Laparoscopic & Bariatric Surgery
Obesity can often cause several life-threatening diseases in people. People who suffer from severe obesity with a BMI of over 40 and life-threatening conditions may need to go through certain medical procedures to reduce the risk factor of their diseases.
Bariatric Surgery is one such procedure that is used for patients who suffer from severe obesity along with many metabolic disorders. A combination of these two could be life-threatening. Hence, gastric bypass along with other weight-loss surgeries (collectively called bariatric surgery) is often recommended to these patients. However, it is important to keep in mind that bariatric surgery is not a cosmetic procedure. Contrary to this, it is a life-saving procedure only recommended to patients who are in dire need of it. This includes those who haven’t been able to improve their condition using diet changes and exercise. Moreover, the surgery consists of major procedures which may pose the danger of side effects and risk factors like any major surgery.
Who requires the surgery?
The surgery aims at reducing the weight of severely obese patients with a BMI of 40 or above who are at risk of life-threatening conditions like high blood pressure, high cholesterol, sleep apnea, heart diseases, stroke, Type 2 diabetes, NAFLD (Nonalcoholic fatty liver disease) or NASH (nonalcoholic steatohepatitis).
People with a BMI of 35-40 may also be prescribed this surgery if they have severe weight-related issues. However, it must be kept in mind that the surgery requires patients to meet certain guidelines and not everyone who is obese can opt for Bariatric surgery. Even after the procedure, patients are required to make major lifestyle changes and do regular follow-ups to monitor their health condition.
Types of Bariatric Surgery
This is one of the most commonly prescribed forms of Bariatric surgery. The way this surgery works for reducing the weight of the patients is by creating a small pouch from the stomach and connecting the newly created pouch directly to the small intestine. The food swallowed by the person then goes into the small pouch from where it is directed to the small intestine. This way only a limited amount of food enters their body.
Weight Loss Surgery
This is another type of Bariatric surgery where the goal is to limit the food intake of the patient. This is done by preventing the stomach from extending to its full size. During this surgery the surgeon may use three of the following techniques:
Laparoscopic adjustable gastric banding
Vertical banded gastroplasty
Biliopancreatic diversion with duodenal switch (BPD/DS)
This is one of the least common types of weight-loss surgeries. This is done in two steps, the first of which is a sleeve gastrectomy. In the second step, a portion of the intestine is bypassed and its end portion is then connected to the duodenum near the stomach. The aim of the surgery is not just to limit the amount of food that a person ingests but also to reduce the absorption of nutrients like proteins and fats.
As has been mentioned, bariatric surgery is a term referring to several surgeries aimed at reducing the weight of a person. As with any other surgery, bariatric surgery may pose certain health risks. These complications may be both short term and long term. Infections, excessive bleeding, blood clots, bowel obstruction, dumping syndrome, breathing problems, etc are common risk factors associated with Bariatric surgery.
Weight Loss Surgery:
This type of surgery is done through the following three procedures:
Laparoscopic adjustable gastric banding:
In this procedure, the surgeon puts a Silastic band around the stomach below the food pipe. This is one of the most minimally invasive procedures of bariatric surgery because instead of one large cut on the abdomen, the surgeon makes small incisions and then inserts a laparoscopic tool fitted with a camera inside the body. Using this tool the band is placed.
Vertical Banded Gastroplasty:
In this procedure, the upper part of the stomach is stapled vertically and a small pouch is created in the upper part of the stomach near the food pipe.
In this type of bariatric surgery, a major chunk of about 80% is removed from the stomach. Consequently, the stomach is reduced to almost 15% of its original capacity. In this type of weight loss procedure, the stomach ends up looking like a tube or a sleeve.
This is the most common form of bariatric surgery. QMCH offers top quality facilities and expert doctors who have years of experience performing this type of surgery.
How can QMCH help?
QMCH provide state-of-the-art facilities along with specialist doctors for bariatric and laparoscopic surgery in Bangalore. We focus on Minimal Access Surgeries that allow surgeons to perform complicated procedures using minimal incisions instead of more invasive open surgical procedures. Almost 70% of surgeries performed at QMCH use the MAS procedure. Consequently, the patients feel less operative pain and undergo quicker recovery. QMCH also ensure that patients undergo extensive medical screening before they can opt for the surgery.
