Laparoscopic Cholecystectomy

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Laparoscopic Cholecystectomy

A laparoscopic cholecystectomy is an operation to remove a diseased or unhealthy gall bladder, most commonly a gallbladder with stones. The operation generally involves four to five small cuts from 3mm to 10mm rather than a large incision. A laparoscope is a small tube camera with light that shows the inside of the abdomen, facilitating the clear identification of organs. Patients go through the process of informed consent. The procedure and potential risk factors are explained to the patient. Risks are quite low but there can be: bleeding form the cuts on the skin or liver or any other blood vessel in the operative area, bile leakage, liver injury, bile duct injury, bowel injury or infections; rarely hernia from the working port sites. Sometimes in the case of a complex operation or to manage any complications, an open technique which requires a bigger cut is used to finish the operation safely. Although this is very rarely required.

 
The different stages invoked in laparoscopic cholecystectomy
A laparoscopic cholecystectomy is an operation to remove a diseased or unhealthy gall bladder, most commonly a gallbladder with stones

Patients are advised to ask questions in order to understand the operation and after care. 

An anaesthetist will see and assess the patient before the operation.

A general anaesthetic is used to induce sleep, relax muscles and control the pain. The abdomen is inflated with carbon dioxide, which is a harmless gas. The laparoscope is passed through a small cut in the navel or above the navel. Working ports are passed through other small cuts.

Laparoscopic port insertion sites for a cholecystectomy
The laparoscope is passed through a small cut in the navel or above the navel. Working ports are passed through other small cuts.

The surgeon can see the gallbladder and surrounding anatomy via laparoscope on the TV screen. The gallbladder is attached to the liver and also with the bile duct through the cystic duct. The gallbladder has an artery supplying it with blood. All these structures are carefully identified and isolated. The cystic duct and gall bladder artery – cystic artery, are then clipped and divided. The gallbladder is then dissected off the liver. Sometimes a cholangiogram (a special X-ray) is carried out to check for stones in the common bile duct.

Cholangiogram of the biliary tree
Sometimes a cholangiogram (a special X-ray) is carried out to check for stones in the common bile duct. (bile duct exploration)

If there are stones in the common bile duct, ideally they should be removed at same time. If not possible then a procedure called ERCP, which is an endoscopy, may be needed post operatively. Operative site is then checked carefully for any bleeding or bile leak. All the working ports are removed under vision. The skin is then closed either using surgical clips or dissolvable stitches or skin glue.

 

Video of a Laparoscopic Cholecystectomy Operation:

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Post-Operative Care after a laparoscopic cholecystectomy

 

Surgical site closure after Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy after closure

Post-Operative Care after a laparoscopic cholecystectomy

There is no special care after a laparoscopic cholecystectomy. Most of the patients are discharged on the same day after the operation. Instructions to the patients include the following:

There is no special diet after the operation.

  • Patient will be given analgesic – pain control medications.
  • Patients are allowed to resume their normal daily activities as soon as they are comfortable.
  • Dressing and skin glue are water resistant, if patients like to shower, they can do so 24 hrs after the operation.
  • In case of any persistent abdominal pain, fever or feeling unwell, patients are advised to contact the operating team or attend a nearby hospital A&E department.
  • Patients will be seen after 4 -6 weeks of their operation in the clinic and will be informed about the results of the histology of their gall bladder.