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-Darlene K., patient
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This is the traditional approach for surgery and what most people think of when are told they need an operation. Open surgery uses large incisions to allow access to the abdominal cavity. The incisions must be large enough to allow the surgeons hands to manipulate the tissues and to see the organs of interest. This type of access is the oldest and has been used for over a hundred years. If there are problems with less invasive types of access, open surgery is what your surgeon may choose to fall back on to insure that you have a safe operation.
This approach for bariatric surgery is relatively new. The technique of performing general surgical procedures with long instruments and a video camera became popular in the mid 1990's with widespread adoption of the laparoscopic cholecystectomy or gallbladder removal. Now, almost any type of general surgical procedure is often done or has been reported to have been done laparoscopically. Routine laparoscopic surgeries include hernia repair, appendix removals, surgery for gastroesophageal reflux, colon resections, and, of course bariatric surgery. Laparoscopic surgery offers distinct advantages over traditional, open surgery. Chief among these is less post-operative pain and much reduced incidence of wound infections and incisional hernias. In comparison to open surgery, a decrease in some post-operative complications, such as pneumonia, are seen, as well as earlier return of bowel function. Both of our surgeons have had the additional training in this approach to maximize the potential benefits and safety of laparoscopic bariatric surgeries.
This is a new variation of laparoscopic surgery that has gained interest in the last 3-4 years. In standard laparoscopy, multiple ports are placed on the abdominal wall. With SILS, we use a single incision, typically about 1-2 inches in size through which all the instruments are introduced. Typically the incision is placed around the belly button to allow a better cosmetic result. The advantage of this approach is potentially reduced pain as well as a much less noticeable scar. Drs. Moeinolmolki and Liao have been using this approach for laparoscopic adjustable gastric banding and vertical sleeve gastrectomy.
NOTES is the performance of abdominal surgery with potentially no scar, by using the bodies natural openings such as the mouth, anus, and in females, through the vagina. Currently surgeons and gastroenterologists use flexible scopes with lights and cameras on the tip to evaluate the stomach, small intestine and colon. With appropriate instrumentation, we can remove polyps, sample masses and stop bleeding. The next generation of devices and procedures seeks to perform much more complex operations, such as anti-reflux procedures and gallbladder removal, as well as revision of gastric bypass without any incisions. For the bariatric surgery patient, we may be able to offer revisional procedures for gastric bypass patients in the near future.
| GBMC Physician Pavilion North • N. Charles Street, Suite 125 • Towson, MD 21204 • 443.849.3779 |
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