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Colostomy

Procedure Part II - Colostomy

The proximal end of the healthy colon is brought out to the skin
of the abdominal wall, where it is sutured in place. An adhesive
drainage bag (stoma appliance) is placed around the opening.
The abdominal incision is then closed.

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 Colostomy

Procedure Part I - Colostomy

A colostomy creates an opening on the abdomen (stoma) for

the drainage of stool (feces) from the large intestine (colon).
Colostomies are usually performed after resection of the
diseased colon. Colostomies may be temporary or they may
be permanent. The procedure is performed while you are deep
asleep and pain-free (under general anesthesia). An incision is
made in the abdomen and the diseased colon is removed
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Colostomy

Indications- Colostomy

A colostomy is performed when the lower large intestine,

rectum, or anus is unable to function normally, or needs rest
from normal functions. Intestinal obstruction with associated
inflammation, as in diverticulitis, is a common indication for
colostomy
More than 90% of colostomy cases are successful. There is
considerable pain after surgery as the anus tightens and
relaxes, but medications are available to relieve this. To avoid
straining, stool softeners are used. Avoid any straining during
bowel movement or urination. Soaking in a warm bath also
 brings additional comfort. Depending on the disease process
being treated, colostomies can be "taken down," and the colon
is reconnected in a second operation within weeks to months
after the first operation

Gallstones
Definition

Gallstones are formed within the gallbladder, an organ that stores bile excreted
from the liver. Bile is a solution of water, salts, lecithin, cholesterol, and other
substances. If the concentration of these components changes, they may
precipitate from solution and form gallstones.

Alternative Names

Cholelithiasis

Causes, incidence, and risk factors

Gallstones often have no symptoms and are usually discovered incidentally by a

routine x-ray, surgery, or autopsy.

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Definition
Gallstones are formed within the gallbladder, an organ that stores bile excreted
from the liver. Bile is a solution of water, salts, lecithin, cholesterol, and other
substances. If the concentration of these components changes, they may
precipitate from solution and form gallstones.

Gallstones may be as small as a grain of sand, or they may become as large as

an inch in diameter, depending on how much time has elapsed from their initial
formation.

Alternative Names
Signs and tests
There are numerous tests to detect the presence of gallstones or gallbladder
inflammation:

• Abdominal ultrasound
• Abdominal CT scan
• Abdominal x-ray
• Oral cholecystogram
• Gall bladder radionuclide scan
 • ERCP (endoscopic retrograde cholangiopancreatography

Treatment
Modern advances in surgery have revolutionized the treatment of gallstones. In
general, surgery is used only if you have symptoms.

In the past, open cholecystectomy (gallbladder removal) was the usual procedure
for uncomplicated cases. This operation required a medium to large incision just
below the right lower rib in order to access the gallbladder. After this operation, a
patient typically spent 3-5 days in the hospital recovering.

However, a minimally-invasive technique called laparoscopic cholecystectomy

was introduced in the 1980s which uses small incisions and camera guidance to
remove the gallbladder.

Currently, laparoscopic cholecystectomy is the gold

standard for treating gallstones that cause
symptoms and is one of the most common
operations performed in hospitals today.

ERCP (Endoscopic Retrograde

Cholangiopancreatography)
Endoscopic retrograde cholangiopancreatography (en-
doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-
PANG-kree-uh-TAH-gruh-fee) (ERCP) enables the
physician to diagnose problems in the liver, gallbladder,
bile ducts, and pancreas. The liver is a large organ that,
among other things, makes a liquid called bile that helps
with digestion. The gallbladder is a small, pear-shaped
organ that stores bile until it is needed for digestion. The
bile ducts are tubes that carry bile from the liver to the
gallbladder and small intestine. These ducts are
sometimes called the biliary tree. The pancreas is a large
gland that produces chemicals that help with digestion
and hormones such as insulin.
The digestive system
ERCP is used primarily to diagnose and treat conditions of the bile ducts, including
gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer.
ERCP combines the use of x rays and an endoscope, which is a long, flexible, lighted
tube. Through the endoscope, the physician can see the inside of the stomach and
duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be
seen on x rays.
For the procedure, you will lie on your left side on an examining table in an x-ray room.
You will be given medication to help numb the back of your throat and a sedative to help
you relax during the exam. You will swallow the endoscope, and the physician will then
guide the scope through your esophagus, stomach, and duodenum until it reaches the spot
where the ducts of the biliary tree and pancreas open into the duodenum. At this time,
you will be turned to lie flat on your stomach, and the physician will pass a small plastic
tube through the scope. Through the tube, the physician will inject a dye into the ducts to
make them show up clearly on x rays. X rays are taken as soon as the dye is injected.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert
instruments into the scope to remove or relieve the obstruction. Also, tissue samples
(biopsy) can be taken for further testing.

