Gallbladder stones, or cholelithiasis, are a prevalent condition worldwide, affecting millions of people. They form when components of bile—such as cholesterol, bile salts, and bilirubin—become imbalanced, leading to crystal formation. While some patients remain asymptomatic, many develop pain, inflammation, or complications requiring surgical intervention. Laparoscopic cholecystectomy, commonly referred to as lap chole, has become the gold standard for gallbladder stone surgery due to its minimally invasive nature, faster recovery, and excellent safety profile.

Indications for Laparoscopic Gallbladder Surgery

Laparoscopic cholecystectomy is indicated in patients with:

Symptomatic gallstones causing recurrent biliary colic

Acute or chronic cholecystitis

Gallstone pancreatitis or cholangitis

Suspicious gallbladder polyps or tumors

Non-functioning gallbladder on imaging studies

Even in asymptomatic patients, surgery may be recommended in cases with a high risk of complications, such as porcelain gallbladder, sickle cell disease, or large stones (>2–3 cm).

Advantages of Laparoscopic Surgery

Laparoscopic gallbladder surgery has largely replaced open surgery due to multiple benefits:

Minimally Invasive – Small incisions reduce trauma and postoperative pain.

Faster Recovery – Most patients resume daily activities within 1–2 weeks.

Short Hospital Stay – Often discharged within 24–48 hours.

Lower Complication Rate – Reduced infection, wound problems, and hernia risk.

Better Cosmetic Results – Small scars compared to a large abdominal incision.

Preoperative Preparation

Successful laparoscopic surgery requires proper preoperative preparation:

Medical Evaluation: Blood tests, liver function tests, and imaging such as ultrasound, CT scan, or MRCP to assess stone size, number, and anatomy.

Fasting: Patients are advised to fast for 6–8 hours prior to surgery to reduce aspiration risk.

Medication Review: Anticoagulants, antiplatelets, and other medications may require adjustment.

Informed Consent: Patients are counseled about the procedure, risks, benefits, and postoperative expectations.

Surgical Technique of Laparoscopic Cholecystectomy
Anesthesia and Positioning

The procedure is performed under general anesthesia.

The patient is placed in a supine position with slight reverse Trendelenburg and left tilt to allow bowel loops to fall away from the gallbladder region.

Port Placement

Typically, four ports are used:

10 mm umbilical port for the laparoscope

10 mm epigastric port for dissecting instruments

Two 5 mm ports in the right upper quadrant for retraction and accessory instruments

Step 3: Exposure of Calot’s Triangle

The gallbladder is retracted to expose Calot’s triangle.

Careful dissection is performed to identify the cystic duct and cystic artery, ensuring the critical view of safety (CVS) is achieved before ligation.

Ligation of Cystic Duct and Artery

The cystic duct and artery are ligated using clips or sutures (e.g., Mishra’s Knot) and divided.

This step prevents postoperative bile leakage and hemorrhage.

Dissection and Gallbladder Removal

The gallbladder is carefully dissected from the liver bed using electrocautery or energy devices.

Once freed, it is retrieved via the umbilical port using a specimen bag to prevent spillage of bile or stones.

Closure

Hemostasis is confirmed.

Ports are removed, and the incisions are closed using absorbable sutures or skin adhesives.

Risks and Complications

While laparoscopic cholecystectomy is safe, potential complications include:

Bleeding – Usually minor, but may require intervention.

Bile leakage – Rare; may result from injury to bile ducts.

Injury to adjacent organs – Liver, intestines, or common bile duct injuries are uncommon but serious.

Infection – Both at incision sites and internally.

Conversion to Open Surgery – Required in cases of severe inflammation, adhesions, or anatomical difficulties.

Postoperative Care

Diet: Gradual progression from liquids to solid food over several days.

Activity: Light activity is encouraged; heavy lifting is avoided for a few weeks.

Pain Management: Analgesics are prescribed as needed.

Follow-Up: Monitoring for complications such as persistent pain, fever, jaundice, or bile leakage.

Outcomes

Laparoscopic gallbladder surgery has excellent outcomes:

Rapid relief of symptoms

Low recurrence, as stones are completely removed

Minimal scarring and faster return to daily activities

High patient satisfaction and quality-of-life improvement

Studies show laparoscopic cholecystectomy has shorter hospital stays, less pain, and quicker recovery compared to traditional open surgery.

Conclusion

Gallbladder stone surgery by laparoscopy is a safe, effective, and minimally invasive procedure for treating symptomatic cholelithiasis and its complications. Proper preoperative preparation, meticulous surgical technique, and postoperative care are essential for optimal outcomes. With modern laparoscopic methods, patients benefit from rapid recovery, minimal complications, and excellent long-term results, making it the standard of care for gallbladder stone management.

If you want, I can also create a step-by-step illustrated guide for laparoscopic gallbladder stone surgery, showing port placement, dissection of Calot’s triangle, and gallbladder removal, which is perfect for surgical training or teaching videos.