New Procedure Has Gallbladder Patients Up And Running

Laser Technique Reduces Hospital Costs, Recovery Time

February 03, 1991|By Dolly Merritt | Dolly Merritt,Contributing Writer

Nancy Mitchell, a Glenelg Country School teacher, had her gallbladder removed in a new procedure last October and spent just one night atHoward County General Hospital.

"I could get up immediately and was walking around," the 54-year-old Ellicott City resident said, recalling the hours after her operation. Mitchell required little medication after surgery and returned to her first-grade classroom within two weeks.

She compared her operation with that of a woman who'd had emergency gallbladder surgery, done the traditional way, and was progressing "weeks behind" Mitchell. "I had so much less pain because of the very tiny scars; the other patient had about a 10-inch scar," Mitchell said.

Mitchell's rapid recovery was due largely to a new type of gallbladder surgery, known as laparoscopic cholecystectomy, which has revolutionized gall bladder surgery. It has been in use at Howard General less than a year.

This procedure is done in about 90 minut, using four incisions -- three in the upper abdomen and one above the navel -- that each are one-third of an inch long.

Afterward, patients' hospital stays are often one night, doctors at Howard General said. Some patients leave the same day. At-home recovery time has beencut to a few days.

In contrast, traditional gallbladder surgery requires a 3- to 6-inch incision. Patients stayed at Howard General about a week, then spent another six weeks recuperating.

This is how the laparoscopic procedure is done:

The patient's abdominal cavityis inflated with carbon dioxide gas to allow a laparoscope, a mini-telescope of sorts, with a tiny video camera on it to get a clear view. The instrument is inserted through the incision near the navel. Surgeons, watching the progress of the cholecystectomy on television monitors on each side of the operating table, manipulate the surgical instruments -- inserted through the three other openings -- to remove the gallbladder. Either laser beams or electrocautery are used to cut tissue and coagulate blood.

"The magnification of the laparoscope is 16-times greater; it's a better view than if you are actually looking into the area," said surgeon Keith Falcao, who led Howard General's first operating room team performing the procedure last May."With the camera looking at the rest of the abdomen, we can make sure there are no other problems, such as fibroids in the uterus or hernias," Falcao said.

He has performed the procedure on about 140 patients so far.

Common complaints of persons who have undergone conventional gall bladder surgery -- such as pain, infections, adhesions in the abdomen and hernias -- "are unheard of in laparoscopic surgery," Falcao said.

Laparoscopy is used for appendectomies, hernias, ulcers and gynecological surgeries at many hospitals in the country.

"I think the laparoscopy technique is a wave of the present and we are getting toward the peak of the wave. Within the next few years, it will be the only way to remove gall bladders, unless there are complications," Falcao said.

Surgeon Vaughan Belcher, a memberof the hospital's professional staff who has been performing cholecystectomies for three months, said he is tremendously pleased with thenew procedure.

The doctor said that charges for the operation area little more than for conventional gallbladder surgery, largely because of the instruments needed. Equipment, which includes a TV camera, two monitors, a laparoscope, special instrumentation for the procedure and a laser machine, cost between $150,000 and $200,000, said hospital spokesman Pam Karwan.

But overall patient costs can be drastically cut -- sometimes halved -- because of the shorter hospital stay, Karwan noted.

The newer procedure has won good reviews from those who've undergone it. Vincent Leoni, 47, had a cholecystectomy lastNovember, staying overnight at Howard General. He took only another three days away from his job at a mental health rehabilitation center, because the Thanksgiving holiday gave him a long weekend. The result: he returned to work one week after surgery.

During the first few days after surgery, the West Friendship man experienced what he called "some discomfort" and had some difficulty moving about. But sincethen, Leoni said, he is "extremely pleased."

Comparing himself toan acquaintance who had traditional gallbladder surgery, Leoni said,"He was in the hospital for a week and out of work for six to seven weeks -- and he still feels a lot of discomfort."

Kathy Kirkwood,44, of Columbia, was equally pleased with her results.

"I went inat 7 a.m., had surgery after 8 a.m., was back in my room by 11 a.m. -- and I was able to have lunch," said the media specialist at Dunloggin Middle School.

Five days after the operation, Kirkwood was driving a car. "The following Tuesday was Christmas and I had done everything I had to do," she said. Her sole complaint was some initial discomfort in the hospital.

The gallbladder stores bile, the greenishfluid secreted by the liver to aid in digestion.

Statistics compiled by the American Medical Association indicate that about 16 million Americans suffer from gallstones, obstructions made of calcium or cholesterol. Each year, about 800,000 new cases of gallbladder diseaseare diagnosed and about 500,000 gallbladders are removed.

Gallbladder disease symptoms vary. Some people have gallstones but no symptoms, others have pain that mimics a heart attack.

"You can have simple indigestion and gaseousness to attacks of severe pain if stones are caught in the gallbladder ducts," said Belcher.

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