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Laparoscopic Surgery

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What is laparoscopy?

Laparoscopy means looking inside the abdomen. This is done with the help of a telescopic camera placed through a small cut made on the abdomen. Any surgery which is performed with this technique using the camera and small incisions without opening up the abdomen is known as laparoscopic surgery.

Many minor as well major surgical procedures of the abdomen can be performed using laparoscopy. The common laparoscopic procedures include-

  1. Laparoscopic cholecystectomy
  2. Laparoscopic hernia repair
  3. Laparoscopic appendicectomy
  4. Laparoscopic hysterectomy
  5. Laparoscopic Fundoplication
  6. Laparoscopic bariatric surgery

Laparoscopic surgery is useful for the following conditions

  1. Elective surgery like stone surgery, hernia, piles, etc
  2. Emergency conditions like peritonitis, ruptured ectopic pregnancy
  3. Trauma including blunt and penetrating trauma of abdomen
  4. Treatment of obesity – Bariatric surgery
  5. Diagnosis, staging and treatment of abdominal cancer
  6. Diagnosis of chronic abdominal/pelvic pain
  7. Evaluation of the infertile woman

Laparoscopic surgery is done using long instruments placed through small cuts made at different sites of the patient’s abdomen. The operative area is visualised using a high definition camera system which provides a clear image under high magnification. A number of gadgets are available which make the surgery fast and bloodless.

The advantages of laparoscopic surgery over conventional surgery are the following-

  1. Less blood loss
  2. Less pain
  3. Shorter hospital stay
  4. Faster recovery
  5. Less chances of infection
  6. More precise surgery

Laparoscopic surgeries are performed in a modern operation theatre of a hospital which is equipped with all the gadgets required to perform this surgery. A good laparoscopic surgeon should have sufficient training as well as experience in performing the procedures with expertise.

Laparoscopic surgeries require specialised setup and Equipments which can make these surgeries a little costly as compared to conventional procedures. However, the shorter hospital stay and earlier return to work make them more cost effective overall. The cost of laparoscopic surgery in Delhi is quite varied depending upon the hospital setup and the treating doctor and may range from Rs 30000 to Rs 100000

Gall bladder surgery

The gallbladder is a small pear shaped organ which is present in the abdomen just underneath the liver. The function of gall bladder is storage of bile juice produced by the liver. The liver produces bile juice continuously which flows into the gallbladder where it is stored and concentrated by absorption of water.  This concentrated bile juice is released by the gallbladder into the intestine upon ingestion of food and this helps in the digestion process.

The gallbladder often becomes the site of stone formation which can cause problems in the body and may require surgical removal of the organ.

Gallbladder stones are of two types- Cholesterol stones and pigment stones. Cholesterol stones are usually formed in obese individuals because of consumption of high fat, cholesterol rich diet. They are more common in females and can occur especially during pregnancy because of hormonal changes which leads to concentration of bile and supersaturation with cholesterol. They may also occur because of rapid weight loss, prolonged fasting and use of birth control pills. Gallstones have a familial tendency and are more common in certain ethnic groups.

Pigment stones are formed as a result of infection in the gallbladder bile. They occur in both males and females equally and also can occur as a result of some blood diseases causing increased breakdown of haemoglobin and hence increased production of bile pigments.

Gallbladder stones may be asymptomatic or give rise to severe symptoms depending upon the stage of the disease. The stones cause disturbance and obstruction in the flow of bile to the intestines which lead to gas bloat and indigestion. In case the stones get stuck in the neck of the gallbladder or block the opening completely, there will swelling of the gallbladder giving rise to severe pain. The pain usually occurs in the right side of the upper abdomen and starts 2-3 hours after taking a fatty meal. Sometimes pain can be present in the centre just below the chest and can go to the back and the right shoulder as well. There may be associated vomiting and fever. If the stone slips back into the gallbladder, the pain gets relieved. In case the stone goes into the bile duct, then there may be jaundice or pancreatitis.

Gallbladder stones can get stuck in the opening of the gallbladder giving rise to infection and swelling of the gallbladder known as acute cholecystitis. This condition is characterised by continuous severe pain, vomiting and occasionally fever. The pain often doesn’t respond to medicines and may require admission to the hospital. The stone may get dislodged from the gallbladder opening back into the gallbladder spontaneously leading to relief of pain and swelling. However, if the blockage persists, there may be absorption of all the bile present in the gallbladder and it may become filled with mucous which is known as mucocoele. If this becomes infected, it gives rise to formation of pus in the gallbladder known as empyaema of gallbladder. In rare severe cases, the pressure in the gallbladder may build up to cause a hole in the gallbladder wall which is known as perforation of the gallbladder.

