Gastroenterology

Laparoscopic Cholecystectomy Treatment

Removal of Gallbladder

Gallstones are stones that form in your gallbladder. They are common and can run in families. The risk of developing gallstones increases as you get older and if you eat a diet rich in fat.For some people gallstones can cause severe symptoms, with repeated attacks of abdominal pain being the most common.

In cholecystectomy, the gallbladder is removed from the body. Laparoscopy enables the removal of the gallbladder while making only 5 small incisions into the abdomen.

Introduction

During the past two decades, laparoscopic cholecystectomy has become the procedure of choice in the surgical treatment of symptomatic biliary lithiasis. The operation is mostly risk-free, but not completely. Some incidents and complications being more frequent in Laparoscopic Cholecystectomy (LC) than with open cholecystectomy (OC).

What is laparoscopic cholecystectomy?


Laparoscopic cholecystectomy is a surgery during which the doctor removes the patient’s gallbladder. This procedure includes several small cuts instead of one large one.
A laparoscope and a narrow tube with a camera are inserted through one incision. This allows the doctor to see one’s gallbladder on a screen. Then the gallbladder is removed through another small incision.Page Image

Use of Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy is used when you have stones in your gallbladder.
The gallbladder stores bile which is a fluid made by your liver. Bile helps in digesting fat in the foods you eat. The flow of bile in your digestive system can be blocked by Gallstones. This blockage can cause vomiting, pain, bloating, and nausea in your abdomen, shoulder, back, or chest. Gallstones can block the ducts that channel the bile from the gallbladder or liver to the intestine. The gallbladder can become infected because of the Gallstones.

Materials and methods
Between December 1991 and September 2002, 14024 biliary operations were performed in Surgical Clinic no. 3 at Cluj-Napoca, of which 4482 (32%) were open procedures. In 719 of these cases, Gallstones were present in the main bile duct
Laparoscopic cholecystectomy (LC) was performed in 9543 (68%) of these patients, 1664 (17.4%) being men and 7877 (82.6%) women. 732 patients were aged over 65 years.
The procedure used for LC was recommended by Zucker regarding both placement of the operative team and the sites of trocar insertion. laparoscopic cholangiography was performed for intra-operative exploration of the main bile duct selective when dilatation of the cystic duct (>3 mm diameter) was associated with small calculi in the gallbladder. Choledochoscopy was also performed by the transcystic route in 153 cases and by choledochotomy in 4 cases, with the extraction of calculi from the main bile duct in 91 cases. Laparoscopic ultrasound (US) was not performed much (with demonstration equipment provided by manufacturing companies). It does not necessitate dissection of the cystic duct in the presence of acute inflammation so It is more sensitive and simple to perform. ERCP was performed 3–5 days postoperatively If stone migration was suspected and the main bile duct could not be explored.

Approach Considerations
An important issue for surgeons while performing a laparoscopic cholecystectomy is whether and when the procedure should be converted to an open cholecystectomy. In the given situations, a low threshold for conversion to an open procedure should be maintained.
• Bleeding is encountered in excess
• Patient anatomy is unclear
• If multiple vessels are seen entering the gallbladder, or a very big cystic duct is seen (especially if it was normal on ultrasonography); these findings suggest that the surgeon may be in the wrong place
Conversion to an open procedure shouldn’t be considered a complication, and the possibility that it will prove necessary or advisable should be discussed with the patient preoperatively. Conversion rates are higher with emergency operations in most series. Reported rates range from 1.5% to 15%, with most studies reporting rates around 6% in elective cases. 
The multivariate analysis identified elevated white blood cell count, low serum albumin, pericholecystic fluid noted on ultrasonography, male gender, diabetes mellitus, and elevated total bilirubin as independent predictors of conversion. Another multivariate analysis identified male sex, positive Murphy sign, gallbladder wall thickness exceeding 4.5 mm, and previous upper abdominal surgery as independent predictors of conversion to an open procedure.
The decision to convert to open cholecystectomy should be made when important anatomic structures cannot be clearly identified or when no progress is being made while Laparoscopic Cholecystectomy. A general rule is there that if the junction of the gallbladder and the cystic duct has not been identified within 30 minutes of the start of the procedure, a laparoscopic cholecystectomy (LC) should be converted to open cholecystectomy (OC).

What are the Benefits of Laparoscopic Cholecystectomy?

The major benefit of this technique is that it is minimally invasive surgery. Minimally invasive surgery means "Lesser Pain" and "Faster Recovery" which are one of the most important reasons that this method is more beneficial.
There is no incision pain as occurs with standard abdominal surgery, so the recovery time is much quicker and also, there is no scar on the abdomen.
Is laparoscopy always advised?
There are very few instances when laparoscopic surgery (LC) is not preferable to conventional surgery for cholecystectomy. This is especially true when the surgical 
and the nursing team is well experienced and qualified in the procedures and post-operative care.
The only most real contraindication is if the anesthetic risk is too high. Other, lesser contraindications - such as during the first 3 months of pregnancy - need not pose a problem to the experienced laparoscopic surgeon. 
• Obesity - there are lesser post-operative complications with laparoscopic surgery
• Previous surgery - adhesions can be successfully dealt
• Common bile duct stones can be removed by laparoscopy otherwise by ERCP
• Severe cholecystitis is best dealt with acutely - one operation and recovery period - and can be done more safely with the laparoscopic technique

What are the Risks & Complications involved?

Like any other abdominal surgery, Laparoscopic Cholecystectomy also carries some risks. Even though infrequent, it still carries the same risks as any other general surgery. Current medical reports indicate that the low complication rate is about the same for this technique as for standard gallbladder surgery.
Complications are mostly rare and may include:
Bleeding & infection may occur but is mostly rare with experienced surgeons.
• In some cases, the gallbladder cannot be safely removed by laparoscopy
• Standard open abdominal surgery is then performed immediately
• Nausea or vomiting may occur after the surgery
• Injury to the blood vessels, bile ducts, or intestine can occur, requiring corrective surgery

Top Doctors for Gastroenterology

Top Hospitals for Gastroenterology