Possible complications of ERCP include pancreatitis (inflammation of the pancreas),

infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such
problems are uncommon. You may have tenderness or a lump where the sedative was
injected, but that should go away in a few days.

ERCP takes 30 minutes to 2 hours. You may have some discomfort when the physician
blows air into the duodenum and injects the dye into the ducts. However, the pain
medicine and sedative should keep you from feeling too much discomfort. After the
procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears
off. The physician will make sure you do not have signs of complications before you
leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you
may need to stay in the hospital overnight.

Preparation

Your stomach and duodenum must be empty for the procedure to be accurate and safe.
You will not be able to eat or drink anything after
midnight the night before the procedure, or for 6 to 8
hours beforehand, depending on the time of your
procedure. Also, the physician will need to know
whether you have any allergies, especially to iodine,
which is in the dye. You must also arrange for someone
to take you home—you will not be allowed to drive
because of the sedatives. The physician may give you
other special instructions

ERCP (Endoscopic Retrograde

Cholangiopancreatography)
Endoscopic retrograde cholangiopancreatography (en-
doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-
PANG-kree-uh-TAH-gruh-fee) (ERCP) enables the
physician to diagnose problems in the liver, gallbladder,

The digestive system

bile ducts, and pancreas. The liver is a large organ that, among other things, makes a
liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ
that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile
from the liver to the gallbladder and small intestine. These ducts are sometimes called the
biliary tree. The pancreas is a large gland that produces chemicals that help with
digestion and hormones such as insulin.

ERCP is used primarily to diagnose and treat conditions of the bile ducts, including
gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer.
ERCP combines the use of x rays and an endoscope, which is a long, flexible, lighted
tube. Through the endoscope, the physician can see the inside of the stomach and
duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be
seen on x rays.

For the procedure, you will lie on your left side on an examining table in an x-ray room.
You will be given medication to help numb the back of your throat and a sedative to help
you relax during the exam. You will swallow the endoscope, and the physician will then
guide the scope through your esophagus, stomach, and duodenum until it reaches the spot
where the ducts of the biliary tree and pancreas open into the duodenum. At this time,
you will be turned to lie flat on your stomach, and the physician will pass a small plastic
tube through the scope. Through the tube, the physician will inject a dye into the ducts to
make them show up clearly on x rays. X rays are taken as soon as the dye is injected.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert
instruments into the scope to remove or relieve the obstruction. Also, tissue samples
(biopsy) can be taken for further testing.

Possible complications of ERCP include pancreatitis (inflammation of the pancreas),

infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such
problems are uncommon. You may have tenderness or a lump where the sedative was
injected, but that should go away in a few days.

ERCP takes 30 minutes to 2 hours. You may have some discomfort when the physician
blows air into the duodenum and injects the dye into the ducts. However, the pain
medicine and sedative should keep you from feeling too much discomfort. After the
procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears
off. The physician will make sure you do not have signs of complications before you
leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you
may need to stay in the hospital overnight.

Preparation

Your stomach and duodenum must be empty for the procedure to be accurate and safe.
You will not be able to eat or drink anything after midnight the night before the
procedure, or for 6 to 8 hours beforehand, depending on the time of your procedure. Also,
the physician will need to know whether you have any allergies, especially to iodine,
which is in the dye. You must also arrange for someone to take you home—you will not
be allowed to drive because of the sedatives. The physician may give you other special
instructions

LAPAROSCOPIC CHOLECYSTECTOMY

Dr. Steven Bolton is presenting a case of laparoscopic

cholecystectomy.

