Chronic cholecystitis surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

Overview

Gallbladder removal, cholecystectomy, can be accomplished by the open surgery or a laparoscopic procedure. Laparoscopic cholecystectomy is the operation of choice in uncomplicated calculous cholecystitis. Open cholecystectomy may be performed in complicated cases or when trained/skilled personal for laparoscopic procedure is not available. Supportive measures are instituted in the meantime to prepare the patient for surgery. These measures include fluid resuscitation and antibiotics. Antibiotic regimens usually consist of a broad spectrum cephalosporin such as ceftriaxone and an antibacterial with good cover against anaerobic bacteria, such as metronidazole.

Surgery

Removal of the gallbladder may be done by open surgery or a laparoscopic approach. Laparoscopic cholecystectomy is the procedure of choice in uncomplicated calculous cholecystitis. Open cholecystectomy may be performed in complicated cases or when trained or skilled personal for laparoscopic procedure is not available. Supportive measures such as fluid resuscitation and antibiotics are instituted in the meantime to prepare the patient for surgery. Antibiotic regimens usually consist of a broad spectrum cephalosporin such as ceftriaxone and an antibacterial with good cover against anaerobic bacteria, such as metronidazole.[1][2]

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is a minimally invasive surgical procedure and has various indications in addition to the chronic cholecystitis. There are two main types of procedures used for the laparoscopic cholecystectomy ; Single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC).[3][4][5][6]

  • Single-incision laparoscopic cholecystectomy (SILC)
    • As compared to CMLC, SILC has the following features:
      • Improved cosmetic results
      • Decreased postoperative pain
      • Increased operative time
      • Increased intraoperative blood loss
  • Conventional multiport laparoscopic cholecystectomy (CMLC)
    • As compared to SILC, CMLC has the following features:
      • Decreased operative time
      • Decreased intra-operative blood loss

Indications

Contraindications

The contraindications of laparoscopic cholecystitis include:[1][2]

Major Complications of cholecystectomy

The major complications associated with the cholecystectomy are:[7]

Percutaneous cholecystostomy

Percutaneous cholecystostomy (PC) is an alternative to emergency cholecystectomy in complicated cases of high-risk patients.[8][9][10]

X-Ray during laparoscopic cholecystectomy

References

  1. 1.0 1.1 1.2 Movchun AA, Koloss OE, Oppel' TA, Abdullaeva UA (1998). "[Surgical treatment of chronic calculous cholecystitis and its complications]". Khirurgiia (Mosk) (in Russian) (1): 8–10. PMID 9511287.
  2. 2.0 2.1 2.2 Fletcher DR (2001). "Gallstones. Modern management". Aust Fam Physician. 30 (5): 441–5. PMID 11432016.
  3. Sato N, Yabuki K, Shibao K, Mori Y, Tamura T, Higure A, Yamaguchi K (2014). "Risk factors for a prolonged operative time in a single-incision laparoscopic cholecystectomy". HPB (Oxford). 16 (2): 177–82. doi:10.1111/hpb.12100. PMC 3921014. PMID 23557447.
  4. Antoniou SA, Pointner R, Granderath FA (2011). "Single-incision laparoscopic cholecystectomy: a systematic review". Surg Endosc. 25 (2): 367–77. doi:10.1007/s00464-010-1217-5. PMID 20607556.
  5. Leung D, Yetasook AK, Carbray J, Butt Z, Hoeger Y, Denham W, Barrera E, Ujiki MB (2012). "Single-incision surgery has higher cost with equivalent pain and quality-of-life scores compared with multiple-incision laparoscopic cholecystectomy: a prospective randomized blinded comparison". J. Am. Coll. Surg. 215 (5): 702–8. doi:10.1016/j.jamcollsurg.2012.05.038. PMID 22819642.
  6. Pisanu A, Reccia I, Porceddu G, Uccheddu A (2012). "Meta-analysis of prospective randomized studies comparing single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC)". J. Gastrointest. Surg. 16 (9): 1790–801. doi:10.1007/s11605-012-1956-9. PMID 22767084.
  7. "www.ncbi.nlm.nih.gov" (PDF). Retrieved 2012-08-20.
  8. Knab LM, Boller AM, Mahvi DM (2014). "Cholecystitis". Surg. Clin. North Am. 94 (2): 455–70. doi:10.1016/j.suc.2014.01.005. PMID 24679431.
  9. Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF (2017). "Acute calculous cholecystitis: Review of current best practices". World J Gastrointest Surg. 9 (5): 118–126. doi:10.4240/wjgs.v9.i5.118. PMC 5442405. PMID 28603584.
  10. Yeo CS, Tay VW, Low JK, Woon WW, Punamiya SJ, Shelat VG (2016). "Outcomes of percutaneous cholecystostomy and predictors of eventual cholecystectomy". J Hepatobiliary Pancreat Sci. 23 (1): 65–73. doi:10.1002/jhbp.304. PMID 26580708.




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