Laparoscopic cholecystectomy

2. What is Laparoscopic cholecystectomy
 Cholecystectomy is the surgical removal of the gallbladder.

3.  the gallbladder is a small hollow
organ where bile is stored and
concentrated before it is released
into the small intestine.
 the pear-shaped gallbladder lies
beneath the liver
 It receives and stores bile,
produced by the liver, via the
common hepatic duct, and
releases it via the common bile
duct into the duodenum, where
the bile helps in the digestion of
fats.

4.  GallStones
A gallstone is a stone formed within the gallbladder out of bile components.
 Gallbladder Polyps
these are growths or lesions resembling growths (polypoid lesions) in the wall of
the gallbladder.
 Cholecystitis
it is the inflammation the of the gallbladder (the presence of choleliths or gallstones,
in the gallbladder), with choleliths most commonly blocking the cystic duct directly.

5.  A gallstone is a stone formed within the
gallbladder out of bile components.
 Bile has high concentration of cholesterol and
bile pigments.
 Most stones form inside gall bladder when the
concentration of cholesterol increases.
 The term cholelithiasis may refer to the
presence of stones in the gallbladder or to the
diseases caused by gallstones.

6.  This usually occurs in females, during pregnancy, prolonged fasting, high fat diet
and taking birth control pills.
 They can also form when infections affect the gallbladder like typhoid fever.
 Sometimes stones can form idiopathically (i.e. without any known causes)

7.  they have complaints of heaviness after meals, nausea, gas
bloat and pain in the upper abdomen.
 the pain can be very severe and is located in right upper
abdomen and goes to the back or shoulder. There can
associated vomiting and fever.
 In complicated cases, the stone can slip and block the
common bile duct which will result in jaundice.

8.  Gallbladder polyps are growths or
lesions resembling growths (polypoid
lesions) in the wall of the gallbladder.
 The main types of polypoid growths of
the gallbladder include cholesterol
polyp/cholesterosis, cholesterosis with
fibrous dysplasia of gallbladder,
adenomyomatosis, hyperplastic
cholecystosis, and adenocarcinoma.
 Gallbladder polyps are usually found
incidentally when examining the
abdomen by ultrasound for other
conditions, usually abdominal pain

9.  Cholecystitis is inflammation of the
gallbladder.
 Symptoms include right upper
abdominal pain, nausea, vomiting, and
occasionally fever.
 Acute Cholecystitis is from blockage of
the cystic duct by a gallstone.
 Complications of acute cholecystitis
include gallstone pancreatitis, common
bile duct stones, or inflammation of the
common bile duct.

10.  Age factor (elder you are, higher are the chances of getting cholecystitis)
 Obesity
 Pregnancy
 Diabetes
 Contraceptives (if taken orally)

11.  Acute Calculous Cholecystitis
In this type of cholecystitis, the bile duct is blocked by gallstones
which contribute to retention of the bile juice within the gallbladder.
As a result, the bladder gets thick and inflamed, making it a reddish
and tense piece of meat.
If it is not dealt with strictly, inflammation might affect the
surrounding organ, hence sabotaging the efficiency of closely located
organs.
 Acalculous Cholecystitis
As the name suggests, in this type of cholecystitis, there is not any
stone lodged in the bile duct. However, symptoms are pretty much the
same, and it constitutes about 5-10% of the total cholecystitis’ cases.
It should be noted that the mortality rate associated with this type of
cholecystitis is pretty high so it must be treated strictly.
Moreover, the disease is gender biased and seems to affect men more
than women,

12.  Chronic Cholecystitis
It is probably the worst form of cholecystitis an individual could
ever face. Most of the times, it occurs due to gallstones blocking
the bile duct, but the reasons are not confined to a few.
Typically, chronic cholecystitis occurs due to the recurrence of
cholecystitis, and it might lead to some other significant
diseases.
It should be noted that XGC (Xanthogranulomatous cholecystitis)
is another complicated type of chronic cholecystitis which
resembles that of cancer but actually, it is not cancer.

13.  Peritoneal irritation might occur, radiating the pain towards scapula
(this is one of the core signs of acute cholecystitis)
 Pain in the epigastric region, localising towards its upper quadrant
 Initially, the intensity of pain might fluctuate, but eventually, it
becomes constant
 Fever
 Vomiting
 Nausea
 Localised tenderness (if it is not treated promptly, complications
might occur without any further warning)
 Jaundice

14.  Ultrasonography (used to generate visual images of the organs to determine
any inflammation or irregularity in the shape of gallbladder and related organs)
 Radiography
 CT scan (particularly used to generated computerised images of the
gallbladder)
 Magnetic Resonance Imaging (MRI)
 Pregnancy testing
 Urinalysis (for determining the probability of renal calculi)
 ERCP
 Cholangiography (a dye is used (injected in the bile duct) to have a view of the
gallbladder and ducts)

15.  Laparoscopic cholecystectomy uses several
(usually 4) small incisions in the abdomen to
allow the insertion of operating ports, small
cylindrical tubes approximately 5 to 10 mm
in diameter, through which surgical
instruments are placed into the abdominal
cavity.
 The laparoscope, an instrument with a
video camera and light source at the end,
illuminates the abdominal cavity and sends a
magnified image from inside the abdomen
to a video screen, giving the surgeon a clear
view of the organs and tissues.

16.  The cystic duct and cystic artery are
identified and dissected, then ligated
with clips and cut in order to remove the
gallbladder.
 The gallbladder is then removed through
one of the ports.
 Laparoscopic surgery is thought to have
fewer complications, shorter hospital
stay, and quicker recovery than open
cholecystectomy.

17.  Laparoscopic surgery is thought to have fewer complications, shorter hospital stay,
and quicker recovery than open cholecystectomy.
 The surgery taken around 30 -45 minutes to perform and the duration of hospital
stay is normally two days.

18.  Complications may include bleeding, infection and injury to
the duct (tube) that carries bile from your gallbladder to your
duodeunum (small intestine).
 during laparoscopic cholecystectomy, the intestines or major
blood vessels may be injured when the instruments are
inserted into the abdomen.
 All of these complications are rare.

19.  Is it not possible to remove the stones through medicines?
Till date, there is no drug which is effective in dissolving or removing
the stones.
if a drug does result in expulsion of the stone, there is a risk of causing
blockage of the CBD resulting in jaundice.
 Is it not possible to remove only the stones leaving the gall bladder
behind?
Since the stones form in a gallbladder which is diseased, it is necessary
to remove the entire gallbladder; otherwise stones would definitely
form inside again.

20.  Is there any problem of digestion of food if the gallbladder is removed?
Since the gallbladder is only responsible for storage of bile, the production of
bile from the liver is unaffected by this operation. Hence, the digestion of food
remains normal even after surgery.
 Diet advised after surgery?
The patient is started on liquids 4-6 hours after the operation.
They can take soft diet the next day and can have their full diet 2-3 days after
the surgery.
They are told to avoid fatty/fried food for at least 2 weeks after the operation.