Dr. Ashish Vashistha, Best Robotic Gallbladder Surgeon in Delhi
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Gallbladder Stones
The PAINLESS and SCARLESS Surgical Experience
LAPAROSCOPIC /
ROBOTIC CHOLECYSTECTOMY
Department of General Surgery & Robotics
Max Superspecialty Hospital, Saket, New Delhi
WHAT IS GALLBLADDER?
Gallbladder is a pear shaped organ present under the liver that stores and concentrates bile. Bile is produced by the liver, NOT BY THE GALL BLADDER.
WHAT ARE GALLSTONES
Gall bladder stones are crystalline masses that get preipitated inside the gall bladder. Gall bladder sludge is the precursor of stone. The size and number of stones may vary but number and size of the tones does not change the management. Surgical removal of gall bladder is the only option.
WHO ARE AT RISK FOR GALL STONES?
Women are more prone than men.
Overweight
Who face sudden weight loss
Genetic (runs in families).
Pregnant women/ women who take hormonal therapy/ birth control pills.
Diet rich in fried/ fatty heavy meals.
SYMPTOMS OF GALLSTONES?
Gall stone attacks occur typically after a fatty meal and mostly occur during the night. A typical attack may cause the following-
- Severe pain in the right upper abdomen that increases rapidly and lasts for few minutes to hours.
- Pain radiates to the back between the shoulder blades
- Nausea / vomitting.
Other unusual symptoms include Abdominal bloating (Gaseous fullness of abdomen), Belching, Indigestion etc which many people misjudge it as symptoms of gastric acidity.
Many patients of gallstones have NO SYMPTOMS. Such kind of presentation is known as a symptomatic or SILENT STONES. However they may become symptomatic at any point of time and may cause serious complications.
HOW ARE GALL STONES DIAGNOSED?
Most of the gall stones are diagnosed simply by Ultrasonography of abdomen and few blood tests like CBC, LFT, Amylase, Lipase. Few a typical cases may need MRCP(MRI).
WHAT IS CHOLECYSTITIS?
Cholecystitis is the acute inflammation of the gall bladder that most commonly occurs when the flow of bile is obstructed due to impaction of a stone at the neck of the gall bladder. The patient presents with severe pain in the right upper abdomen along with fever and vomiting with raised TLC. One should not wait for the complication to occur which includes Mucocele/ Empyema Gall bladder (Gall bladder filled with pus), Gangrene and perforation.
COMPLICATIONS OF GALL STONES
Recurrent severe abdominal pain or vomiting
Pus formation in the gallbladder(Empyema)
Cholangitis (Life threatening infection of biliary system)
Gangrene and perforation of the gallbladder
Acute pancreatitis (swelling of pancreas) which can have a catastrophic sequel of multi-organ failure and other serious complications
Jaundice due to blockage of the common bile duct because of stones
Associated with Cancer of gall bladder in the long term
WHAT IS BILLIARY PANCREATITIS?
Biliary pancreatitis is a very serious and life threatening condition and is associated with high morbidity and mortality. It occurs when gall bladder stones migrate into the Common Bile Duct (CBD) and block the pancreatic opening. Many patients will need a prolonged stay that may include ICU stay and other life supportive measures. Many of these patients may end up with damaged and destroyed pancreas ultimately leading to conditions like Diabetes, etc. It is also associated with high morbidity and mortality.
HOW ARE GALLSTONES TREATED?
There is no medical/ conservative management of gallstones. Injectable painkillers and antibiotics can be only given to subside the symptoms of an attack, which will mostly reccur frequently if gall bladder is not removed surgically.
Surgical removal of gallbladder by Laparoscopy/ Robotic is the GOLD STANDARD treatment of gallbladder stones/ Cholecystitis which is known as Laparoscopic Cholecystectomy. The surgery is performed by maiking 4 tiny cuts through which laparoscope (camera) and instruments are inserted into the abdomen after filling the abdomen with Carbon dioxide gas.
NEXT GENERATION ROBOTIC SURGERY
The Next-Generation Robot, da-VINCI robotic surgical system, is designed to provide all the advantages of laparoscopic surgery with added precision and safety. Backed by Machine Learning and Artificial Intelligence. It enables a 3D view which gives a greater depth perception to the surgeon thus improving the accuracy, reducing the surgical time and in turn enhancing the safety of the procedure.