In some cases, the stones may slip from the gallbladder into the common bile duct leading to blockage of flow of bile from the liver which causes jaundice. In some cases, the stones get stuck in the common channel of the bile and pancreatic duct giving rise to swelling of the pancreas known as pancreatitis.

In long standing cases, the irritation caused by the stone may lead to formation of cancer of the gallbladder which is a disease with high mortality and poor prognosis.

The treatment of gallbladder stones is through surgical removal of the gallbladder. This procedure can be done by open surgery, or more commonly now, by laparoscopy.

The surgery for just removal of stones leaving the gallbladder behind will not be successful as stones have a tendency to form repeatedly in a diseased gallbladder. Thus, surgical removal of the gallbladder is necessary for complete cure.

During gallbladder surgery, the cystic duct which takes bile to and from the gallbladder is dissected and clipped and the gallbladder is removed. After this surgery, there is a continuous flow of bile from the liver via the common bile duct into the intestine. Hence, the bile is always available for digestion and only its periodic release is replaced by a continuous flow. There is thus no problem in digestion of food even after the surgery.

Patients typically require only 1-2 days stay in the hospital for a gallbladder surgery. After discharge, they can resume their normal activities and diet within a week’s time and sometimes even earlier.

Patients are advised to take a light, soft diet for a few days after gallbladder surgery. They are instructed to take small frequent meals and also to avoid oily and spicy foods.

The cost of gallbladder surgery in Delhi may vary from Rs 40000 to Rs 75000 and may be higher in certain setups.



The appendix is a small, blind ending, tubular organ which is attached to the first part of the large intestine. It is a vestigial organ in human beings which means that it has no function but often becomes the site of disease.

The infection of appendix causing its swelling inside the body is known as appendicitis. Appendicits may occur as a result of faecal matter getting impacted at the base of the appendix or it may occur as a result of parasitic infections or tumours of the appendix.

The most common symptom of appendicitis is abdominal pain. This pain usually starts in the central part of the abdomen near the navel and then may shift to the right lower abdomen as it progresses. The pain may be associated with nausea, vomiting and anorexia. If the infection becomes severe, there may be associated fever.

Appendicitis is detected by a combination of clinical history, examination and tests. A blood test showing increase in the number of white blood cells and an ultrasound of the abdomen showing a swollen appendix are usually confirmatory

The treatment of acute appendicitis is by surgical removal of the appendix. The appendix can be removed by open surgery, or more commonly, by laparoscopy.

Medicines can be used for treatment of very mild uncomplicated cases of appendicitis. Even in such cases, there is a chance that the symptoms might recur in the future. All established cases of appendicitis should be treated by surgical removal.

The most common and feared complication of appendicitis is bursting of the appendix known as perforation. Perforation of the appendix leads to spread of pus and infection throughout the abdominal cavity and can be life threatening. It requires immediate surgery with removal of the appendix along with thorough cleaning of the abdominal cavity. Other complications include abscess formation, mucocoele of appendix, pyelophlebitis and liver abscess.

The patient requires a hospital stay of 1-2 days after an uncomplicated appendix operation. The time to complete recovery is generally one week or sometimes even less.

Since the appendix is a vestigial organ which has no use in the body, its removal doesn’t cause any side effect in the body.

The patient is generally allowed to resume a clear liquid diet within 4-6 hours of an uncomplicated appendix surgery. The diet is then progressed to a soft and then a normal diet over the next few days.

The cost of laparoscopic appendix surgery in Delhi can range between 30000 INR to 70000 INR depending upon the institute, the treating doctor and the complexity of the case.


Laparoscopic fundoplication/Hiatal hernia repair

GERD stands for Gastro esophageal reflux disease. It is a medical condition in which acid in the stomach goes upward through a defective lower esophageal valve into the esophagus and causes injury to its lining.

The causes of GERD are –

  1. A defective/loose lower esophageal valve
  2. Overeating
  3. Obesity
  4. Certain foods like tea, coffee, ginger , garlic, alcohol and aerated drinks
  5. Hiatus hernia in which part of the stomach migrates into the chest through an abnormally large opening in the diaphragm

The symptoms of GERD are-

  1. Heartburn or chest pain
  2. Nausea and sour taste in mouth
  3. Bloating
  4. Palpitations
  5. Dry cough and wheezing

The symptoms are more severe after meals and while lying down and get relieved in the upright position.

