1) What is laparoscopy?

A laparoscope is a special telescope designed for medical use. It is connected to a high intensity (fiber-optic) light source as well as a high-resolution television camera. This allows the surgeon to view the abdominal cavity. The laparoscope is placed into the abdominal cavity through a hollow tube (trocar) and the image is viewed on a TV monitor.

2) What are the advantages of laparoscopic surgery?

There are many advantages over traditional open surgery. People who undergo laparoscopic procedures often have a shorter hospitalization. On average 1 to 2 days for laparoscopic versus 5 to 7 days for open surgery. Also, since laparoscopy utilizes much smaller incisions, the risk of wound infection is less and consequently the risk of hernia formation is less. While postoperative pain is different for everybody, patients often report much less pain after laparoscopy.

3) What are the complications associated with laparoscopic surgery?

The most frequent complications of any operation are bleeding and infection. There is a small risk of other complications that include, but are not limited to, injury to the abdominal organs, intestines, urinary bladder or blood vessels. As with any laparoscopic procedure, there is a chance of "conversion" to the open procedure. Most often this occurs to people that have had many previous abdominal surgeries and have a lot of scar tissue. In the hands of experienced laparoscopic surgeons conversion to open is very rare.

4) What are the benefits of laparoscopic cholecystectomy:

1. Less post-operative pain

2. Faster recovery

3. Short hospital stay

4. Less post-operative complications like wound infection, adhesion, hernia, etc.

5. Cost-effective in working group

5) Is every patient fit for laparoscopic cholecystectomy?

No. Most surgeons would not recommend laparoscopic cholecystectomy in those with pre-existing disease conditions. Patients with cardiac diseases and COPD should not be considered a good candidate for laparoscopy. Laparoscopic cholecystectomy may also be more difficult in patients who have had previous upper abdominal surgery. The elderly may also be at increased risk for complications with general anaesthesia combined with pneumoperitoneum. Laparoscopy does add to the surgical risk in patients with a lowered cardio-pulmonary reserve with regard to the consequences of the pneumoperitoneum and a longer operative time.

6) Can GI Surgery can be done Laparoscopically?

Laparoscopic intestinal surgery can be used to perform the following operations:

Proctosigmoidectomy. Surgical removal of a diseased section of the rectum and sigmoid colon. Used to treat cancers and noncancerous growths or polyps, and complications of diverticulitis.

Right colectomy or Ileocolectomy. During a right colectomy, the right side of the colon is removed. During an ileocolectomy, the last segment of the small intestine - which is attached to the right side of the colon, called the ileum, is also removed. Used to remove cancers, noncancerous growths or polyps, and inflammation from Crohn's disease.

Total abdominal colectomy. Surgical removal of the large intestine. Used to treat ulcerative colitis,Crohn's disease, familial polyposis and possibly constipation.

7) What is evidence based medicine (EBM)?

Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. Read the full article by clicking on the relevant link:

Evidence based medicine: what it is and what it isn't:

Good doctors and health professionals use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients. Evidence-based medicine is not restricted to randomised trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions.

The Five Steps of EBP

Evidence-based practice is primarily based on five well defined steps. The five steps of EBP were first described in 1992 and most steps have now been subjected to trials of teaching effectiveness Sicily statement on evidence-based practice.

1. Asking Focused Questions: translation of uncertainty to an answerable question

What makes a clinical question well built? First, the question should be directly relevant to the problem at hand. Next, the question should be phrased to facilitate searching for a precise answer. To achieve these aims, the question must be focused and well articulated for all 4 parts of its 'anatomy'.

1. the patient or problem being addressed;

2. the intervention or exposure being considered;

3. the comparison intervention or exposure, when relevant;

4. the clinical outcomes of interest.

2. Finding the Evidence: systematic retrieval of best evidence available

Training improve search performance and the quality of evidence retrieved.Improving searching skills

Searching the literature could improve the treatment of many medical inpatients, including those already receiving evidence-based treatment.

3. Critical Appraisal: testing evidence for validity, clinical relevance, and applicability

Critical appraisal is the process of assessing and interpreting evidence by systematically considering its validity, results and relevance to an individual's work. Within the last decade critical appraisal has been added as a topic to many medical school and UK Royal College curricula, and several continuing professional development ventures have been funded to provide further training. Teaching critical appraisal skills in health care settings.

4. Making a Decision: application of results in practice

Many health professionals have recognized the need for instruction in evidence-based medicine. A curriculum intended to develop a resident-produced, evidence-based guideline for the care of patients with diabetes. Each resident was supervised going through the steps of evidence-based medicine: asking a clinical question, searching for the evidence to answer that question, appraising that evidence, and producing an evidence-based answer. These answers were then compiled into a guideline distributed in the residency practice. An evaluation of this curriculum using focus group and survey data showed that learners appreciated the skills and knowledge gained in devising guidelines in an evidence-based manner but were uncertain that their searches were complete. The clinical evaluation of the guideline implementation showed improvement in several clinical markers of diabetes care. Teaching evidence-based medicine skills through a residency-developed guideline.

