Sometimes, when it comes to problems in the abdominal area, an ultrasound is not clear enough for a diagnosis. In such cases, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed. This procedure gives the doctor a clear view of the duodenum, bile duct, pancreatic ducts, gallbladder and papilla of Vater.

This procedure is usually performed under intravenous sedation without general anesthesia. This procedure involves the use of a duodenoscope, which can be described as a thin, long, flexible tube with a camera at one end. It also has a fiber optic bundle that transmits lights to the camera and a chip to transmit video images to a TV screen.

This is inserted through the patient s mouth and sent down the throat through the food pipe to the stomach and duodenum while the patient is lying on his or her back. The air pipe is left undisturbed so as to not interfere with the patient s breathing. Since the patient is not under general anesthesia, he or she can move and turn according to the doctor s needs. The papilla of Vater is a small nipple like structure with an opening to the bile duct and pancreatic duct. Once this has been identified, a small plastic catheter is passed through the duodenoscope into the bile duct or pancreatic duct through the papilla. Dye is then injected into the area and X-rays are taken of the bile ducts and pancreatic duct. In cases where a biopsy is needed, other instruments can also be passed through the endoscope. Plastic or metal stents can also be passed through this to relieve obstructions in the bile ducts and pancreatic ducts.

ERCP can be used to diagnose and treat a number of conditions in the liver, bile ducts, gall bladder, pancreas and papilla of Vater. These include:

  Blockage of the bile duct by gallstones, cancer, scars, tumors or compression from adjacent organs.

  Jaundice due to an obstructed bile duct. This can also cause light stools and dark urine.

  Persistent upper abdominal pain

  Unexplained weight loss and loss of appetite

  Diagnosing a Dysfunctioning Sphincter of Oddi within the Papilla of Vater

ERCP can also be used to confirm pancreatic cancer and cancer of the bile duct. Once the diagnosis is confirmed, the doctors can customize treatment according to the patient s needs.

Endoscopic Retrograde Cholangiopancreatography - Procedure and Results

Gall bladder is a very important digestive gland, which is located on the right side of your abdomen, just beneath your liver. Its main function is to collect, store and release bile, a digestive fluid produced in your liver, essential for metabolizing fats, into your small intestine.

Sometimes, small hard stones comprising of cholesterol, bile pigments and calcium salts in the shape of a pebble, can form in your gall bladder. Gallstones may cause no symptoms but when the gallstone lodges in ducts and blocks the flow of bile, it can cause persistent high-intensity pain which requires gallstone surgery.

Surgery is then prescribed to remove the gall bladder. This surgery is called cholecystectomy. It s done when there are

Gallstones in the gallbladder
Gallstones in the bile duct
Gallbladder inflammation
Inflammation in pancreas
Gallstone surgery or cholecystectomy is a common surgery, and it comes with only a small risk of complications and you can walk out of the hospital on the day of the surgery itself.

Procedure

Minimally invasive or laparoscopic cholecystectomy
During this procedure, the surgeon makes 4 tiny incisions in your abdomen and inserts a tube with a tiny video camera inside it.
Through a video monitor, the surgeon watches while he inserts surgical tools through the other 3 incisions to remove your gallbladder.
After the surgery, the surgeon confirms that there are no gallstones left. Once this is done, he sutures your incisions and you are taken to the recovery area. A laparoscopic cholecystectomy takes just 2 hours or so.
But the problem with this procedure is that it  not appropriate for everyone. Sometimes, what happens is that, the surgeon may start with a laparoscopic surgery and then may decide to go for an open gallstone surgery because of scar tissue or complications.
Traditional or open cholecystectomy
This procedure requires a bigger incision of about 6-inches in your abdomen, below your ribs on the right side. The liver and gallbladder are exposed and the surgeon removes the gallbladder.
An open cholecystectomy takes one or two hours.
Single-incision Laparoscopy Surgery

Traditional laparoscopic surgeries use a telescopic rod attached to a video camera called a laparoscope, which is inserted through a small incision. Apart from this, 3 to 5 additional small cuts are made to insert the other surgical instruments to perform the surgery.