Moreover, extensive care is provided during follow up of the procedure. Bariatric surgery requires good quality and extensive after-care to avoid any complications. We have experts who carefully do all the required follow-ups and checks on their patients.
Advanced Laparoscopic Surgeries
A cholecystectomy is a surgical procedure to remove your gallbladder. A pear-shaped organ that sits just below your liver on the upper right side of your abdomen. Your gallbladder collects and stores bile — a digestive fluid produced in your liver.
A cholecystectomy is a common surgery, and it carries only a small risk of complications. In most cases, you can go home the same day of your cholecystectomy.
A cholecystectomy is most commonly performed by inserting a tiny video camera and special surgical tools through four small incisions to see inside your abdomen and remove the gallbladder. Doctors call this a laparoscopic cholecystectomy.
In some cases, one large incision may be used to remove the gallbladder. This is called an open cholecystectomy.
Why it’s done?
A cholecystectomy is most commonly performed to treat gallstones and the complications they cause. Your doctor may recommend a cholecystectomy if you have:
- Gallstones in the gallbladder (cholelithiasis)
- Gallstones in the bile duct (choledocholithiasis)
- Gallbladder inflammation (cholecystitis)
- Large gallbladder polyps
- Pancreas inflammation (pancreatitis) due to gallstones
A cholecystectomy carries a small risk of complications including:
- Bile leak
- Injury to nearby structures, such as the bile duct, liver and small intestine
- Risks of general anaesthesia, such as blood clots and pneumonia
Your risk of complications depends on your overall health and the reason for your cholecystectomy.
How you prepare?
Food and medications
To prepare for a cholecystectomy, your surgeon may ask you to:
- Eat nothing the night before your surgery.You may drink a sip of water with your medications, but avoid eating and drinking at least four hours before your surgery.
- Stop taking certain medications and supplements.Tell your doctor about all the medications and supplements you take. Continue taking most medications as prescribed. Your doctor may ask you to stop taking certain medications and supplements because they may increase your risk of bleeding.
Most people go home the same day of their cholecystectomy, but complications can occur that require one or more nights in the hospital. Plan ahead in case you need to stay in the hospital by bringing personal items, such as your toothbrush, comfortable clothing, and books or magazines to pass the time.
Find someone to drive you home and stay with you. Ask a friend or family member to drive you home and stay close the first night after surgery.
What you can expect?
Before the procedure
A cholecystectomy is performed using general anaesthesia, so you won’t be aware during the procedure. Anaesthesia drugs are given through a vein in your arm. Once the drugs take effect, your health care team will insert a tube down your throat to help you breathe. Your surgeon then performs the cholecystectomy using either a laparoscopic or open procedure.
During the procedure
Depending on your situation, your surgeon will recommend one of two surgical approaches:
Minimally invasive (laparoscopic) cholecystectomy
During a laparoscopic cholecystectomy, the surgeon makes four small incisions in your abdomen. A tube with a tiny video camera is inserted into your abdomen through one of the incisions. Your surgeon watches a video monitor in the operating room while using surgical tools inserted through the other incisions in your abdomen to remove your gallbladder. Then your incisions are sutured, and you’re taken to a recovery area.
A laparoscopic cholecystectomy isn’t appropriate for everyone. In some cases your surgeon may begin with a laparoscopic approach and find it necessary to make a larger incision because of scar tissue from previous operations or complications.
Traditional (open) cholecystectomy
During an open cholecystectomy, the surgeon makes a 6-inch (15-centimeter) incision in your abdomen below your ribs on your right side. The muscle and tissue are pulled back to reveal your liver and gallbladder. Your surgeon then removes the gallbladder.The incision is sutured, and you’re taken to a recovery area. An open cholecystectomy takes one or two hours.
A cholecystectomy can relieve the pain and discomfort of gallstones. Conservative treatments, such as dietary modifications, usually can’t stop gallstones from recurring. In most cases, a cholecystectomy will prevent gallstones from coming back.
