
Recovery: This seems to vary from patient to patient. Some return to work shortly after surgery, others require several weeks until full recovery. On the average, one to two weeks after surgery patients are ready to resume all normal activities.

Nissen Fundoplication: Videoscopic surgery for chronic heartburn

Indications: This is the formal name of the procedure done for people who suffer from severe chronic heartburn or gastro-esophageal reflux. Some doctors call this disease GERD or Gastro Esophageal Reflux Disease. Since many Americans suffer from this ailment, surgery is reserved for those people who have symptoms that persist despite medical management, people who have complications of reflux disease such as esophageal narrowing, aspiration of stomach acid, or irritating changes in the lower esophagus. Some forms of asthma are even traced to this disease.

Procedure: Similar to gallbladder surgery, a camera is inserted near the belly button. And typically four other holes are made under the ribs. The uppermost portion of the stomach is loosened and then wrapped around the esophagus to prevent the flow of acid, and yet still permit normal swallowing.
Pre-Op Prep: Several studies are usually required preoperatively including upper endoscopies, upper GI series, and measurement of esophageal manometry. In addition routine laboratory studies and an EKG are usually required. Surgery invariably follows a period of maximal medical management to insure that conservative measures are ineffective in symptom control.
Inpatient vs. Outpatient: Most of these procedures require an overnight stay in the hospital. Occasionally an extra night is required to insure a stable postoperative recovery. This is in stark contrast to the old-fashioned surgery when patients were typically hospitalized for five to seven days.
Recovery: Patients usually require liquids or a soft diet to prevent dysphagia or swallowing problems after surgery. This is primarily because the surgery involves wrapping the stomach around the esophagus, and there is usually some temporary swelling involving this area for several days to weeks. Return to work and normal activities is similar to the recovery of those patients having gallbladder surgery, usually in the order of one to two weeks.

Courtesy of Ethicon Endo-Surgery, Inc.

Colon Resection:

Indications: Colon disease including cancer. Colon strictures from old diverticular disease, benign polypoid disease are examples of the types of colon lesions amenable to this technique.
Procedure: Laparoscopic surgery involves four to six small incisions, less than one-half inch in length. A camera is inserted into the abdomen through one of these holes. The other holes are used for the insertion of instruments that the surgeon uses to resect the colon. Upon completion of the resection, an incision is made to remove the colon from the abdominal cavity and is usually two-three inches in length.
Pre-Op Prep: Routine bowel preparation is needed. Routine studies are ordered prior to surgery based on the patient’s age and the presence of any existing medical problems. An empty stomach is required and instructions are given to every patient concerning this and the appropriate medications to take on the day of surgery. For example, blood thinners are commonly discontinued, heart medicines are continued and adjustments are made in insulin dosing.
Inpatient vs. Outpatient: Most patients will require extended observation, with discharge when bowel function returns.
Recovery: This seems to vary from patient to patient. On the average, one to six weeks after surgery patients are ready to resume all normal activities.

Ventral Hernia Repair:

Indications: Ventral or incisional Hernias can be treated laparoscopically. Laparoscopic treatment is usually reserved for large and complex ventral hernias.
Procedure: The defect(s) are repaired using prosthetic mesh that covers all of the defects from the inside of the abdominal cavity. The mesh material is sewn to the body wall in a way that eliminates the defects.
Pre-Op Prep: Routine studies are ordered and the patient requires an empty stomach for about eight hours prior to surgery.
Inpatient vs. Outpatient: This procedure can be done as an outpatient, with overnight stay in the hospital occasionally necessary.
Recovery: Patients recover much faster when compared to the open procedure.

Diagnostic Laparoscopy:

Indications: Trauma or need for lymph node biopsy.
Pre-Op Prep: Routine studies are ordered and the elective patient requires an empty stomach for about eight hours prior to surgery. Trauma patients are treated as dictated by their condition.
Recovery: Patients usually recover within a day.

Splenectomy:

Indications: Malignancies, hypersplenism and ITP are common indications for this procedure.
Pre-Op Prep: Routine studies are ordered and the elective patient requires an empty stomach for about eight hours prior to surgery.
Recovery: Patients usually recover within a day or two. Time in the hospital is often determined by the patients underlying condition.

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