Cholecystectomy
Surgical removal of the gallbladder and associated stones in the biliary
tract may be by open surgery or laparoscopic surgery.
Cholecystectomy may be indicated for symptomatic gallstones.
Cholecystectomy is also considered in younger patients with asymptomatic
gallstones in order to prevent complications such as acute pancreatitis. Carcinoma
of the gallbladder is treated by wider resection, including neighbouring
segments of the liver and regional lymph nodes.
Open cholecystectomy is usually performed through a right subcostal
(Kocher) incision or by a paramedian or midline incision. Cholangiography may
be used to visualise the duct system. The gallbladder is removed with ligation
and division of the cystic duct and artery. If stones have been found, the
common bile duct may be opened longitudinally and the stones removed. A T-tube is
sited into the opening, which is brought out to the abdominal wall. The T-tube
allows drainage of bile and also allows a cholangiogram later. Alternatively,
common bile duct stones are removed at endoscopic retrograde
cholangiopancreatography (ERCP).
Laparoscopic cholecystectomy requires three or four cannulae inserted
through the anterior abdominal wall, for visualisation and access with
operative instruments. The cystic duct and artery are clipped and dissected,
while the gallbladder is held retracted.
Open cholecystecomy often requires quite a long stay in hospital,
possibly a week or more, whereas laparoscopic cholecystectomy may be conducted
as a day case.
Complications include haemorrhage, respiratory problems and wound
infection. Bile leakage and haemorrhage may require further surgery.
Laparoscopic technique reduces the incidence of respiratory problems and
surgical site infection.
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