5. Evaluating Performance: auditing evidence-based decisions

It appears logical that healthcare professionals would be prompted to modify their practice if given feedback that their clinical practice was inconsistent with that of their peers or accepted guidelines. One such strategy, audit and feedback, continues to be widely used as a strategy to improve professional practice.

8) What are some of the symptoms of liver disease?

The most important thing to recognize about liver disease is that up to 50 percent of individuals with underlying liver disease have no symptoms. The most common symptoms are very non-specific and they include fatigue or excessive tiredness, lack of drive, occasionally itching. Signs of liver disease that are more prominent are jaundice or yellowing of the eyes and skin, dark urine, very pale or light colored stool or bowel movements, bleeding from the GI tract, mental confusion, and retention of fluids in the abdomen or belly.

9) What are the types of cholestatic liver disease?

Biliary atresia, Idiopathic neonatal hepatitis, Alagille Syndrome , Alpha-1 Antitrypsin Deficiency (Alpha-1), Bile Acid Synthesis Defect, Progressive Familial Intrahepatic Cholestasis (PFIC), Mitochondrial Hepatopathy

10) Can liver damage be reversed?

The liver is a unique organ. It is the only organ in the body that is able to regenerate... that is completely repair the damage. With most organs, such as the heart, the damaged tissue is replaced with scar, like on the skin. The liver, however, is able to replace damaged tissue with new cells. An extreme example is a patient who suffers an overdose from Tylenol. In this example up to 50 - 60 percent of the liver cells may be killed within 3 - 4 days. However, if no other complications arise, the patient's liver will repair completely, and a liver biopsy after 30 days will appear completely normal with no signs of damage and no scar. However, the long-term complications of liver disease occur when regeneration is either incomplete or prevented by progressive development of scar tissue within the liver. This occurs when the damaging agent such as a virus, a drug, alcohol, etc., continues to attack the liver and prevents complete regeneration. Once scar tissue has developed it is very difficult to reverse that process. Severe scarring of the liver is the condition known as cirrhosis. The development of cirrhosis indicates late stage liver disease and is usually followed by the onset of complications.

11) Can the liver be treated using blood treatment procedures similar to those used for kidney dialysis?

Yes, but only with restrictions and only in specialised liver intensive care units, for example those attached to liver transplant centres. This type of treatment cannot be offered to outpatients. Short treatments repeated over a period of weeks or months are of little help. Liver support machines, where the patient is continuously connected to a machine can be employed in cases of acute liver failure caused, for example, by poisoning. This applies to intensive care patients who are suffering from acute, life-threatening hepatic coma. However, this method of treatment is not suitable for patients suffering from chronic liver diseases (chronic viral hepatitis) or liver cancer. Due to the level of risk involved for the patient, this treatment can only justified in the case of hepatic coma

12) What is Fatty Liver Disease and is it caused by eating too much fat?

Fatty Liver Disease, also known as "fatty infiltration of the liver," is not caused by excessive eating of fats, although obesity is a risk factor for

fatty liver. In some patients, the fat is associated with inflammation and scarring and may lead to cirrhosis.

Nutritional causes of fat in the liver include alcohol, starvation, obesity, protein malnutrition, and intestinal bypass operation for obesity.

Diabetes is another factor associated with fatty liver.

13) Are there alternative treatments for liver disease?

There are effective medicines for some liver diseases, while for others only palliative treatment for complications is available. Treatment of complications may be all that is required if the liver is not failing. Frequently medical treatment delays, but does not eliminate, the need for transplantation.

There are effective medicines for some liver diseases, while for others only treatment for complications is available. Treatment of complications may be all that is required if the liver is not failing. Frequently medical treatment delays, but does not eliminate, the need for transplantation.

14) What is the treatment for liver disease?

Treatment options for liver disease will depend upon your health condition. Sometimes liver disease may best be treated by medical interventions. Severe liver disease may require medical and surgical intervention. For example, you may benefit from surgical intervention such as a shunt procedure

15) What is end stage liver disease?

End stage liver disease is the final stage of liver failure. It includes symptoms like yellowing of the skin (jaundice), itching, dark colored urine, gray or clay colored stools, ascites (fluid collection in the abdomen), encephalopathy (mental confusion), coma, easy bruising, intestinal bleeding and fatigue. In general, people who qualify for liver transplantation have end stage liver disease.

16) What are the signs and symptoms of liver disease?

Typical signs include fatigue and weakness, nausea and vomiting, loss of appetite and weight loss, itchy skin, jaundice and fluid in the abdomen.