Most people won’t experience digestive problems after a cholecystectomy. Your gallbladder isn’t essential to healthy digestion. Some people may experience occasional loose stool after the procedure, which generally resolves over time. Discuss with your doctor any changes in your bowel habits or new symptoms following your procedure.
The bulging of an internal organ or tissue through the wall of the muscle wherein it usually resides is called a hernia. It commonly occurs in the abdominal wall where the intestine pushes through a weak area in the wall, usually the inguinal canal and this results in inguinal hernia which is the most common type of hernia.
What Are The Types Of Hernia?
The common types of hernia are:
Inguinal hernia – When the intestine protrudes through one of two openings in the lower abdominal wall called inguinal canals, it causes pain in the inner groin area.
Femoral hernia – Deep passages called femoral canals appear in the upper thigh/outer groin area. If a part of a tissues pushes through this area it results in femoral hernia. They are significantly less prevalent than inguinal hernias, and they affect women more than men. This can result in a high-risk condition if not repaired at the earliest.
Ventral hernia – It occurs through an opening in the abdominal muscle. A ventral hernia is further classified into three types. They are:
Epigastric hernia – This occurs above the bellybutton
Incisional hernias – They are caused by a weakening of the abdominal muscle as a result of a previous abdominal surgery wound.
Umbilical hernia – It occurs near the belly button. This type of hernia is very common in infants who are born prematurely. By the time the child turns four, the hernia heals by itself. It can be more serious if it occurs in adults.
Umbilical open hernia technique – This technique involves a dissection of tissue to provide a mesh overlap of 3 cm to 5 cm beyond the fascial defect’s outer edge. At 1-cm intervals, the mesh is secured with interrupted long-term absorbable sutures. Polypropylene or nylon mesh is utilized to make the repair. After any defect repair such as required under this technique that necessitates extensive subcutaneous tissue dissection and leads to bleeding or the creation of dead space, drains are implanted.
Umbilical laparoscopic hernia technique – After inspecting the abdominal cavity with the laparoscope, two 5-mm trocars are put as far away as feasible from the hernia defect for laparoscopic repair. Blunt and sharp dissection with judicious use of electric cautery or harmonic arc are used to decrease the contents of the hernia. The mesh is measured with the abdomen deflated, allowing for at least a 3 cm to 5 cm overlap beyond the borders of the fascial defect, and is secured with tacks and full thickness sutures made of non-absorbable suture material, or tacks are placed every centimeter and full thickness sutures are placed every 3 cm to 5 cm.
Hiatal hernia – When the top half of the stomach bulges into the chest through a small opening in the diaphragm (the hiatus), it causes heartburn. The esophagus, which transports food from the mouth to the stomach, can pass through the diaphragm.
What Are The Symptoms Of A Hernia?
A lump or protrusion accompanied by discomfort or pain is a common symptom of most hernias. The lump or bulge may or may not be present at all times; for example, it may disappear when the patient lies down. Symptoms worsen when the patient stands, strains or tries to lift heavy objects. Doctors confirm the presence of a hernia during a physical exam in most cases or sometimes through imaging techniques.
On the other hand, hiatal hernia does not cause a bulge rather symptoms such as heartburn, acid reflux and regurgitation of food or liquids occur that can be treated with medication.
- Immediate surgery is required if the following signs are observed.
- A bulge that is larger than before
- A bulge that gets back inside the abdomen usually but suddenly does not go back
- Redness in the area affected with hernia
- Tenderness in the area of a hernia
- Abdominal pain, bloating, nausea and vomiting
How Is A Hernia Surgery Carried Out?
Most symptoms of Hiatal hernias can be treated with medicine, while most other types of hernias require surgical correction. There are two main types of procedure to rectify hernias:
Open hernia surgery – To see and repair the hernia, the surgeon cuts through the groin. After treating the hernia, the surgeon closes the abdominal wall with only stitches or if required, stitches along with a mesh. The mesh is intended to strengthen the weak portion of the abdominal wall where the hernia had developed.