This is a case of a 42 year old male with a previous history of

abdominal pain for 6 months. He was admitted to the
hospital with nausea but vomiting or fever. An
ultrasound study showed gallstones with some thickening
of the gallbladder wall. The diagnosis of cholecystitis was
made and the patient was scheduled to undergo a
laparoscopic cholecystectomy. This picture shows the
omentum partially covering the gallbladder in its normal
position.
Hook electrocautery is used to dissect the gallbladder off
the liver bed

This picture shows the body of the

gallbladder, that becomes distended during
removal. Caution must be used to avoid
rupture while pulling
 This picture shows the body of the gallbladder, that
becomes distended during removal. Caution must be
used to avoid rupture while pulling
Laparoscopic Cholecystectomy
The gallbladder is a pear-shaped organ that sits beneath the liver in the right-upper
abdomen. It's function is to store bile. It is attached to the bile ducts that come from the
liver. These ducts carry bile from the liver to the gallbladder and intestine where the bile
helps digest food. The gallbladder is not necessary to maintain good health.

Gallstones
. They are a very common medical problem. When they cause pain or other problems,
treatment is usually needed. The removal of the gallbladder is one of the most common
types of surgery done in this country. In the past, open abdominal surgery was the
standard treatment. This procedure required a 3 to 7 day stay in the hospital and a 3 to 7
inch incision and scar on the abdomen.

Laparoscopy
Most females have heard of laparoscopy, also known as "bellybutton" or "Band-Aid"
surgery. Gynecologists have long used this technique to tie the Fallopian tubes and to
inspect the female reproductive organs. Now the use of laparoscopy has been expanded to
include removing a diseased gallbladder. With new video technology, the laparoscope
has become a miniature television camera. Powerful magnification is now possible,
showing the intestinal organs in great detail.

Laparoscopic Cholecystectomy
A cholecystectomy is the surgical removal of the gallbladder. Using advanced
laparoscopic technology, it is now possible to remove the gallbladder through a tiny
incision at the navel. The technique is performed as follows. The patient receives general
anesthesia. Then a small incision is made at the navel (point A) and a thin tube carrying
the video camera is inserted. The surgeon inflates the abdomen with carbon dioxide, a
harmless gas, for easier viewing and to provide room for the surgery to be performed.
Next, two needle-like instruments are inserted (points B). These instruments serve as tiny
hands within the abdomen. They can pick up the gallbladder, move intestines around, and
generally assist the surgeon. Finally, several different instruments are inserted (point C)
to clip the gallbladder artery and bile duct, and to safely dissect and remove the
gallbladder and stones. When the gallbladder is freed, it is then teased out of the tiny
navel incision. The entire procedure normally takes 30 to 60 minutes. The three puncture
wounds require no stitches and may leave very slight blemishes. The navel incision is
barely visible.

What Are the Benefits?

The main benefit of this procedure is the ease of recovery for the patient. There is no
incision pain as occurs with standard abdominal surgery. The patient is up and about the
same day. In fact, up to 90% of patients go home the same day. The remainder are
usually discharged the next day. And within several days, normal activities can be
resumed. So the recovery time is much quicker. Also, there is no scar on the abdomen.

What Are the Complications?

While the procedure seems very easy for the patient, it is still abdominal surgery. And,
even though infrequent, it still carries the same risks as general surgery. Current medical
reports indicate that the low complication rate is about the same for this procedure as for
standard gallbladder surgery. These complications may include:

• In about 5 to 10% of cases, the gallbladder cannot be safely removed by

laparoscopy. Standard open abdominal surgery is then immediately performed.
• Nausea and vomiting may occur after the surgery.
• Injury to the bile ducts, blood vessels, or intestine can occur, requiring corrective
surgery.
• Quite uncommonly, a diagnostic error or oversight may occur.
Indications
Gallbladder surgery is done to treat gallbladder disease, which consists predominantly of
the formation of gallstones in the gallbladder (cholelithiasis) which can cause:

In each case, removal of the gallbladder (cholecystectomy) is indicated.