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Laparoscopy by Best Laparoscopic Surgeon

Laparoscopic surgery is done by laparoscopic surgeon, Best laparoscopic surgeon or advance laparoscopic surgeon do even complex abdominal surgery Laparoscopically, Also known as minimally invasive surgery as the incision used by laparoscopic surgeon is less

Benefits: Less pain in the post-op period as incision is less, Analgesia need is very less; Patient mobility is enhanced, patient can take deep breath and can do lung exercise, Lung infection chance is less; As the patient mobility is increased chances of deep vein thrombosis also decreases because the most common risk factor for deep vein thrombosis is immobilization; Bowel movements come early in patients when Laparoscopic surgery is done, reason explained by best laparoscopic surgeon is that in this surgery as bowel are handed very less may be the reason for this early movements of bowel, this early movement allow early enteral feeding which increases nutrition and immunity helping in early and better wound recovery

Best Laparoscopic Surgeon near me
Best Laparoscopic Surgeon

Symptoms of CBD Stones

Common bile duct stones may be asymptomatic but when symptomatic the most common symptom is pain abdomen, Pain is usually located on right upper abdomen, when Common bile duct stone causes complete obstruction of CBD patient will have jaundice; The typical feature of obstructive jaundice is pale colored stool, itching due to deposition of bile salts; If obstructed bile gets infected patients may have fever; the triad of fever/jaudice/pain abdomen suggest cholangitis and require immediate intervention

Treatment of Common Bile Duct Stones

There are two types of stones in the common bile duct,one is primary common bile duct stone and other is secondary common bile duct stone; Primary common bile duct stone form primarily in the CBD (Common bile duct) only whereas when stone in the gallbladder slips into the common bile duct these are called as secondary common bile duct stones;
The primary treatment of Common bile duct stone is Endoscopic stone removel (ERCP stone removal), Chances of ERC stone removal is less if there are multiple and large stones; treatment of failed ERC is surgical removal of CBD stones; The surgical options are (A) CBD exploration and CBD stone removal with primary closure of CBD (B) CBD exploration and CBD stone removal with T-tube drainage (C) CBD exploration with CBD stone removal with Choledocho-duodenostomy (D) CBD exploration with CBD stone removal with Hepatico-jejunostomy

Asymptomatic Gallstones: Treat or Not to Treat ?

Asymptomatic gallstones mean patient is diagnosed to have gallstones but never have abdomen pain, Asymptomatic Gallstones disease is common, As Ultrasound abdomen is the investigation of choice in any abdomen complaint the incidence of aymptomatic gallstones has increased, Management of asymptomatic gallstones disease is controversial

Now the question arises should gallbladder be removed or not for asymptomatic gallstones; Gallbladder stone disease have various complications like jaundice/cholangitis/pancreatitis/Gallbladder Cancer; It is said that first presentation with these complications are rare, first patient will have pain of gallbladder stone and if not treated then the rate of these complications increases but there are few patients also who present directly with gallbladder stone complications and sometimes these complications are life threatening also, Laparoscopic cholecystectomy is a day care procedure, patient is discharged same day of surgery and from next day onward can do normal day to day activity, thats why some recommend to do Laparoscopic cholecystectomy in asymptomatic patients also

Consult GI Surgeon/ Gastrointestinal Surgeon/Gastroenterologist/Hepatologist/ Surgical Gastroenterologist/Laparoscopic Surgeon/ Gallbladder Specialist to know more about Asymptomatic Gallbladder stone/ Management of asymptomatic Gallbladder stone/ Treatment of Asymptomatic gallbladder stone disease/ Complications of Gallbladder stone

 

FNAC in Cancer Gallbladder

Incidence of Cancer Gallbladder is more in North India, Gallbladder stone disease is one of the risk factor ; Most of the patients are elderly but the incidence is increasing in young population also; Most common complain is right sided upper abdomen pain along with anorexia and weight loss, patient can have jaundice when mass in the neck causes compression over the hilum
The most common investigation in pain abdomen is ultrasound abdomen; The findings on ultrasound abdomen are focal thickening in gallbladder, mass in the gallbladder; whenever there is suspicious on ultrasound it should be followed by CECT abdomen which gives more information, PET scan is not done routinely but in high risk patients it can be done
The standard treatment in suspected Cancer Gallbladder is Surgery and intra-operative frozen section; Fine needle aspiration cytology is only done in advanced cancer for Neo-adjuvant therapy or metastatic Gallbladder Cancer if planned for palliative chemotherapy; in patients with jaundice pre-op biliary drainage is required if major liver resection is planned

Cancer Gallbladder

Management of Jaundice in Gallbladder Cancer

Gallbladder Neck mass causing compression at the hilum resulting in biliary tract obstruction is the most common cause of jaundice in Gallbladder Cancer patient
There can be two conditions in these patients
(A) Tumor is resectable, Surgery is the treatment of choice, but as these patients also require Liver resection and liver resection in jaundice patients can lead to liver failure, it is important to reduce the bilirubin before surgery, Endoscopic biliary drainage is preferred if possible otherwise percutaneous transhepatic biliary drainage is done (PTBD); Once the bilirubin level comes down after these procedures surgery is planned according to the tumor site, Most commonly these patients require extended right hepatectomy
(B) Tumor is unresectable, in case of locally advanced tumor or metastatic tumor patient require palliation for jaundice; Endoscopic biliary drainage if possible is done and metallic biliary stenting is done, advantage of metallic biliary stenting being less chances of blockage; if endoscopic biliary drainage is not possible then percutaneous transhepatic biliary drainage (PTBD) is done