Laparoscopic hernia surgery – The surgeon makes multiple small cuts (usually three) in the lower belly and inserts special tools and a special camera for visualization of the affected area. This procedure carries lower risk and involves minimal scarring. However, it might not be possible to recommend this procedure in case of more complicated cases. To seal and strengthen the abdominal wall, the surgeon usually employs a piece of mesh. Some surgeons prefer robotic surgery, which includes sitting at a console and controlling the robotic arms that execute the procedure.
While mesh is commonly used and is proven to help reduce hernia recurrence, it also has significant drawbacks in some cases, including persistent pain.
What Can You Expect During The Post-Surgical Care For Hernia?
Hernia operations are usually performed as outpatient procedures. In general, the sooner a patient can get up and move, the better. Constipation and blood clots can be avoided with this exercise. The doctor will direct the patients as to what they can lift, how they can lift it, and for how long. The doctor will also recommend long term and short-term precautions that patients will need to follow.
Appendectomy is a surgical procedure that is used for removing an infected appendix. The appendix is a small pouch that connects the large intestine to the stomach, and it is located in the lower right corner of the stomach. When the appendix becomes inflamed, enlarged, and infected, this condition is called appendicitis, and it can be extremely painful to deal with. If left untreated, it can lead to further complications.
In the case of appendicitis, the appendix has to be removed at the earliest to avoid the risk of it bursting. Due to the high level of risk associated with such an event, this condition is considered life-threatening.
Why Is An Appendectomy Required?
If the patient has symptoms of appendicitis; the doctor will suggest an appendectomy procedure to remove the appendix. The symptoms are:
- Pain in the lower abdomen that starts on the right side and progresses to the left.
- Sudden pain in the lower right abdomen that begins around the navel.
- Coughing, walking, or other jarring movements aggravate the pain.
- Vomiting and nausea.
- Appetite loss.
- Diarrhea or constipation
- Bloating in the abdomen
There is a significant possibility of the appendix bursting or rupturing if one is suffering from appendicitis, and this might happen within 48 to 72 hours from the onset of symptoms. This condition can also induce peritonitis, a life-threatening infection in the stomach.
The patient must visit the doctor immediately if the symptoms of appendicitis exist.
What Are The Types Of Appendectomy?
The appendix can be removed using two methods- An open appendectomy (most common procedure) or a laparoscopic appendectomy.
Open appendectomy: For this procedure, the surgeon will make an incision of 2 to 4 inches in the lower right-hand side of the belly or abdomen. Through this incision, the surgeon will gain access to the appendix region and then surgically remove the infected appendix.
Laparoscopic appendectomy: This type of surgery is a minimally invasive procedure performed without the need for a major incision. During this procedure, one to three small incisions are made around the abdominal region, and a laparoscope (a long, thin tube) is inserted through one of the incisions. The laparoscope consists of a camera at the end. The surgeon uses the feed relayed by the camera to a TV display to see into the abdomen and navigate the laparoscope. On reaching the appendix, the surgeon will use the laparoscope to remove the appendix and stitch up the area to avoid further bleeding. Once the appendix is removed, the surgeon will remove the laparoscope, and the incision(s) will be stitched shut.
What Are The Risks Associated With An Appendectomy?
The following are some of the possible risks involved in an appendectomy:
- Infection at the incision area
- Appendix rupture during surgery, infection, redness, and swelling (inflammation) of the abdomen (peritonitis)
- Bowel blockage
- Organ damage
Other risks that are specific, may exist due to pre-existing conditions or other factors. Before surgery, discuss with the doctor about any concerns.
What Are The Post-Operative Care Instructions For Appendectomy?
At the hospital premises:
After surgery, you will be brought to the recovery room, where the surgical staff will monitor your vital indicators, such as heart rate and respiration. Once the vitals have been deemed stable, the patient will be moved to a standard hospital room.
The patient will also be given pain medication as needed, and this could be from a doctor’s prescription or a nurse’s recommendation. The patient can also administer it to themselves using a device attached to the IV (intravenous) line if provisioned by the doctor.
