Sarnelle Surgeon
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Laparoscopic Surgery

Laparoscopic Surgery

      Laparoscopic gall bladder surgery was introduced to the Stamford community 21 years ago by Doctor James Sarnelle.  Dr. Sarnelle was the first surgeon in Fairfield County to perform laparoscopic cholecystectomy which revolutionized surgery.  Doctor Sarnelle traveled to Atlanta,Georgia to learn the technique from the pioneers Drs. Reddick and Olsen. Since then, laparoscopic surgical techniques has been applied to other aspects of surgery including hernia surgery, colon surgery, appendectomy and others.  Laparoscopic surgery is a minimally invasive procedure  which has replaced the traditional surgical incision. Laparoscopic surgery gives a much better cosmetic result with faster recovery. 

This is what a gallbladder looks like as seen with a laparoscope. The gallbladder is normally a "robin's egg" blue color and is attached to the undersurface of the liver. The photo shows two instruments which are placed through hollow trocars.  The trocars  a like hollow straws which allow the surgeon to place fine instruments to dissect out the gallbladder. This is what a surgeon will see on the video monitor in the operating room. As you can see, there is magnification of the organs which allows for precision in the operating room.



Laparoscopic Cholecystectomy
    Laparoscopic cholecystectomy is removal of the gallbladder using minimally invasive techniques. Through a tiny incision in the umbilicus(belly button) a laparoscope is inserted into the abdominal cavity. A laparoscope is a thin pencil- like instrument which has a camera chip at its tip. CO2  is introduced which distends the abdominal cavity and allows the surgeon to visualize the gallbladder on a video monitor. Under direct vision two or three pencil thin "trocars" are place. Trocars are like straws which allow the surgeon to place very thin surgical instruments inside the abdomen in order to perform the operation. The gall bladder is removed through the belly button. The typical patient goes home the same day. 


Below is a drawing  showing the basic anatomy of the gallbladder and its relationship to the liver and stomach and duodenum. This drawing shows gallstones which can block the cystic duct. The cystic duct is the duct that connects the gallbladder to the main bile duct,known as the common bile duct. As you can see, the cystic duct is a rather narrow tube. When the gallbladder contracts, it may push one of the gallstones into the cystic duct where it may get stuck.  This will cause discomfort and pain. If the gallstone is completely stuck in the cystic duct , the patient will develop acute cholecystitis, which is the medical term for a severe gallbladder infection and inflammation. During laparosocopic gallbladder surgery, the surgeon will place small tiny clips on the cystic duct between the gallbladder and the common bile duct. These clips seal off the cystic duct so that there is no leakage of bile after the gallbladder is removed. One common question about gallbladder surgery is," why not just remove the gallstones and not remove the entire gallbladder?"  Many years ago surgeons learned that if you only removed the gallstones, in a few years the patient would form new stones again , and then be faced with the same problem. There are times when the surgeon is face with a critically ill patient or in whom there is just too much inflammation that it is not safe to try to remove the gallbladder.  In these circumstances the surgeon might opt to place a tube into the gallbladder known as a cholecystostomy to drain the gallbladder infection. Another option is for the surgeon to convert from a laparoscopic procedure into the conventional open procedure.  This is not common in the elective case as the huge majority of gallbladders can be removed with laparoscopic techniques.


Do I need my Gall Bladder ?

     
      You can live a normal life without your gall bladder. You can eat your normal diet. Patients with gall stones will feel a lot better once they have their gall bladder removed. Their discomfort will be relieved and they will no longer have to avoid oils and fatty foods which often cause gall bladder attacks.

What are symptoms of gall bladder disease ?

    Often patients with gallstones will think that they have acid reflux because they may have heartburn, bloating, indigestion or discomfort under their ribs or upper abdomen. Gallstones are more common in women but many men suffer from gall bladder disease.  I have seen many patients over the years who have been diagnosed as having peptic ulcer disease or acid reflux, who have had gall bladder disease all along.  The gallbladder sits right next to your duodenum, which is the first part of your intestine after the stomach. If the gall bladder is irritated, it can often affect the duodenum and cause these symptoms of reflux, bloating, heartburn and nausea.  If a gall stone gets stuck and blocks the flow of bile from the gall bladder it may cause severe pain. Some patients have gall bladder symptoms but do not have gall stones. They may have a condition known a biliary dyskinesia, which is a disease where the gall bladder does not contract and empty properly. This will cause symptoms similar to if your urinary bladder could not empty, but the discomfort would be in your upper rather than lower abdomen.

How is  Gall Bladder disease diagnosed ?


   
  An ultrasound will diagnose gall stones over 98 percent of the time. Sometimes gall stones are found incidentally when getting a CT scan for another problem.  Some patients may have a normal ultrasound yet have typical gall bladder disease symptoms. They may have a condition known as biliary dyskinesia which is a problem with the ability of the gall bladder to contract.  Usually after a fatty meal, the gall bladder will contract and allow bile to flow into the duodenum.  If the gall bladder does not empty properly, patients may notice discomfort in their upper abdomen after a meal, especially if they ate fried or fatty foods.


Why choose Dr. Sarnelle ?

 
 Dr. Sarnelle has been performing laparoscopic cholecystectomy longer than any surgeon in Stamford.  Experience counts when doing this kind of surgery.  During his fellowship in vascular surgery, Dr. Sarnelle acquired fine surgical skills in microsurgery and precise attention to detail.  He as applied these additional skills to his laparoscopic techniques with excellent results.
Laparoscopic Hernia Surgery

   Laparoscopic hernia surgery has improved recovery time and cosmetic results over traditional open hernia surgery. Hernias can occur in the groin area--
inguinal or femoral hernias.  They may also occur in the belly button or navel--umbilical hernia. Hernias may also occur at the site of a previous abdominal incision--ventral or incisional hernia.  Laparoscopic techniques can be applied to all of these hernias. A hernia is a weak spot or bulge in part of the abdominal wall.  It may be hereditary but more often is acquired over time from years of straining or lifting. Men and women can develop hernias. Most often, the patient notices a mild bulge or lump in the area. It may or may not be painful. Sometimes, a hernia is not noted by the patient and is found by their primary care physician on a routine physical.  Hernias will not go away on their own and will only get larger over time.  It is better to have them repaired before they cause complications such as strangulation of the intestine.
Laparoscopic hernia surgery involves using a small pencil thin laparoscope along with a few small straw like "trocars" which allow the surgeon to place surgical instruments to repair the hernia. Doctor Sarnelle has over 25 years of experience in repairing hernias. 

For more information on hernias visit:

YourHernia.com


James Sarnelle,MD
203-353-8088
90 Morgan Street  Suite 304
Stamford,CT06905


www.sarnellesurgeon.com



    

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