Laparoscopic Surgery

Gallbladder

The gallbladder is a pear-shaped organ with a capacity of 50 ml, lying on the inferior surface of the liver and adhering to it. It ensures the storage and concentration of the bile juice. Bile juice produced by the liver accumulates in this sack through the channels, and is delivered into the small intestine after eating, for the purpose of digesting especially fatty foods. Gallstones existing one in every 10 adults are seen more commonly in women, especially after 30 years of age. After 60 years of age, gallstones develop in 10-15 percent of men, and in 30-40 percent of women.

Admissions to Hospitals

One out of every five patients admitted to hospitals due to gallstones have inflammations related to duct obstruction caused by gallstones appearing after 60 years of age. Although gallstones do not cause cancer, gallstones are found in 70 percent of patients, who have undergone surgery due to gallbladder cancer. “The possibility of cancer is between 20 and 60 percent in cases of gallbladders containing porcelain or calcific stones. Surgery is recommended to such patents even if there is no complaint.

“Gallstones form as a result of the precipitation of solids in the bile. Most of stones contain cholesterol. There may be only one stone in the gallbladder; however, there are cases where the number reaches thousands. Gallstones are common in blond women, obese people, those who lose weight very fast, patients receiving long term intravenous feeding, and those who have undergone bariatric surgery involving the removal of a portion of the stomach. There is evidence that the disease is hereditary in some respects. There are publications indicating that caffeinated beverages and alcohol reduce gallstones. Gallstones can prevent the discharge of the sack’s content by clogging its duct; and consequently lead to inflammation called cholecystitis. Gallstones can cause bile to get mixed with blood (a condition called ‘jaundice’) by clogging the bile duct, and can cause inflammation of the pancreatic gland (pancreatitis) by clogging the pancreatic duct. 60 percent of patients with gallstone have no symptoms. 20 percent of hospital admissions related to gallbladder disorders are the cases of sack inflammation (acute cholecystitis), a condition in which the suddenly developed stone clogs the duct. Severe complications such as jaundice, cholangitis (inflammation of the external bile ducts), and pancreatitis are seen in 10 percent of these patients.”

Diagnosis And Treatment of Gallbladder Disorder

Today, ultrasonography the most commonly used method for diagnosis of gallbladder disorder. Its frequent use does not cause harm to the patient.

“Oral administration of ursodeoxycholic acid and other similar substances gives positive results in the treatment of some gallstone conditions. However, the success rate of this remains very low and stone development recurs in the first 4 years in half of the patients. Today, laparoscopic cholecystectomy is the gold standard for patients with symptoms related to gallstones. Surgical operations performed with this technique become less painful, and the patient can return to work within 2-3 days. Complete removal of the gallbladder eliminates the possibility of recurrence of the disorder, stone formation, as well as development of cancer and complications. Non-availability of gallbladder does not cause serious problems in humans.”

Hernia Surgery

Hernia is the condition in which the intra-abdominal organs (mostly the intestines) together with peritoneal membrane covering the abdomen protrude through weak points in the abdominal wall.

It is most commonly seen in the groin area. It is common in the male population. It is characterized by swelling on the abdominal wall as well as pain felt from time to time. The only treatment of the hernia is the surgery. When untreated, incarceration of the intestines in the hernia is a dangerous complication.

Today, laparoscopy is particularly used for surgical operations in the inguinal region (groin area), and is preferred especially in young people and athletes because it causes less pain and enables patients to return to their routine activities earlier.

Obesity

Obesity is excessive fat accumulation in the body that may impair health. It occurs in conditions where the energy intake is higher than the energy consumption. Obesity is an important health problem, not only due to aesthetical reasons but also due to some other reasons such as the facts that it paves the way for the occurrence of certain diseases, and adversely affects the length of life.

Risk Factors That Cause Obesity

• Inadequate Physical Activity
•  Dietary Habits
•  Age
•  Gender (Female)
•  Racial Factors
•  Educational Level
•  Marriage
•  Number of Childbirths
•  Smoking Cessation
•  Alcohol
•  Psychological Disorders
•  Metabolic and Hormonal Disorders

Determination of Obesity

The best way to determine whether a person is overweight is to use an easily calculated value known as Body Mass Index BMI.

How is Body Mass Index calculated?

It is calculated by dividing the body weight (in kg) by the height (in meters).

For example: Body mass index of a person with a body weight of 70 kg and

a height of 1.60 m:

70/1.602=70/1.60X1.60=70/2.56=27.34 kg/m².

How is Body Mass Index Evaluated?

Bariatric Surgical Procedures

Gastric banding that restricts food intake

In this surgical procedure, food intake of the patient is restricted by means of a band placed around the entrance of the stomach. Except for special cases, the band is not removed even if the patient got to his/her ideal weight. The procedure is performed under general anesthesia; and the next day, the patient can begin to take nourishment with liquid foods.

Surgical procedures that reduce the volume of the stomach and decrease food absorption

These surgical procedures are performed laparoscopically. The patient loses weight, no matter how much he/she eats, because of the impaired food absorption. Laparoscopic gastric bypass is the most common surgical procedure.

Intragastric Balloon

The balloon is placed endoscopically through the mouth, and then is inflated. It is aimed to create the feeling of satiety, so as to enable the patient to lose weight. The balloon has to be removed after 6 months. It is a procedure that does not require general anesthesia. After removal of the balloon, the patient is at a high risk of weight regain.