A small plastic tube may be inserted into the stomach through the nose. This is utilized to get rid of any stomach fluids or air that the patient may have swallowed. When the bowels start functioning normally, the tube will be removed. The patient won’t be allowed to drink or eat until the tube is removed.
The healthcare professional will schedule a follow-up appointment for the patient, and this usually happens in two to three weeks following surgery.
When the patient is at home, make sure the incision site is clean and dry. The doctor will provide specific instructions when it comes to bathing and cleaning the incision site. During a follow-up appointment with the doctor, any stitches or surgical staples that were used for sealing the incision site will be removed. It is vital to keep adhesive strips dry if the patient is using them, as they usually come off within a few days.
The incision area and the abdominal muscles may hurt, especially if the patient stands for long periods. Only take medications that the doctor has prescribed. Aspirin and other pain relievers can make more prone to bleeding.
During recovery, the patient may experience the following symptoms, which necessitate immediate consultation with the doctor:
- Chills or a fever
- Incision site redness, oedema, bleeding, or other discharge
- Increased discomfort in the area of the incision
- Appetite loss or inability to eat or drink
- Non-stop coughing, breathing problems, or shortness of breath
- Pain, cramping or swelling in the abdomen
- Lack of bowel movement for over two days
- Diarrhea for over three days
Adhesiolysis is a surgical procedure that removes abdominal adhesions.
After abdominal surgery, the scar tissue is formed over the surgical wounds. This is part of the healing process. In some cases, the scars thicken giving rise to bands or lumps of scars known as abdominal adhesions. These adhesions can form between two organs or between an organ and the abdominal wall.
Adhesiolysis can be performed in two ways:
Open adhesiolysis: A single, large cut (incision) is made through the midline of your body which can be extended to either side of your belly button to remove the abdominal adhesions.
Laparoscopic adhesiolysis: A tube-like camera is inserted through a single, small incision made into your abdomen to visualize and remove the abdominal adhesions.
What causes abdominal adhesions?
There are 90-95% chances that you may develop abdominal adhesions due to abdominal surgery.
Other causes of abdominal adhesions include:
- Pelvic inflammatory disease (PID): Infections of the reproductive organs of a woman
- Crohn’s disease: Chronic inflammatory bowel disease
- Diverticulitis: Infection of the pouches that may get formed in your intestine
- Peritonitis: Infection of your abdominal cavity (peritoneum)
- Radiation: High-energy waves used in cancer therapy
- Congenital: Present by birth
When do you need open adhesiolysis?
Abdominal adhesions do not usually present with troublesome signs and symptoms. They remain undetected until found accidentally. However, if you experience health issues due to the adhesions, your doctor may recommend you undergo adhesiolysis.
These may be:
- Chronic abdominal pain
- Small bowel obstruction
Open adhesiolysis is generally preferred over laparoscopic procedures when it is difficult to locate the adhesion that is causing the symptoms.
A pilonidal sinus (PNS) is a tiny hole or tunnel in the skin that could get filled with fluid or pus causing formation of an abscess or cyst. A pilonidal cyst mostly crops up in the cleft at the top of the buttocks. Pilonidal cysts typically comprise hair, dirt, and debris. It can cause extreme pain and may frequently become infected. If it becomes infected, it can leak pus and blood and emit a bad smell.
PNS is a disease that mostly affects men and is also common in young people. This is also common among those who sit a lot
What Causes Pilonidal Sinus Disease?
The accurate cause of this condition is unknown, but its cause is presumed to be a combination of changing levels of hormones (since it happens after puberty), hair growth, friction from clothes, or sitting for long periods of time.
Friction and pressure like skin rubbing against skin, tight clothing, bicycling, sitting for long periods of time forces the hair down into the skin. As a response to the hair as a foreign substance, the body forms a cyst around the hair. A person can sometimes have multiple sinuses that connect under the skin.
What Are The Symptoms Of Pilonidal Sinus?
