LAPAROSCOPIC CHOLECYSTECTOMY

Definition

Removal of the gall bladder through small punctures in the abdomen to permit the insertion of a laparoscope and surgical instruments

Patient Selection : LC is indicated in patients who develop symptoms or complications of the disease. INDICATIONS: 1. Gallstones with biliary pain 2. Acute cholecystitis 3. Chronic cholecystitis 4. Acalculus cholecystitis 5. Mucocele gall bladder 6. Emypema gall bladder 6. Gall stone pancreatitis

EXPERIENCE OF SURGEON MAKES NUMBER OF INDICATIONS INVERSLY PROPORTIONAL TO CONTRAINDICATIONS

CONTRAINDICATIONS
All patients who are otherwise unfit for GA; Previous surgery is not contraindication.

Procedure Incisions are made in the skin to place ports which allow passage of instruments to dissect the gallbladder off the liver

It appears that the laparoscopic approach has several advantages:

• 1. Cosmetically better outcome.
  2. Less tissue dissection and disruption of tissue planes
  3. Less pain postoperatively.
  4. Low intra-operatively and postoperative complications.
  5. Early return to work.

Open vs Laparoscopic Cholecystectomy

Open operation, laparotomy, may have to be performed if there are difficulties experienced in identifying the anatomy and there is a danger of damaging vital structures such as the bile duct. This can occur if there has been chronic or acute infection in the gall bladder or where there is abnormal anatomy. Open surgery may also be necessary when the abdomen is adhesed due to previous surgery preventing views in the abdominal cavity, with bleeding disorders and with pregnancy.

What are the complications of surgery?

1. 1.) Damage to the bile duct can lead to leakage or even obstruction of bile flow. Laparotomy to drain or repair the bile duct may be necessary. This is a serious problem but is rare with an incidence of less than 1%.
   2.) Bleeding from blood vessels feeding the gall bladder or liver. This is usually controllable at the laparoscopy but may require laparotomy to stop the bleeding. If the bleeding starts after the surgery has been completed, the patient may have to return to the operating theatre to stop the haemorrhage. Again this is a very rare complication.
   3.) Damage to other organs or blood vessels. This is extremely rare and the incidence is minimised by using a special blunt tipped instrument to enter the abdominal cavity through the incision beneath the umbilicus.
   4.) Gas embolism. This can occur when CO2 enters an open blood vessel and passes to the heart. This is very rare.
   5.) Pulmonary embolism. This occurs when clots form in the deep veins of the legs and pass up the veins to the lung blocking the flow of blood to the lungs. This again is very rare.
   6.) Keloid scars. These are thickened scars to which some patients are prone. With the small incisions, scarring is minimal in most cases

How long will I be in hospital and how long off work?

Usually patients can go home 1-2 days postoperatively. One week off work is sufficient for sedentary workers. For those who do heavy lifting I advise four weeks off to allow the umbilical wound to settle and strengthen.