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Gastroplasty
   
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Laparoscopy
   
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Laparoscopic Cholecystectomy
   
   
   
   
   
   
   
   
   
   
   
   
   
   
 
   
 

In case of excess weight and after the failure of traditional diets and treatments, gastroplasty can become necessary.

   
 

Gastroplasty consists in surrounding your stomach with an adjustable gastric banding so as to decrease its volume. The size of your stomach can be adjusted and controlled thanks to this band.

   
 

This surgical intervention done in visceral surgery in La Parisière private hospital offers the possibility of being reversible, which is one of its many advantages.

   
 
   
   
   
   
 
 

Laparoscopy, which represents a huge progress in visceral surgery, has developed after the first cholecystectomy (removal of the gallbladder) in 1987, in Lyon.

What is it?

This surgical technique uses inert carbon dioxide introduced into the peritoneal cavity in order to explore it with an optical instrument and an appropriate video camera.
At first, interventions were performed with direct eye control but the evolution of technology has allowed us to use video cameras adapted to surgery.

How is it used?

The peritoneal cavity is normally “virtual”. Therefore, surgeons artificially widen this space by injecting gas in order to establish a pneumoperitoneum. Surgeons can then introduce surgical instruments into the body to perform the intervention required. The number of incisions (scars) as well as their size depends on the type of intervention.

This is done in several steps:

  • Gas is injected into the peritoneal cavity either with an appropriate needle carefully inserted, or with a direct small incision into the peritoneal cavity.
  • Optical instrument enables internal exploration.
  • Trocars are used to enable surgeons to introduce their surgical instruments so as to perform the required intervention.
  • Trocars and instruments are finally withdrawn at the end of the intervention and the incisions are stitched up.

What are the advantages?

This minimally invasive surgery offers many advantages:

  • It reduces the size of surgical incisions and therefore minimizes the risk of postoperative rupture.
  • It decreases postoperative pain.
  • It allows patients to resume eating more rapidly.

 

Patients awaken earlier and rapidly recover autonomy, which reduces the postoperative risks of complications due to prolonged stay in bed.

This technique also offers surgeons good-quality exploration and surgical vision which rival with or at least are equivalent to standard surgery.

What are the risks and drawbacks?

Both are associated but not necessarily specific to laparoscopic surgery. For example:

  • The type of intervention can have an influence.
  • The conditions during the intervention can also be significant. Indeed infections, perforations or occlusions can occur during the intervention and alter the standard course of operations, be it in open surgery or laparoscopic surgery. We may therefore have to switch from laparoscopic surgery to standard open surgery (“conversion”). For instance, a trained surgeon performs more than 95% of laparoscopic cholecystectomies (removal of the gallbladder) but this percentage falls down to about 80% in case of inflammations such as cholecystitis.

It also presents risks that are specific to minimally invasive surgery:

  • Wounds, perforations and haemorrhages are possible, particularly when introducing trocars and needles, as they can damage intra-abdominal organs, but also during the intervention as the visual field is more limited. This is quite rare but it can happen. In that case, suture must immediately follow and may require “conversion”.
  • The establishment of a pneumoperitoneum with gas injection into the abdomen alters the body regulation mechanisms, which can cause disorders. Some patients will therefore not apply for this surgery. Sometimes, carbon dioxide may also cause pain in shoulders during the 2 days following the intervention.

 

Laparoscopy does not apply to all types of surgery. However, it has become a reference in some interventions such as gallbladder removal or other gynaecologic interventions. Its use has become more and more widespread and now concerns diseases such as inguinal hernia, gastroesophageal reflux disease and liver disorders, but also obesity surgery. Now, it has become possible to use laparoscopy to perform more important interventions such as colon removal when conditions are favourable. Yet it is still little adapted to major surgery.
More recently, laparoscopy has proved to be of interest in urology for the treatment of urinary system disorders.

Conclusion:

Laparoscopy has offered surgeons the possibility of having new surgical techniques to treat patients. It has now become a reference in some surgical interventions which benefit from its technological evolution and improvement.
Laparoscopy offers many advantages such as minimally invasive surgery with best postoperative comfort for patients. However, minimally invasive surgery is not necessarily the best solution. Surgeons will choose between open surgery and laparoscopy during preoperative consultation, and they will decide which solution is best for the patient.

Laparoscopic surgery has been performed since 1989 in La Parisière which has progressively offered more and more laparoscopic interventions to its patients thanks to the progressive careful, diversified education of its surgeons in the best European centres.

Regular investments in state-of-the art materials such as tri-CCD video cameras, ultrasonic shears or monitoring devices allow us to keep our technical equipment up to date to offer the best conditions to the hospital’s surgeons who keep up their education regularly.

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