When a pilonidal cyst is infected, it becomes a swollen mass (abscess). The symptoms of an infected pilonidal cyst also include the following:
- Pain, redness, and swelling at the base of the spine
- Pus or blood oozing from an opening in the skin
- Bad smell from the pus that has oozed out
How Is A Pilonidal Sinus Diagnosed?
The doctor will start by performing a complete physical exam. During the exam, they will check the line of the buttocks for signs of a pilonidal cyst.
When people have a pilonidal cyst, it should be noticeable to the naked eye. If the doctor can spot a pimple or a dripping cyst, they may ask a number of questions to the patient, including:
- If the cyst has changed in appearance?
- Is it discharging any fluid?
- If the patient has any other symptoms?
- At times, though rare, the doctor can ask for a CT or MRI to look for any sinus cavities (small holes) that might have formed below the surface of the skin.
How Are Pilonidal Sinuses Treated?
When people are diagnosed with one or more pilonidal cysts, they will receive a treatment plan that best suits each individual case. This treatment depends on the answers to many questions such as:
- If they already had a pilonidal cyst before?
- If they have had any other skin problems (such as abscess or sinus) in the same area?
- How fast are they recovering?
- Depending on the severity of the symptoms, people might or might not require surgery to remove the pilonidal cyst. There are many other treatments available
- Draining the cyst – this procedure can be done at the doctor’s office. A tiny cut is made to open and drain the fluid from the infected cyst.
Injections – injections might cure mild to moderate pilonidal cysts.
Antibiotics– antibiotics can cure skin inflammation. However, antibiotics cannot cure pilonidal cysts on their own.
Laser Therapy – Laser therapy can remove hair that otherwise can become ingrown, resulting in pilonidal cysts.
Surgery – if people have recurrent pilonidal sinuses or more than one sinus tract, the doctor can advise surgery. Initially, local anaesthesia will be administered to the patient. The surgeon then opens the lesions, draining all the pus and debris. Once this procedure is complete, your surgeon will close the wound with stitches. After the surgery is completed, the doctor will explain the method to change the dressings and advise shaving the site to prevent hair growth into the wound.
How Can Pilonidal Sinus Be Prevented?
People can prevent chronic pilonidal sinus by washing the buttocks area daily with mild soap, making sure that all the soap is removed, keeping the buttocks area completely dry, and avoiding sitting for longer hours.
While pilonidal cysts are not dangerous, they can become difficult to treat and convert into a chronic condition when people do not seek help quickly, which is why people need to undergo a physical exam at the first sign of any symptoms of a pilonidal cyst.
Anti-reflux surgery is a treatment for acid reflux, also known as GERD (gastroesophageal reflux disease). GERD is a condition in which food or stomach acid comes back up from your stomach into the esophagus. The esophagus is the tube from your mouth to the stomach.
Reflux often occurs if the muscles where the esophagus meets the stomach do not close tightly enough. A hiatal hernia can make GERD symptoms worse. It occurs when the stomach bulges through this opening into your chest.
Symptoms of reflux or heartburn are burning in the stomach that you may also feel in your throat or chest, burping or gas bubbles, or trouble swallowing food or fluids.
The most common procedure of this type is called fundoplication. In this surgery, your surgeon will:
First repair the hiatal hernia, if one is present. This involves tightening the opening in your diaphragm with stitches to keep your stomach from bulging upward through the opening in the muscle wall. Some surgeons place a piece of mesh in the repaired area to make it more secure.
Wrap the upper part of your stomach around the end of your esophagus with stitches. The stitches create pressure at the end of your esophagus, which helps prevent stomach acid and food from flowing up from the stomach into the esophagus.
Surgery is done while you are under general anesthesia, so you are asleep and pain-free. Surgery most often takes 2 to 3 hours. Your surgeon may choose from different techniques.
Your surgeon will make 1 large surgical cut in your belly.
A tube may be inserted into your stomach through the abdomen to keep the stomach wall in place. This tube will be taken out in about a week.
Your surgeon will make 3 to 5 small cuts in your belly. A thin tube with a tiny camera on the end is inserted through one of these cuts.
Surgical tools are inserted through the other cuts. The laparoscope is connected to a video monitor in the operating room.
