DIAGNOSIS

It is based on clinical presentation and evidence of gallstones on imaging. An abdominal ultrasound is the standard diagnostic test for gallstones and acute or chronic cholecystitis.

TREATMENT / INDICATIONS

Laparoscopic cholecystectomy, there is no other medical treatment that definitively and permanently resolves gallbladder diseases. It offers excellent long term results with the disappearance of symptoms.

• Indications for laparoscopic cholecystectomy:
  • Symptomatic patients with gallstones or gallbladder disease (e.g., acute or chronic cholecystitis)
  • Diabetics should be treated immediately because of the increased risk of complications.
  • Pregnant women with symptomatic gallstones in whom expectant management fails can safely undergo surgery during the second trimester.
  • Biliary dyskinesia or gallbladder dyskinesia
  • calcification of the gallbladder wall («porcelain gallbladder»)
  • Gallstone larger than 2 cm, even if asymptomatic

• Contraindications:
  • Patient unable to tolerate general anesthesia.
  • Pregnancy, first or third trimester.
  • High bleeding risk

ADVANTAGES OF LAPAROSCOPIC SURGERY

• Very small incisions (3 to 4) and in selected cases, even ONE incision (single port access surgery).
• Rapid recovery time (one night hospitalization)
• Minimal postoperative pain.
• Lower morbidity rate
• Shorter hospital stay
• Return to normal activity and return to work in a shorter period of time (full recovery in 5 to 7 days).
• Decreased risk of wound infection and hernia formation.
• Minimal scarring

COMPLICATIONS (ALL RARE IN EXPERT HANDS)

• Wound infection 1 to 4%.
• Sangrado <1%
• Pancreatitis <0.3%
• Bile leakage 0.7% Bile leakage 0.7% Bile leakage 0.7% Bile leakage 0.7% Bile leakage
• Piedra retenida en Ducto común (colédoco) <5%
• Bile duct lesion 0.4%.
• Conversion to open surgery less than 5%. **

** Conversion should never be considered a failure, but rather a tool when Dr. Rosales decides that the laparoscopic approach could lead to unnecessary complications. Factors contributing to the need to convert to an open procedure are:

• • Elderly patient
  • American Society of Anesthesiologists (ASA) High Class
  • Extreme obesity
  • Thickened gallbladder wall

SURGICAL TECHNIQUE (SIMPLIFIED EXPLANATION)

Under general anesthesia, a 10 mm incision is made in the umbilicus, CO2 is introduced into the cavity, then 3 more incisions are made in the abdomen (one of 10 mm and 2 of 5 mm) to introduce the rest of the instruments. The gallbladder and the structures that join it to the body are identified, stapled and cut, then the gallbladder is removed through one of the incisions, closed with sutures and the procedure is completed.

Incisions for Laparoscopic Gallbladder Surgery