However, single-incision laparoscopy surgery (SILS) is a revolutionary minimally invasive surgical procedure conducted through a single incision. It provides a better cosmetic outcome, as a small incision is made through the patient s navel or belly button, resulting in an almost scarless outcome.

Indications

Most patients who are good candidates for laparoscopic surgery are eligible for single-port procedures. Some of the surgeries that single incision laparoscopy is indicated for include cholecystectomy (removal of gall bladder), appendectomy (removal of appendix), splenectomy (removal of spleen), hepatectomy (removal of liver) and adrenalectomy (removal of adrenal glands). SILS can also be used for diagnostic purposes.

However, patients who have previously undergone multiple major surgeries to the abdominal region and those who are morbidly obese are not considered for SILS.

Procedure

Single Incision Laparoscopy is usually performed as day surgery either in the hospital or outpatient surgery center under general, regional, or occasionally local anesthesia depending on the type of procedure performed and the surgeon s preference.

The patient is made to lie down in a tilted position so that the feet are placed higher than the head. The surgeon makes a single incision of about 3/4th of an inch at the belly button and injects a harmless gas to expand the area and obtain a clear view of the operative site. A tube called a trocar or port is placed through the incision, through which the laparoscope (a narrow telescope having a light source and camera) and tiny surgical instruments are inserted. The laparoscope guides your surgeon with images of the abdominal contents that can be viewed on a large screen. Once the diseased organ is excised, your surgeon removes the instruments, releases the gas, and closes the incision with a small bandage.

Recovery

Common post-operative guidelines following Single Incision laparoscopy include the following:

You will need someone to drive you home after you are released as the anesthesia may make you feel groggy and tired
Do not remove the dressing over the incision for the first two days and keep the area clean and dry.  No showering or bathing during this time.  The incision usually heals in about 5 days
Your surgeon may give you activity restrictions such as no heavy lifting. It is very important that you follow your surgeon s instructions for a successful recovery
You may feel soreness around the incision area. Your surgeon may give you a prescription pain medicine or recommend NSAID s (non-steroidal anti-inflammatory drugs) for the first few days to keep you comfortable
If the abdomen was distended with gas, you may experience discomfort in the abdomen, chest, or shoulder area for a couple days while the excess gas is being absorbed
Diet

You must be very careful with your diet after gallstone removal as your body will not be able to digest fats well. You will of course be sticking to a liquid diet for a week or two and then introduce solids back into your diet. When you do so, you have to stick to a low fat diet. Stay off fried foods and gas-forming foods. Also make sure that you consume no more than 60 gm of fats per meal to avoid discomfort. Stay off spicy foods to avoid bloats and abdominal pains.

Gallbladder Surgery - Aftercare Tips To Help You Recover Better!

Diet and other lifestyle factors such as lack of exercise and high waist-hip ratio are seen to be the significant contributing factors of certain medical conditions, gallstones one among them. Gallstones have become a highly prevalent issue in India, with an increasing number of patients reporting abdominal pain and discomfort. And it is also seen to be more common in females than in males. If your doctor suspects this problem, then he would proceed with the diagnosis and treatment as applicable.

How are gallstones treated?
If gallstones are not leading to any signs or symptom, then in such cases the treatment is not required. However, if an individual suffers from any symptoms or a gallbladder attack, then the health care provider normally recommends undergoing surgery. This surgery is used for removing the gallbladder. Sometimes, the individual may not be in a condition to undergo surgery and, in such cases, conventional treatment may be used for curing the disorder.

The surgery for the removal of the gallbladder is known as the cholecystectomy and is one of the most common surgical interventions performed for people with gallstones. The gallbladder is not considered to be a significant organ in the human body. This means that an individual can easily survive without the gallbladder. As the gallbladder is removed, bile starts flowing out of the liver through common and hepatic bile ducts without creating any issues.

What are the surgical options required for removal of gallstones?
There are two types of surgeries used for removal of stones in the gallbladder. These are explained below.