5S of Robotics
SAFE STABLE SECURE STEADY SUPERIOR
ONLY THE STONES ARE REMOVED OR THE ENTIRE GALLBLADDER?
ALONG WITH THE STONES, THE ENTIRE GALL BLADDER IS REMOVED, BECAUSE THE DISEASE IS IN THE WALL OF GALL BLADDER.
WHAT IF A STONES LIPSIN TO COMMON BILE DUCT (CBD)?
Usually smaller stones slip into the CBD and on slippage, patient experiences severe abdominal pain associated with jaundice. This condition requires and endoscopic intervention known as ERCP by Gastroenterologist to remove the CBD stone before surgery.
HOW TO CONFIRM STONE IN THE CBD?
Usually CBD stones are not detected on Ultrasonography. The LFT of the patient will be deranged indicative of a CBD stone which is further confirmed by a MRI scan known as MRCP.
WHAT IS ERCP?
ERCP is an endoscopic procedure done by Gastroenterologist in which endoscope is inserted through the mouth to reach the CBD and the CBD stones are crushed and retrieved. A stent is placed in the CBD which is usually removed after 4-6 weeks.
WHAT HAPPENS WHEN THE SURGERY IS PLANNED?
ADMISSION
Patient is usually admitted on the same day of the surgery or a day prior to the surgery in the evening.
After admission, the patient is examined and investigations are reviewed by the team of doctors.
A member of the anaesthesia team conducts the Pre-Anaesthetic Checkup (PAC) and preoperative investigations are performed, if
The performed, if needed. overnight or for 8 hours before the surgery(the patient is not allowed to take even water during this time).
SURGERY: The patient is shifted to the Operation Theatre about an Hour or so prior to the surgery. The surgery is done under General Anaesthesia (GA). The procedure is of approximately 45 minutes duration in most cases.
AFTER SURGERY: As soon as the surgery is over, the patient is then shifted to the recovery ward under the care and supervision of the anaesthesia team. Normally, the patient is observed in the recovery ward for a few hours after the surgery and then shifted back to the room and patient is made to walk with in an hour.
Water proof dressings are applied on the port sites and the patient may bathe when comfortable.
The patient is advised to visit again after 5 days when the dressings are removed.
HOW LONG WILL I HAVE TO STAY IN THE HOSPITAL AFTER SURGERY?
The patient is discharged on the same day (if insurance policy allows), or discharged the next day morning. One additional day of stay is required if patient under goes ERCP for CBD stones.
WILL MY INSURANCE COVER THIS SURGERY?
Although insurance coverage depends upon individual insurance plans, still in almost all the cases of Laparoscopic Cholecystectomy, patients face no issues for insurance approval.
DIET AFTER SURGERY?
The patient is allowed liquids orally 4 hours after the surgery. From the next day, patient is given Normal diet. Patient is advised to have bland diet for next 5-7 days following which patient resumes normal habitual diet as it was before the surgery.
The Team that Cares
Dr. Ashish Vashistha
MBBS, MS, FNBE (MAS), FIAGES, FALS (Bariatrics) SENIOR DIRECTOR & HOD –
DEPARTMENT OF GENERAL SURGERY AND ROBOTICS LAPAROSCOPIC, ROBOTICS (GI), HERNIA, BARIATRIC AND METABOLIC & LASER SURGEON. HISTORICAL FIRST FELLOW- NATIONALBOARD, (FNBE) MAS.
FOUNDER MEMBER, CRSA, ROBOTIC (USA) EXECUTIVE MEMBER IAGES, HSI. EXECUTIVE MEMBER, OSSI.
REVIEWER JOURNAL OF MINIMAL ACCESS SURGERY
For Appointment:-
Visit at :-
B-41 First Floor Shivalik, Main Shivalik Geetanjali Road
Near Malviya Nagar, New Delhi – 110017, India
OPD TIMING
MON, WED, FRI:2PM TO 5PM TUES, THURS, SAT:10AM TO 2PM
FOR APPOINTMENT
Call on 98711 42425