Gallbladder Cancer Specialist

Gallbladder Cancer Specialist team include Gallbladder Oncologist & Gallbladder Cancer surgeon, This team act as a unit to deal with Gallbladder Cancer, Gallbladder Cancer if resectable then surgery is done by Oncosurgeon and if not then Chemotherapy is given by Medical Oncologist, Incidence has increased in young population also

Gallbladder Cancer disease is common in North India, High incidence is seen in female sex, Most cases are diagnosed in advanced stage when the tumor is unresectable, CECT abdomen is done to stage the tumor, FNAC is not done if there is doubt for cancer as it may risk the seedling of cancer cells in the needle tract,  Gallbladder is situated on the inferior aspect of right lobe of liver adhered to it so it is removed along with the part of liver to which it is adhered and standard lyphadenectomy is done, this whole procedure is called as radical cholecystectomy; cystic duct margin is sent for frozen section intra-operatively and if it comes to be positive then common bile duct is also excised and then Roux-en-Y Hepatico-jejunostomy is performed, Extended right hepatectomy is done if tumor is located at the neck and involve right sided portal structures
Staging Laparoscopy is the first step ; Staging laparoscopy is done to look for metastatic deposits missed on CT scan; If metastatic deposits are seen on staging laparoscopy then biopsy is taken from the deposits and sent for frozen section and if these comes to be positive then surgical procedure is abandonedGallbladder cancer specialist

Jaundice in Gallbladder Cancer

Jaundice caused by gallbladder cancer is obstructive jaundice; The most common cause of jaundice in Gallbladder Cancer is mass at GB Neck causing compression over the hilum resulting in biliary tract obstruction; Patient have features of Surgically obstructive jaundice such as dark urine/ pale stool/itching; Other causes of jaundice in Cancer Gallbladder are tumor emboli which pass through the cystic duct into the common bile duct and causes luminal obstruction; compression of the biliary channel by the enlarged lymph nodes; associated Common Bile Duct stones
Consult GI Surgeon/Oncosurgeon to know more on Gallbladder Cancer and Jaundice/ Management of Gallbladder Cancer with Jaundice/ Causes of Gallbladder Cancer and Jaundice/ Treatment of Jaundice in Gallbladder Cancer patient/ Treatment of Jaundice caused by Gallbladder Cancer

Esophagus Cancer Clinical Features

Esophagus is food pipe that connects from mouth to stomach or in other words it carries food from the mouth to the stomach; Esophagus cancer incidence is increasing; the length of esophagus is divided into three parts upper third, middle third and lower third esophagus; cause of lower third esophagus cancer is obesity and gastro-esophageal reflux disease and histologically it is adenocarcinoma; cause of middle and upper third cancer is smoking and alcohol and histologically it is squamous cell carcinoma
Cancer causes obstruction to the passage of food bolus thats why the most common symptom these patients complain is dysphagia that is difficulty in swallowing food; these patients adapt there food intake, when they have dysphagia to solid food they start eating soft diet and when narrowing does not allow soft diet they start taking liquid diet the most common presentation of esophagus cancer
Esophagus cancer

What is Biliary Pancreatitis Management

The most common cause of acute pancreatits are alcohol intake and gallbladder stone; When acute pancreatitis is caused by biliary stones it is called as biliary pancreatitis; Biliary pancreatitis management involve team work of critical care doctor, Gastrophysician, Gastrointestinal surgeon & Radiologist, Patients present with features of acute pancreatitis like severe acute abdomen pain radiating to back; Investigations show increased serum amylase and Lipase level with deranged Liver function tests (LFT)
The main stay of biliary pancreatitis management is supportive; MRI/MRCP abdomen is done to know the status of Common bile duct; Mostly stone has passed through the Common bile duct into the duodenum; If the MRI/MRCP show stone in the common bile duct then patient require ERCP and CBD stone clearance; The need for ERCP is urgent if the patient condition is not stable and is in cholangitis/septic shock otherwise ERCP is done on elective basis once pancreatitis settle
In mild biliary pancreatitis managementwith no associated fluid collection gallbladder is removed during same hospitalization because gallstone is the cause and the gallbladder is the source; if not removed patient may again develop pancreatitis; In moderate biliary pancreatitis management and severe pancreatitis cholecystectomy is advised after 4 weeks as if some comlications of pancreatitis require intervention that can also be done at same time
Consult GI Surgeon/ Gastrointestinal Surgeon/Gastroenterologist/Hepatologist/ Surgical Gastroenterologist/Laparoscopic Surgeon/Pancreas Specialist to know more about Biliary pancreatitis/ Management of biliary pancreatitis/ Clinical features of biliary pancreatitis/ Treatment of biliary pancreatitis/ Diagnosis of biliary pancreatitis

Biliary pancreatitis management