Laparoscopic cholecystectomy: In this surgery, the surgeon makes small incisions in the abdomen for the insertion of a laparoscope, which has a tiny camera attached to it. This camera enables a magnified image to be sent to the video monitor so that the surgeon can see the tissues and organs clearly. At the same time, the surgeon uses certain instruments for carefully separating the gallbladder from the liver, bile ducts and other organs. Then the gallbladder is carefully removed through one of the small incisions. This is the most suitable options for the removal of the gallbladder since it is performed on an outpatient basis, which means that the patient can go home the same day.
Open cholecystectomy: This is done when the gallbladder has severe inflammation or infection or scars from different operations. This may also be performed at the time of the laparoscopic cholecystectomy. In such cases, the surgeon switches to open cholecystectomy as a safety means for the patient.
What to expect after the procedure?
A small percentage of the patients have softer and more frequent stools after the removal of the gallbladder. These changes in bowel habits are normally temporary, and they are required to be consulted with the expert.
Since the incidence of gallstones is found to be related to gallbladder cancer, it is essential to work with your doctor to avail proper treatment and avoid such dire complications.

Surgical Option To Remove Gallstones - Know Which One Will Be Better For You!

It is an extremely embarrassing situation to have a bladder leakage. Social life could be altered, with reduced socialising for fear of losing control in the presence of others. Though not discussed frankly, it is an extremely common issue and about 25 million people in the United States suffer from this, with 75% of these being women.

Treatment depends on the type of incontinence, such as stress, urge, overflow, functional, or mixed. It starts with least invasive methods like lifestyle changes moving over to surgical approaches.

Ways to manage it

With trips to the toilet increasing considerably when you have urinary incontinence, simple measures can help manage leakage.

Bladder training: Train your bladder to control the urge for another 10 minutes. This happens by voluntarily contracting the muscles and holding up the urge to go to the toilet. Gradually, it will help increase the frequency of the visit to 4 to 6 hours.
Scheduled toilet trips: Whether or not there is an urge, visit the toilet every 4 to 6 hours.
Double emptying: Even after you have voided, force yourself to void one more time. The residual urine, which is almost always present in the bladder, also gets emptied.
Food/diet modifications: Stress incontinence is worsened by alcohol, spicy foods, acidic foods, and caffeine. Avoiding these can help reduce bladder leakage.
Kegel exercises: The simple repetition of contracting the pelvic floor muscles, holding it in place, and releasing it can do wonders for strengthening the pelvic floor. This can be done anywhere and any time of the day and is very effective for improving bladder control.
Catheters: These can be used if the incontinence is short-lived; the person would need to learn how to safely insert and remove it.
Absorbent pads and medical devices: The absorbent pads are helpful in preventing embarrassment during social situations. On the other hand, medical devices like pessary are inserted into the vagina to support the bladder neck and thereby prevent leakage from the bladder.
Drugs: Anticholinergics/antimuscarinics are useful to control a leaking bladder. Botox injections can help paralyse the overactive bladder muscles and provide a solution. Topical oestrogen may be used in small amounts to improve tone and reduce incontinence. Alpha blockers are also used in some people with good results. There are muscles that relax the bladder and increase the amount of urine it can contain.
Surgery: In the event that all these measures are not useful, surgical correction is possible. Sling procedure where an artificial mesh is used to support the urethra. Bladder neck suspension is where the bladder neck is given support to prevent leakage. If there is a pelvic organ prolapse, that is corrected to rectify the bladder leakage.

 Bladder Leakage - Solutions To Help You Manage It!

Gallstones are solid deposits/stones of digestive fluids that form in the gall bladder. The size of these stones varies from person to person. While some people may develop only one stone in the bladder, others may develop multiple gallstones simultaneously.

Signs you must watch out for-

Abdominal pain
Pain in the back or between the shoulder blades
Vomiting and nausea
Heartburn
Bloating and indigestion
Change in bowel movement
Dark urine
Fever and chills
Rapid heartbeat
Yellowish skin and pale eyes (Jaundice)
These are the most common symptoms that a person with gallstones encounters. One should consult the doctor right away upon experiencing these symptoms. If ignored for long, these signs can aggravate and lead to further complications.

