Prof John Windsor

Laparoscopic Cholecystectomy

Cholecystectomy is a surgical procedure to remove gallbladder. The gallbladder is a small pear shaped organ attached to the undersurface of the liver, and empties into the common bile duct, which runs from the liver to the duodenum. The gallbladder stores bile and releases it during eating to aid digestion. Removing the gallbladder does not reduce the amount of bile available for digestion.

The most common reason for removing the gallbladder is recurrent pain (biliary colic), infection (acute cholecystitis) and after acute pancreatitis. Gallstones are usually present in these settings.

The gallbladder is removed laparoscopically most of the time, and an open procedure is usually only required if the gallbladder is severely scarred or the anatomy is not clear. This is called a conversion and is not a complication and is only done when it is considered necessary for safety. Laparoscopic cholecystectomy is preferred because it requires a shorter hospital stay, is associated with less pain after surgery and a quicker return to work.

Laparoscopic cholecystectomy involves 4 small puncture wounds. One is close to the umbilicus and this is for the camera system and for inflating the abdomen with carbon dioxide. The gallbladder is grasped and elevated to allow clear exposure of the important area where it connects to the bile duct. Careful dissection is used to demonstrate the connection (cystic duct) and the artery to the gallbladder (cystic artery). When the anatomy is clear these structures are clipped and divided. The gallbladder is then separated from the liver and extracted through the umbilicus. The small puncture wounds are closed.

If there is a concern about the possibility of a stone in the common bile duct, having escaped from the gallbladder, then an X-ray can be done during the operation to detect this (intraoperative cholangiogram). If a small stone is detected an attempt will be made to flush this through into the duodenum. If a larger stone is found then a decision will be made to either deal with it at the time of surgery or rely on postoperative endoscopic treatment (ERCP).

A laparoscopic cholecystectomy is very safe, but can be associated with a number of rare complications. The most important is bile leak due to injury of the common bile duct. This occurs because the anatomy is not clearly displayed before structures are divided. Other possible complications include bleeding, blood clots, and wound infection.

The expectation is that patients can go home the following day and take things quietly for a week or so.

Royal Australasian College of SurgeonsThe University of AucklankMercy Ascotacckuland sages isdeihbpaaasuniversity-society-of-surgeonsssatiap Royal Society Newzealand