Your surgeon does the repair while viewing the inside of your belly on the monitor.
The surgeon may need to switch to an open procedure in case of problems.
This is a new procedure that can be done without making cuts. A special camera on a flexible tool (endoscope) is passed down through your mouth and into your esophagus.
Using this tool, the doctor will put small clips in place at the point where the esophagus meets the stomach. These clips help prevent food or stomach acid from backing up.
Why the Procedure is Performed?
Before surgery is considered, your health care provider will have you try:
- Medicines such as H2 blockers or PPIs (proton pump inhibitors)
- Lifestyle changes
- Surgery to treat your heartburn or reflux symptoms may be recommended when:
- Your symptoms do not get much better when you use medicines.
- You do not want to keep taking these medicines.
- You have more severe problems in your esophagus, such as scarring or narrowing, ulcers, or bleeding.
- You have reflux disease that is causing aspiration pneumonia, a chronic cough, or hoarseness.
- Anti-reflux surgery is also used to treat a problem where part of your stomach is getting stuck in your chest or is twisted. This is called a para-esophageal hernia.
Risks of any anesthesia and surgery in general are:
- Reactions to medicines
- Breathing problems
- Bleeding, blood clots, or infections
- Risks of this surgery are:
- Damage to the stomach, esophagus, liver, or small intestine. This is very rare.
- Gas bloat. This is when the stomach overfills with air or food and you are unable to relieve the pressure by burping or vomiting. These symptoms slowly get better for most people.
- Pain and difficulty when you swallow. This is called dysphagia. In most people, this goes away during the first 3 months after surgery.
- Return of the hiatal hernia or reflux.
Before the Procedure
You may need the following tests:
- Blood tests (complete blood count, electrolytes, or liver tests).
- Esophageal manometry (to measure pressures in the esophagus) or pH monitoring (to see how much stomach acid is coming back into your esophagus).
- Upper endoscopy. Almost all people who have this anti-reflux surgery have already had this test. If you have not had this test, you will need to do it.
- X-rays of the esophagus.
- Always tell your provider if:
- You could be pregnant.
- You are taking any drugs, or supplements or herbs you bought without a prescription.
Before your surgery:
You may need to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other drugs or supplements that affect blood clotting several days before surgery. Ask your surgeon what you should do.
Ask your provider which drugs you should still take on the day of your surgery.
On the day of your surgery:
- Follow your provider’s instructions about when to stop eating and drinking.
- Take the drugs your doctor told you to take with a small sip of water.
- Follow instructions for showering before surgery.
- Your provider will tell you when to arrive at the hospital. Be sure to arrive on time.
After the Procedure
Most people who have laparoscopic surgery can leave the hospital within 1 to 3 days after the procedure. You may need a hospital stay of 2 to 6 days if you have open surgery. Most people can return to normal activities in 4 to 6 weeks.
Heartburn and other symptoms should improve after surgery. Some people still need to take drugs for heartburn after surgery.
You may need another surgery in the future if you develop new reflux symptoms or swallowing problems. This may happen if the stomach was wrapped around the esophagus too tightly, the wrap loosens, or a new hiatal hernia develops.
VATS (video-assisted thoracic surgery) is a type of minimally invasive thoracic surgery of the chest, performed with a thoracoscope (small videoscope) using small incisions and special instruments to minimize trauma.
Other names for this procedure include thoracoscopy, thoracoscopic surgery or pleuroscopy,
During thoracoscopic surgery, three small (approximately 1-inch) incisions are used, as compared with one long 6- to 8-inch chest incision that is used during traditional, “open” thoracic surgery. Surgical instruments and the thoracoscope are inserted through these small incisions.
The thoracoscope transmits images of the operative area onto a computer monitor that is positioned next to the patient.
As compared with traditional surgery, patients who undergo minimally invasive surgery experience:
- Decreased postoperative pain
- Shorter hospital stay
- More rapid recovery and return to work
- Other possible benefits include reduced risk of infection and less bleeding.
Almost all traditional thoracic surgeries can be performed using a minimally invasive technique.
