Laparoscopic Abdominoperineal Resection

Laparoscopic surgery is also called minimally invasive surgery, bandaid surgery or keyhole surgery. It is a modern surgical technique in which operations are performed far from their location through small incisions (usually 0.5-1.5cm)elsewhere in the body and insert tiny instruments and a camera into the site to view internal organs and repair or remove tissue. The key element in laparoscopic surgery is the use of laproscope, which is a long fiber optic cable system which allows the viewing of the affected area by shaking the cable from a more distant but more easily accessible location

Advantages of Laparoscopy:
There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include

  • Reduced hemorrhaging which reduces the chance of needing blood transfusion.
  • Smaller incision which reduces pain and shortens recovery time as well as resulting in less postoperative scarring and less postoperative discomfort.
  • Less pain leading to less pain medication needed
  • Although procedure times are usually slightly longer, hospital stay is less and often patient is discharged on the same day which leads to an early return to their normal life.
  • Reduced exposure to internal organs which will reduce the risk of acquiring infections to the organs

Surgery/Transplants Procedure

The procedure involves the following steps:

  • Patient is given general anesthesia(totally asleep) and feels no pain throughout the procedure
  • One or more small incisions are made in the abdomen, mostly around the belly button area.
  • A tube is inserted at the incision site and the abdomen is filled with carbon dioxide gas. This allows the surgeon a better view of the internal organs, all the reproductive organs, especially the womb, ovaries and tubes. And it will give more room for work. With good technique this surgery can be done safely in women who are significantly overweight or have had prior abdominal or gynecologic surgery.
  • The laparoscope is inserted through the tube and images of the internal structures are relayed to the TV monitor.
  • When the diagnostic part is done and something has been found that requires surgery, surgical instruments are inserted via further small incisions that can be made depending on what the surgeon finds and what procedures they need to perform.
  • Once the operation is finished, the gas is expelled from the abdomen and the incision is closed using stitches.

How it Works?


Operations now often performed laparoscopically like the following amongst others

  • Removal of diseased organ such as gallbladder or appendix
  • Removal of anus, rectum and sigmoid colon is through Laparoscopic abdominoperineal resection
  • Removal or repair of the bladder, uterus or kidneys(Urinary system)
  • Removal or repair of diseased parts of the colon or stomach(digestive system) or rectum which is called Colorectal laparoscopic surgery or laparoscopic colorectal surgery
  • Tube ligation
  • Removal of a kidney in a living donor
  • Removal or repair of women’s reproductive organs such as the uterus or fallopian tubes
  • Weight reduction process like gastric bypass
  • Repair of hernia
  • To view the pancreas for presence of cancer or tumors
  • To view abdomen for signs of disease that has been difficult to diagnose(exploratory surgery)
  • To view injury after trauma or accident
  • To view tumor in the abdomen
  • To remove scar tissue and check the source of abdominal pain
  • To look for the source of internal bleeding or fluid buildup if the patient has a normal blood pressure.


After Effects

  • Slight pain or throbbing is possible where the small cuts were made
  • If stitches were used a follow up appointment for removal of stitches may be schedules in a week or two as directed.
  • Sometimes the carbon dioxide gas used during the procedure can trigger pain after the procedure. Some of the same nerves that reach the shoulder are present in the abdomen. The pain will go away over time
  • Pressure from the gas may cause a sensation of needing to urinate more often and more urgently. This sensation goes away overtime.
  • The doctor will determine when does eating and drinking be resumes and once a person has sufficiently recovered, he or she will be sent home.

Risks


Some of the risks of the surgery are as follows

  • The most common risk is from trocar injuries during insertion into the abdominal cavity, trocar is inserted blindly which might end up injuring the abdominal wall leading to abdominal hematoma, umbilical hernias, umbilical wound infection and penetration of blood vessels or small or large bowel. The risk of such injuries is increased in patients who have a low Body mass index or past history of abdominal surgery. While these injuries are rare significant complications can occur and they are primarily related to the umbilical insertion site. Thus, it is very important that these injuries to be recognized as early as possible
  • There may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold and dry gases for insufflations.
  • Some patients have sustained electrical burns unseen by surgeons who are working with electrodes that leak current into the surrounding tissue. The resulting injuries can result in perforated organs and can also lead to peritonitis. The risk can be eliminated by utilizing an active electrode monitoring though.
  • Carbon Dioxide that is inserted into the abdominal cavity is not removed completely and might end up causing a difficulty in breathing and pain in the shoulder. However, the pain is transient as the body tissues will absorb the Carbon dioxide and eliminate through respiration.
  • Patients with existing pulmonary disorders may not tolerate pneumoperitoneum (gas in the abdominal cavity) resulting in need for conversion to open surgery after the initial attempt to laparoscopic approach.
  • Intra-abdominal adhesion formation is a risk associated with both laparoscope and open surgery and remains significant unresolved problem. Complications of adhesions include chronic pelvic pain, bowel obstruction and female infertility. The use of surgical humidification therapy during laparoscopic surgery may minimize the incidence of adhesion formation, and other techniques like physical barriers such as films or gels, broad-coverage fluid agents to separate tissues during healing following a surgery
  • Coagulation disorders and dense adhesions from previous abdominal surgery may pose added risk for laparoscopic surgery and are considered relative contraindications for the approach.


 Cost


India has become a new medical destination for various medical treatments including laparoscopy. Many international patients from all the corners of the world are coming on medical tour for various laparoscopic surgeries in India taking a benefit from it since it is affordable and good quality. India has a few of the best colorectal laparoscopic surgeons who will provide the treatment at much cheaper cost without the compromise on quality.


The price of the laparoscopy starts ranging from USD 5000-15000.In India ranging from INR 6000 for minor incisions to 3, 50,000 for Bariatric surgery, which varies from hospital to hospital and from surgeon and type of laparoscopy you want to go for.

Recovery
Once your laproscopy is completed you will be observed for several hours before discharge from hospital. The timing of your recovery varies depending on the factors mentioned below:

  • Your physical condition
  • The type of anesthesia used
  • Your body’s reaction to the procedure

Some cases require an overnight stay. You will be taken to a recovery room where all the vitals will be monitored and any reaction to anesthesia or the procedure is checked. When the effects of anesthesia wear off you will be discharged but if you are given general anesthesia you will not be permitted to dive yourself home.


You will not be allowed to lift heavy objects for about a week
You can go back to eating your normal diet when you feel hungry

You can resume all normal activities within a week. And you are required to return to your physician in about two weeks.

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