GERD is detected by a combination of clinical history and certain tests. An upper GI endoscopy is essential to document the evidence of reflux associated injury to the esophageal lining and for diagnosis of hiatal hernia or a loose LES. Reflux may be detected or a barium swallow study or more accurately using a 24 PH manometry which objectively documents the reflux episodes.

The complications of GERD include-

  1. Esophageal ulcers
  2. Esophageal shortening or narrowing
  3. Barrett’s esophagus
  4. Chronic cough/Asthma

The treatment of GERD involves a combination of medication, diet and lifestyle modification and in severe cases, may require surgical intervention. In most cases, acid suppressing medicines along with changes in diet and weight reduction are successful to control the reflux. Patients are instructed to eat small frequent meals, separate liquids from solids and keep a gap of at least 2-3 hours between taking food and lying down.

Surgical treatment of GERD is recommended in the following conditions-

  1. Long standing severe reflux
  2. Dependence upon acid suppressive medicines
  3. Endoscopy documented large hiatal hernia or severe esophagitis
  4. Presence of Barrett’s esophagus

The surgical treatment of GERD is known as a fundoplication. It involves dissecting the area of the lower esophageal valve and tightening it by placing stitches. Then, the upper part of the stomach is wrapped partly or fully around the lower end of the esophagus to construct as new valve. This procedure can be done by an open surgery but more commonly by laparoscopy.

The surgery generally takes 1-2 hours to perform and patient is started on a liquid diet after 6-8 hours of the procedure. The recovery time is between 1-2 weeks and dietary restrictions are present for 4-6 weeks.

The person is started on a clear liquid diet within a few hours of surgery. This diet is continued for 8-10 days after which a pureed diet is allowed which is continued for the next 2 weeks. The patient can generally start a soft diet after 4 weeks and can resume normal eating after 6-8 weeks of surgery.

Laparoscopic fundoplication surgery in Delhi can cost between 80000 INR to 1.5 lac INR depending upon the institute, treating doctor and the complexity of the procedure.

Laparoscopic hernia repair

A hernia is an abnormal protrusion of fat or internal organ like intestine through a weakness or defect in the musculature of the abdominal wall.

The different types of hernia are-

  1. Groin or inguinal hernia
  2. Paraumblical hernia
  3. Epigastric hernia
  4. Lumbar hernia
  5. Incisional hernia
  6. Hiatal hernia

he causes of hernia are-

  1. Defect/ Abnormal opening present in the muscular tissues since birth
  2. Muscle weakness due to old age
  3. Increased abdominal pressure due to cough/constipation/difficulty in urination
  4. Sudden strain as in heavy lifting
  5. Smoking

The symptoms of hernia are a visible swelling found in the abdomen or groin which increases on straining and exertion and decreases or disappears on lying down. It may be associated with a dragging pain or heaviness. In cases of large hernias, there may be associated bladder/bowel complaints.

The natural history of hernia is that of progression which means that it increases in size and symptoms with time. As the hernia becomes larger, its contents become more voluminous and may become irreducible. This causes the swelling to remain constant and cannot be reduced on pressing. When the contents become obstructed, there may be vomiting and constipation. Sometimes, the blood supply to the contents of the hernia may get blocked which is known as strangulation and this causes severe pain in the hernia and it becomes tense and tender.

A hernia is diagnosed based on the clinical history and physical examination. The diagnosis is usually confirmatory on physical examination but ultrasound and CT scan help to document the hernia.

The treatment of hernia is through a surgical repair which can be open or laparoscopic. Nowadays, the laparoscopic mesh repair has become the gold standard for treatment of most types of hernia.

The current recommendation is that a person should get operated as soon as possible to avoid the complications of the disease from occurring.

The advantages of laparoscopic hernia repair over open surgery are-

  1. Smaller incision which means less pain and better cosmesis
  2. Less chances of infection
  3. Larger mesh can be placed which decreases recurrence
  4. Less trauma and blood loss which leads to faster recovery

The recovery time after laparoscopic hernia repair generally 1-2 weeks. The patient can be discharged from the hospital within 1-2 days and resumes a normal diet and activity within a few days.

Laparoscopic hernia surgery in Delhi can cost anywhere between 50000 INR to 1.5 Lacs INR depending upon the institute, the treating doctor and the complexity of the case.