Laparoscopic Cholecystectomy

Diseases of Gall Bladder

Gall bladder stone
Acalculous cholecystitis
Tumours of gall bladder (90% malignant)
Gall bladder polyp ( pre- malignant condition , that can lead to gall bladder malignancy)
Cholesterosis of gall bladder ( deposit of cholesterol on gall bladder wall, pre malignant condition)
Dysfunction or non functioning gall bladder

Complications of Gall Bladder Stone

Empyema gall bladder ( severe inflammation and infection of gall bladder with pus )
Cholangitis ( infection of gall bladder)
Obstructive jaundice (gall stone migrating in to main bile duct causing obstruction, leading to jaundice and infection)
Gall stone acute pancreatitis (self destruction of pancrease stimulated by migrated gall stone , can be vert fatal , involving all the organs of the body)
Malignancy of gall bladder (cancer of gall bladder , most common with large gall bladder stone , in neglected cases, or few genetic disorders that run in families )

TREATMENT PROTOCOL

Gold standard of gall bladder disease and gall stone, recommended worldwide, is removal of gall bladder, by LAPAROSCOPIC CHOLECYSTECTOMY

LAPAROSCOPIC CHOLECYSTECTOMY

It is done under general anaesthesia after anaesthesia check up , and necessary pre operative investigations.
4 holes are made in abdomen and the abdomen in inflated with carbon dioxide gas , and entire operation is done under video assistance.

ADVANTAGES

Minimal pain
Minimal bleeding
Early recovery and short hospital stay (48 hrs)
Less loss of working days
Minimal chance of infection
Minimal chance of post operative incisional hernia
Six times magnified image of abdomen and better visualisation of entire abdominal organs .

TREATING COMPLICATIONS OF GALL STONE

COMMON BILE DUCT STONE WITH JAUNDICE

After treating infection , stone from common bile duct is removed endoscopically (ERCP)

but for very large CBD stones there may be failure of retrieval of CBD stones the procedure is converted to open surgery , cholwdocholithotomy

ACUTE GALL STONE PANCREATITIS

Pancreatitis is a fatal complication of gall stone , and patient should be hospitalised at earliest.

After treating acute pancreatitis conservatively, ERCP is done to remove the culprit CBD stone and laparoscopic cholecystectomy is done

GALL BLADDER CANCER

Prognosis of gall bladder cancer is fatal and life expectancy is short .

After initial investigations , like ultra sound , CT scan, MRCP, blood parameters, abd cancer markers like CA 19.9 , radical cholecystectomy is done with wedge resection of gall bladder bed ,or segment iii resection of gall bladder

FAQ

Who are the candidates for laparoscopic cholecystectomy?

All patients with gall bladder disease ,except patients with heart failure , severe respiratory disease, gross infection of gall bladder, advanced malignancy of gall bladder, ascitis, history multiple open surgeries of abdomen, and any a condition where general anaesthesia can not be administered .

What is the usual duration of hospital stay?

Patients with no co- morbidities like hypertensions and diabetes , usual hospital stay is 48 hours approximately .

Is gall bladder essential for digestion?

No gall bladder is not essential for digestion , it acts as temporary store house of bile ,and bile helps in fat digestion ,and after operation patient continues with normal life style .

Is there any diet restriction?

Fat free diet is recommended before operation , and after operation for 4 weeks.

What is the chance of conversion to open surgery?

World wide the chance of conversion to open surgery may be 5-15% , varies from institution to institution ., if the anatomy could not be ascertained by video assistance as 45 % of population have anomaly of gall bladder, or due to gross infection.

Is there any chance of residual?

If the anatomy can not be ascertained by the surgeon, due anomaly of anatomy or gross infection called Mirrizi syndrome , sub total cholecystectomy is advocated by authors , and in those cases chance of residual stone is .2 -2 % . Re operation may need to be undertaken either open or laparoscopy.

What are the complication of surgery?

With gaining experience of laparoscopic surgery for last 25 years of the surgical community , the chance of complication is very less ,involve injury of commob bile duct , bleeding nd occasional post operative pancreatitis ( very less for laparoscopic surgery) .