If you need thoracic surgery, a minimally invasive surgical approach will first be considered. However, there are still some procedures that are best performed using a traditional, “open,” technique. Your surgeon will carefully evaluate you to determine the safest surgical approach to treat your medical condition.
Types of Thoracoscopic Surgery Procedures
Thoracic surgery procedures routinely performed using a minimally invasive technique include:
Lobectomy (removal of a large section of the lung) is the most common surgery performed to treat lung cancer. Lobectomy has been traditionally performed during thoracotomy surgery. During thoracotomy surgery, an incision is made on the side of the chest between the ribs. The ribs are then spread apart so the surgeon can see into the chest cavity to remove the tumor or affected tissue. During video-assisted lobectomy, three 1-inch incisions and one 3- to 4-inch incision are made to provide access to the chest cavity without spreading of the ribs. The patient experiences a more rapid recovery with less pain and a shorter hospital stay (usually 3 days) with video-assisted lobectomy as compared with traditional thoracotomy surgery.
Although minimally invasive approaches are considered for every patient, in some cases, patients who have a large or more central tumor may not be candidates for video-assisted lobectomy.
A wedge resection is the surgical removal of a wedge-shaped portion of tissue from one, or both, lungs. A wedge resection is typically performed for the diagnosis or treatment of small lung nodules.
A lung biopsy is a procedure in which a small sample of lung tissue is removed through a small incision between the ribs. The lung tissue is examined under a microscope by expert pathologists and may also be sent to a microbiological laboratory to be cultured. The lung tissue is examined for the presence of lung diseases such as infectious or interstitial lung disease.
Drainage of Pleural Effusions
A pleural effusion is the build-up of excess fluid between the layers of the pleura – the thin membrane that lines the outside of the lungs and the inside of the chest cavity. Normally, very little fluid is present in this space. The excess fluid is removed (drained) during a thoracoscopic procedure called thoracentesis and may be collected for analysis to indicate possible causes of pleural effusion such as infection, cancer, heart failure, cirrhosis, or kidney disease. Sterile talc or an antibiotic may be inserted at the time of surgery to prevent the recurrence of fluid build-up.
Mediastinal, Pericardial, and Thymus Thoracoscopic procedures
The mediastinum is the area in the middle of the chest between the lungs.
The pericardium is the area surrounding the heart.
The thymus is a small organ located in the upper/front portion of the chest, extending from the base of the throat to the front of the heart. The cells of the thymus form a part of the body’s normal immune system. Early in life, the thymus plays an important role in the development of the immune system.
Thoracoscopic techniques can be used to examine the mediastinum, pericardium, or thymus, remove tissue samples, or surgically remove cancerous growths in the affected area.
When you meet with the thoracic surgeon, a physical exam will be performed and your treatment options will be discussed. The thoracic surgeon will discuss the benefits and potential risks of the surgical procedure that is recommended for you.
- In general, preoperative tests include:
- Blood tests
- Pulmonary function test (breathing test)
- CT scan
Your surgeon will determine if any additional preoperative tests are needed, based on the type of procedure that will be performed. If a cardiac (heart) evaluation is necessary, a consultation with a cardiologist will be scheduled.
As part of your preoperative evaluation, you will meet with an anaesthesiologist who will discuss anaesthesia and postoperative pain control.
The thoracic surgery scheduler will schedule any additional tests and consultations that have been requested by your surgeon. In general, after your first meeting with your surgeon, all tests are scheduled on a single returning visit for your convenience.
The length of your hospital stay will vary, depending on the procedure that is performed. In general, patients who have thoracoscopic lung biopsies or wedge resections are able to go home the day after surgery. Patients who have a VATS lobectomy are usually able to go home 3 to 4 days after surgery.
Your thoracic surgery team, including your surgeon, surgical residents and fellows, surgical nurse clinicians, social workers, and anaesthesiologist, will help you recovery as quickly as possible. During your recovery, you and your family will receive updates about your progress so you’ll know when you can go home.
Your health care team will provide specific instructions for your recovery and return to work, including guidelines for activity, driving, incision care, and diet.