Laparoscopic cholecystectomy

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is a routine gallbladder removal procedure. It is considered extremely safe and effective for the removal of symptomatic gallstones. Decreased postoperative pain and reduced need for postoperative analgesia make it a preferred procedure for the management of gallstones. There are a wide number of gallbladder disorders that seek laparoscopic cholecystectomy treatment.

Indications for gallbladder removal

  • Gallstone pancreatitis: Patients will undergo MRCP (Magnetic Resonance Cholangiopancreatography), ERCP (Endoscopic Retrograde Cholangiopancreatography), EUS (Endoscopic Ultrasound) and IOC (Intraoperative Cholangiogram) prior to the procedure. Surgery is performed only after clinical manifestations of biliary pancreatitis have been cleared.
  • Mirizzi syndrome: Gallstones are lodged in the cystic duct or the Hartmann pouch. The common hepatic duct is thus compressed, causing obstructive jaundice. Endoscopic stone fragmentation along with papillotomy and stenting are performed before a cholecystectomy.
  • Choledocholithiasis: Preoperative or postoperative ERCP with sphincterotomy and laparoscopic common bile duct exploration are some options available for treatment, followed by laparoscopic cholecystectomy.
  • Incidental gallbladder cancer: It is usually an incidental finding during a laparoscopic cholecystectomy.

 

Silent gallstones or asymptomatic gallstones

Silent gallstones have a tendency to become symptomatic. With comorbidity factors considered, elective laparoscopic cholecystectomy is performed to avoid the risk of complications. Prophylactic cholecystectomy may be performed in the following cases:

  • Nonfunctional gallbladder
  • Chronic obliteration of cystic duct
  • Trauma to the gallbladder
  • Calcified gallbladder
  • > 10mm gallbladder polyp

 

Symptomatic gallstones disease

  • Biliary colic with stones, identified under sonography
  • Acute cholecystitis, treated laparoscopically within 72 hours of detection

 

How is it performed?

  • Before the start of the surgery, the patient is given general anaesthesia.
  • Three to four small, 1-inch incisions are made in the abdomen.
  • A laparoscope is advanced into the abdominal cavity through one incision to visualise the gallbladder.
  • Once the gallbladder is visualised, special instruments to hold and cut the tissues and blood vessels holding the gallbladder are inserted through the other incision sites.
  • Once separated, the gallbladder is removed from the body through the largest incision and the blood vessels are cauterised to prevent bleeding.
  • The incisions are closed and the area is dressed.

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