Cholecystectomy (; plural: cholecystectomies) is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. The operation is performed either laparoscopically, using a video camera, or via an open technique. There are advantages and disadvantages between either operation. The surgery can lead to postcholecystectomy syndrome, as well as more serious complications such as bile duct injury.
Video Cholecystectomy
Medical use
The gall bladder is removed in order to treat inflammation of the gall bladder (cholecystitis) Cholecystitis may be acute or chronic, and may or may not involve the presence of gall stones. Risk factors for gall bladder cancer include a "porcelain gallbladder", or calcium deposits in the wall of the gall bladder, and an abnormal pancreatic duct.
It is also used to prevent the relapse of pancreatitis that is caused by gall stones that block the common bile duct.
Maps Cholecystectomy
Contraindications
There are no specific contraindications for this procedure, but anyone who cannot tolerate general surgery should not receive it. Typically this is people who cannot tolerate general anesthesia, who have end-stage liver disease with portal hypertension, or whose blood does not clot properly, should not have their gall bladder removed.
Procedure
Laparoscopic cholecystectomy
By 2013 laparoscopic cholecystectomy had replaced open cholecystectomy as the first-choice of treatment for gallstones and acute cholecystitis, a condition where the gallbladder is inflamed, unless there are contraindications to the laparoscopic approach. The preference to perform laparoscopic cholecystectomy vs open is because the laparoscopic approach has decreased mortality, decreased morbidity, and decreased cardiac and respiratory complications.
Laparoscopic cholecystectomy requires several (usually 4) small incisions in the abdomen to allow the insertion of operating ports, small cylindrical tubes approximately 5 to 10 mm in diameter, through which surgical instruments and a video camera are placed into the abdominal cavity. The surgeon inflates the abdominal cavity with carbon dioxide to create a working space prior to starting. The camera illuminates the surgical field and sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. The surgeon watches the monitor and performs the operation by manipulating the surgical instruments through the operating ports. The gallbladder fundus is identified, grasped, and retracted superiorly. With a second grasper, the gallbladder infundibulum is retracted laterally to expose and open Calot's Triangle (cystic artery, cystic duct, and common hepatic duct). The triangle is gently dissected to clear the peritoneal covering and obtain a view of the underlying structures. The cystic duct and the cystic artery are identified, clipped with tiny titanium clips and cut. Then the gallbladder is dissected away from the liver bed and removed through one of the ports
A technique called Laparoendoscopic Single Site Surgery or "LESS" or Single Incision Laparoscopic Surgery or "SILS" has been developed, in which a single cut is made through the navel, instead of the 3-4 four small different cuts used in standard laparoscopy. There appears to be a cosmetic benefit over conventional four-hole laparoscopic cholecystectomy, and no advantage in postoperative pain and hospital stay compared with standard laparascopic procedures. There is no scientific consensus regarding risk for bile duct injury with SILS versus traditional laparoscopic cholecystectomy.
Open cholecystectomy
Sometimes people need open surgery instead of laparascopy. In open cholecystectomy, a surgical incision of around 8 to 12 cm is made below the edge of the right ribcage and the gall bladder is removed through this large opening, typically using electrocautery. The liver is retracted superiorly, and a top-down approach is taken (from the fundus towards the neck) to remove the gallbladder from the liver, . This is done if the person has severe cholecystitis, emphysematous gallbladder, fistulization of gallbladder and gallstone ileus, cholangitis, cirrhosis or portal hypertension, and blood dyscrasias.
Sometimes problems arise during the laparoscopic procedure -- for example, the person has unusual anatomy and the surgeon cannot see well enough through the camera, or it looks like the person has cancer -- and the laparascopy is stopped and the person is opened up instead.
Open cholecystectomy is associated with greater post-operative pain, longer hospital length of stay, increased use of antibiotics, and a longer proportion of time out of work than a laparoscopic cholecystectomy.
Biopsy
After removal, the gallbladder should be sent for pathological examination to confirm the diagnosis and look for an incidental cancer. If cancer is present, a reoperation to remove part of the liver and lymph nodes will be required in most cases.
Procedural risks and complications
All surgery carries risk of serious complications or even death. The mortality rate for laparoscopic or open cholecystectomy is <0.3%.
The most serious complication of cholecystectomy is damage to the bile ducts. In laparoscopic cholecystectomy, this occurs in between 0.3% and 0.6% of cases. Approximately 25-30% of biliary injuies are typically noticed intraoperatively during laparoscopic cholecystectomy and the rest during the early post-operative period. Damage to the duct that causes leakage typically manifests as either fever, jaundice, and abdominal pain several days following cholecystectomy or manifests in laboratory studies as rising total bilirubin and alkaline phosphatase.
Leakage from the stump of the cystic duct is a complication that is more common with the laparoscopic approach than open approaches but still rare, occurring in less than 1% of procedures; it treated by drainage followed by insertion of a bile duct stent.
Long-term prognosis
A portion of the population, from 5% to 40%, develop a condition called postcholecystectomy syndrome, or PCS. Symptoms can include gastrointestinal distress and persistent pain in the upper right abdomen.
As many as 20% of people develop chronic diarrhea. The cause is unclear, but is presumed to involve the disturbance to the bile system. Most cases clear up within weeks or a few months, though in rare cases the condition may last for many years. It can be controlled with medication such as cholestyramine.
Epidemiology
About 600,000 people receive a cholecystectomy in the United States each year.
In a study of Medicaid-covered and uninsured U.S. hospital stays in 2012, cholecystectomy was the most common operating room procedure.
History
The first cholecystectomy was performed in 1882 by Carl Langenbuch. Introduced in 1987 by Phillipe Mouret in France, the laparoscopic cholecystectomy, which is a less invasive surgery than an open cholecystectomy, has become the standard operation for the treatment of symptomatic gallstones.
See also
- List of surgeries by type
References
Source of the article : Wikipedia
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