Gallbladder Disease
In the United States, approximately 20% of the population has gallstones. Only 20% of those individuals have symptoms. Once an attack has occurred, it is highly recommended that the patient have the gallbladder removed in order to prevent subsequent problems such as pancreatitis, yellow jaundice, or infection. Gallbladder surgery is done using laparoscopic equipment by placing a small camera through the bellybutton and three other holes, called "ports". The gallbladder can be removed this way over 95% of the time. The DeKalb Clinic surgeons have been able to maintain this national average. (For more information, please see the "GI file". This will cover gallbladder attacks in more detail.) Many patients after gallbladder surgery are able to return home the same day and return back to work in 7-10 days, although infrequently two weeks is required.
Colon Surgery
This is the newest use of this equipment. The large and small intestine as well as small portions of stomach can be removed using this approach with excellent results. Drs. Wagoner and Maillefer have accomplished training in this area and have successfully performed these procedures locally. The end result requires a 2-inch incision in the left lower quadrant to remove the specimen. These patients do very well and again, return to work in approximately two weeks (compared to the average of six). They are also in the hospital for only 3-4 days (versus 7-10). This approach is ideal for diverticulitis, polyps in which malignancy cannot be ruled out, and even some cancers can be removed this way.
Appendicitis
Appendicitis occurs secondary to inflammation of the appendix, which is located in the right lower quadrant. This can be removed using the laparoscope with a camera through the bellybutton and a small one down by the pubis and one other small hole in the right flank. The indications for this procedure are typically in females in which ovarian pain versus appendicitis cannot be ruled out. At the time of the operation, appendicitis in encountered and can therefore be removed in this fashion. Recovery is approximately the same versus the open technique.
Hernias
Hernias develop in several places. The most frequent are inguinal (groin) hernias followed by umbilical (bellybutton) hernias, and then incisional hernias. All of these have been repaired locally using state-of-the-art techniques and equipment. With umbilical and incisional hernias, the recurrence rate after laparoscopic repair is reported to be less than 5% versus, in some studies, as high as 25-40%. Inguinal surgery is performed using three small incisions to introduce a mesh behind the defect in the groin. (The recurrence rate of inguinal hernias is approximately the same when comparing laparoscopic to open techniques.). Our experience at the DeKalb Clinic would suggest that this is less painful than a traditional open repair. Return to work is as fast, if not faster, than a traditional repair.
Gastroesophageal Reflux Disease (Heartburn)
A patient who has failed to improve their reflux symptoms on medicine, can undergo laparoscopic surgical repair of their reflux disease. This is performed after appropriate screening (For more details, please see 'GI FILE'.) and requires an overnight stay in the hospital. The operation lasts 1-2 hours. This can be completed laparoscopically over 95% of the time. The stomach is wrapped around the esophagus and securely tied to itself with permanent sutures. In addition, the diaphragm is tightened to close off any chance of an hiatal hernia. Symptom relief is immediate and successful in 100% of the patients. The long-term results suggest a 90% symptom-free relief at 10 years. Because small holes are used, the chance of incisional hernias is rare. The DeKalb Clinic surgery department has successfully completed over 100 cases.
Spleens
Occasionally, individuals with sick spleens, usually from a form of leukemia, can have their spleens removed laparoscopically. The benefits of this technique are the same as those mentioned above with regards to less pain, faster recovery, faster return to work.
Lung
Individuals who have had a spontaneous hole in the lung which fails to seal on its own or if there is a question of a mass in need of biopsy, 3 small holes can be made in the chest wall to allow for a small camera. Then, the area of concern can be stapled off. This usually requires 3 days in the hospital to recuperate and to monitor the lung for healing. Return to work is generally in 1 week (versus the old-fashioned approach of a 1 foot incision which requires 5-7 days in the hospital and 4-6 weeks off of work). A chest tube is left in the chest cavitiy after surgery for 2-3 days to assist the lung in re-expanding. Often, a night in the Intensive Care Unit is required.