Complications that may arise from gallstones-
There are quite a few complications of gallstones, including the following-

Cholecystitis- when gallstones become stuck at the neck of the gallbladder, it causes inflammation.
Obstruction in the pancreatic duct- a gallstone blocking the pancreatic duct can cause pancreatitis followed by intense abdominal pain.
Blockage in the bile duct- if the gallstones create a blockage in your bile duct, the outcome may be an infection or jaundice.
Gallbladder cancer- people, who have a history of gallstones, are more likely to develop gallbladder cancer.
Treatment of Gallstones-
Gallstones can certainly be treated, if diagnosed early in time. To confirm the diagnosis, your doctor may perform a CT scan, X-ray, Ultrasound or an ERCP. Once the condition is diagnosed, your doctor will recommend a surgery to remove the stones in the gallbladder (known as Cholecystectomy). The preferred choice of surgery includes the following-

Laparoscopic removal- In most of the cases, the doctor adopts this minimally invasive approach to remove gallstones. First, he makes a small incision in the abdomen. He will then insert a tube-like instrument with an attached camera into the gallbladder to have a clear sight of the gallstones, and surgically remove them from the gallbladder.
Open surgery- This is performed under general anesthesia. During this procedure, a single, long incision of roughly 3-6 inches is made on the upper side of your right abdomen. The tissues and muscles are pulled back to divulge the gallbladder. The gallstones are then removed, and the incision stitched up. Open surgery is performed when laparoscopic surgery is not suitable for the patient.
Gallstones cannot be managed with just diet and medications. A surgery is usually needed to remove the stones and cure the patient. For Laparoscopic surgery, the rate of success is nearly over 95%. Identify the symptoms before it aggravates, and consult a doctor for treatment.

Gall Stones - Is Surgery The Only Treatment?

Gallstone removal surgery is mainly of two types i.e. keyhole surgery and open surgery. In the case of the former, the patient is not required to stay in the hospital after the surgery, but in the case of the latter, the patient cannot be immediately discharged. Even though after the surgery the amount of bile that is necessary is made by the liver, still patients sometimes feel difficulty in digesting foods with fatty acids. But there are some steps which you can undertake that will give you relief from the complications that arise after the surgery.

A proper diet: A proper diet is very necessary for the fast recovery of your gall bladder. So, introduce different food groups gradually. To start with you can have liquid foods like broth or gelatin and then progress to solid foods. You should avoid fatty foods and fried foods as much as you can. Maintain a low-fat diet. Hence, the food items which you must discard from your list includes pizzas, creamy soups, burgers, chocolate, spicy foods, meat gravies and oily foods. And probably after a month, you can start eating the high fiber foods like nuts, legumes, whole-grain bread, broccoli, cabbage and others which would help prevent constipation.
Do some mild exercise: Exercise is essential in improving body condition in any circumstance, and gallstone removal surgery is no exception. Heavy exercise that will place stress on your wounds is not recommended. You can go for a walk or indulge in such mild workouts. Any physical activity that causes discomfort should be stopped immediately.
Increase your fluid intake: Don t let your body be dehydrated. Drink water from time to time. Dehydration will slow down the recovery process and also result in fatigue. Drink fruit juices too as they will not help in restoring the nutrients in your body but also prevent dehydration.
Take care of your incision area: Taking care of the cuts is very important otherwise they might get infected. So take care of your incisions and change the bandage regularly. Wash the area carefully, and you can apply any antiseptic too but only with the advice of the doctor. You must avoid swimming pool or warm water or bathtub till the incision is completely healed.
Take pain medications if it becomes unbearable: If you experience too much after the surgery, then you can ask your doctor to prescribe some pain medications that will help you with the pain. However, don t panic as the pain is completely normal in the initial days and you may even feel pain in other portions of the body like your shoulders as well.
With these points in mind, you will be able to recover very fast and resume your normal day-to day activities in no time.

Gallstone Removal Surgery - Get Relief In A Fast And Easy Way!

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