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Gastroenterology (Expert Forum)
GALL BLADDER LAPORASCOPIC SURGERY WITH ILEOSTOMY
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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GALL BLADDER LAPORASCOPIC SURGERY WITH ILEOSTOMY
by GWALKEN, Mar 06, 2004 12:00AM
I WAS DIAGNOSED WITH GALLSTONES ABOUT TWO YEARS AGO. I AVE AN 18 YEAR OLD ILEOSTOMY (COLON AND RECTUM WERE REMOVED). THE OSTOMY WORKS WELL.
I WANT TO HAVE THE GALLSTONES REMOVED LAPRASCOPICALLY (SP?. HOW MUCH DANGER IS THERE OF THE CARBON DIOXIDE TEARING THE SMALL INTESTINE LOOSE FROM THE STOMACH MUSCLES AT THE STOMA? HOW MUCH RISK IS THERE THE SURGEON WILL NOT BE ABLE TO SEE WELL ENOUGH TO REMOVE THE GALL BLADDER WITHOUT GOING TO MAJOR SURGERY?
I HAVEN'T HAD ANY GALL BLADDER ATTACKS AND SO DON'T WANT TO HAVE MAJOR SURGERY TO REMOVE THE GALL BLADDER WITH CHANCE OF MORE ADHESIONS. HOWEVER, IF IT CAN BE REMOVED LAPRASCOPICALLY THEN I THINK IT'S WORTH IT.
I AM 60 YEARS OLD AND IN EXCELLENT HEALTH AND TAKE NO MEDICATIONS. I HAVE BEEN UNABLE TO FIND ANY HELP ON GOOGLE SO AM USING THIS FORUM.
THANK YOU.
I WANT TO HAVE THE GALLSTONES REMOVED LAPRASCOPICALLY (SP?. HOW MUCH DANGER IS THERE OF THE CARBON DIOXIDE TEARING THE SMALL INTESTINE LOOSE FROM THE STOMACH MUSCLES AT THE STOMA? HOW MUCH RISK IS THERE THE SURGEON WILL NOT BE ABLE TO SEE WELL ENOUGH TO REMOVE THE GALL BLADDER WITHOUT GOING TO MAJOR SURGERY?
I HAVEN'T HAD ANY GALL BLADDER ATTACKS AND SO DON'T WANT TO HAVE MAJOR SURGERY TO REMOVE THE GALL BLADDER WITH CHANCE OF MORE ADHESIONS. HOWEVER, IF IT CAN BE REMOVED LAPRASCOPICALLY THEN I THINK IT'S WORTH IT.
I AM 60 YEARS OLD AND IN EXCELLENT HEALTH AND TAKE NO MEDICATIONS. I HAVE BEEN UNABLE TO FIND ANY HELP ON GOOGLE SO AM USING THIS FORUM.
THANK YOU.
Doctor's Answer
by Kevin Pho, MD, Mar 08, 2004 12:00AM
, Mar 08, 2004 12:00AM
As I am not a surgeon, I do not have the experience nor information necessary to answer this question. Our surgical colleague has graciously offered his thoughts in the comments below, and I would agree with his opinion.
His comments are reprinted here:
"The main issue surgically is whether adhesions exist from previous surgery that would prevent doing the procedure laparascopically. The only risk to the stoma would be from direct injury, not from the carbon dioxide/abdominal pressure. There's really no way to know about adhesions without doing the procedure: with prior surgery, the techniques for getting into the abdomen to place the scope, and infuse the carbon dioxide are different; but not until you try can you find out if it's possible. I'm sure any surgeon you saw would tell you the chances of having to convert to open surgery are significantly greater in your situation; and you'd have to be prepared and willing. Moreover, I'd say that the main reason to remove gallstones is to relieve symptoms; I wouldn't have the operation just because you perceive laparoscopy to be less "invasive." You still need to have general anesthesia, you still face the possibility of open surgery, you still could have surgical complications (bile duct injury, while quite rare, occurs more often with laparoscopy than open surgery), and you still face the slight possibilty of side effects from gallbladder removal (diarrhea being the most common.) So in my opinion, the decision to have surgery has not to do with the method, but with the pros and cons of not having a gallbladder with stones in it -- the risk/benefit of removing the gallbladder to prevent problems rather than to solve them, in the case of someone with stones but no symptoms."
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
His comments are reprinted here:
"The main issue surgically is whether adhesions exist from previous surgery that would prevent doing the procedure laparascopically. The only risk to the stoma would be from direct injury, not from the carbon dioxide/abdominal pressure. There's really no way to know about adhesions without doing the procedure: with prior surgery, the techniques for getting into the abdomen to place the scope, and infuse the carbon dioxide are different; but not until you try can you find out if it's possible. I'm sure any surgeon you saw would tell you the chances of having to convert to open surgery are significantly greater in your situation; and you'd have to be prepared and willing. Moreover, I'd say that the main reason to remove gallstones is to relieve symptoms; I wouldn't have the operation just because you perceive laparoscopy to be less "invasive." You still need to have general anesthesia, you still face the possibility of open surgery, you still could have surgical complications (bile duct injury, while quite rare, occurs more often with laparoscopy than open surgery), and you still face the slight possibilty of side effects from gallbladder removal (diarrhea being the most common.) So in my opinion, the decision to have surgery has not to do with the method, but with the pros and cons of not having a gallbladder with stones in it -- the risk/benefit of removing the gallbladder to prevent problems rather than to solve them, in the case of someone with stones but no symptoms."
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
the first 2 surgeons I saw said no right off the bat. I have extensive adhesions and they didn't want to chance it. the third was willing to try, but I got the distinct feeling he already had his mind set that he'd convert to an open. the fourth one is the one I went with, she is the chief of minimally invasive surgery at a teaching hospital. she was willing to try and spent quite a bit of time with me explaining some of the benchmarks she would use to determine if she would convert to an open procedure. I felt very comfortable with her and had confidence that she would push to complete it laparoscopically as far as she could without creating problems. it took quite a bit of time because my liver was encased in adhesions, but she prevailed and I had a smooth, quick recovery. the incisions for me were above the navel (at the top of my vertical incision from the previous abdominal surgeries) one above that near my breastbone, one right at the edge of my ribcage below my right breast and one directly below that at my waistline. they form a square.
good luck, I hope you are able to find a surgeon you are comfortable with