Gallbladder Stone Operation/Surgery: Laparoscopic Cholecystectomy

Indications for Laparoscopic Cholecystectomy

The most common indication for laparoscopic cholecystectomy is gallbladder stones disease or gallstone. Not all gallstones disease require surgery. It is only symptomatic one which require surgery. Gallstone disease may lead to biliary colic, acute cholecystitis or chronic cholecystitis. Porcelain gallbladder which is a risk factor for gallbladder cancer is also an indication for gallbladder removal

Patient Preparation

As it is an elective procedure all routine lab investigations are done. Pt require Chest-X ray and ECG. Pre-Anesthetic check up is done. Patient require fasting for 6hr before surgery. Avoid hypogylcemic drug on day of surgery. Continue anti-hypertensive drug and thyroxine tablet on day of surgery with sips of water

Surgical ProcedureLaparoscopic Cholecystectomy

Done mostly through four ports, but if there are no so much adhesions it can be done through three ports by experienced laparoscopic surgeon.Camera port is inserted. Under vision other ports are placed. Adhesionolysis is done if present. Cystic duct and artery dissected, clipped and divided.Gallbladder is dissected out. Gallbladder is extracted. Bile and stone spillage is avoided

Post-op Recovery after Laparoscopic cholecystectomy

Patient is allowed orally four hrs after surgery, starting from liquids and gradually increased to normal diet. Patient is encouraged to walk. It is day care surgery. If patient is comfortable can be discharged on same day of surgery otherwise next day. From next day onwards patient can do all his normal activities

Diet after Laparoscopic Cholecystectomy

Generally it is advised to avoid excessive fat in the dist for 2-3 months post surgery. After that patient can have normal diet

Complications of Gallbladder Surgery

Bleeding: It occur due to injury to blood vessels. Whenever there is bleeding intra-operatively dont be panic.First step should be applying pressure at the bleeding site. Small venous injury stops after packing only. Field should be cleared and after proper visualization bleeding point should be identified and either cauterized or clipped should be applied. Do not hesitate to convert to open surgery if bleeding is not controlled laparoscopically
Bile duct Injury : The incidence of bile duct injury has been decreased after the learning curve of laparoscopic surgery. It occur in difficult cases with dense adhesions at gallbladder fossa.In such cases it should be converted to open surgery. Dissection should be done close to the gallbladder.Intra-operatively whenever there is doubt of bile duct injury convert to open. If injury cannot be managed then put a drain and refer the patient to higher centre
Injury to Bowel: Bowel gets adhered to gallbladder fossa due to recurrent inflammation. Pylorus and duodenum are most commonly injured organs. Hepatic flexure is another common site of injury. In post-op period if recovery is not smooth and Common Bile duct is normal a high suspicious of bowel injury should be suspected and CECT abdomen should be done

 

 

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