Minimally invasive surgery has revolutionized abdominal procedures by reducing postoperative pain, accelerating recovery, and improving cosmetic outcomes. Among these innovations, laparoscopic cholecystectomy and appendectomy performed through the same port has emerged as an effective technique for patients with concurrent gallbladder and appendiceal pathology. This combined approach offers the advantage of treating two common surgical conditions simultaneously while minimizing surgical trauma and hospital stay.

Indications and Patient Selection

Combined laparoscopic cholecystectomy and appendectomy are indicated in patients who present with both cholelithiasis (gallstones) and acute or chronic appendicitis, or in rare scenarios where incidental appendiceal pathology is discovered during gallbladder surgery. Ideal candidates are those with no significant comorbidities that would contraindicate laparoscopic surgery and those with favorable anatomy allowing safe visualization and dissection through a single port. Proper preoperative evaluation is critical, including abdominal ultrasonography, CT scan if needed, and routine laboratory investigations.

Advantages of the Same-Port Technique

Performing both procedures through the same port provides several advantages:

Reduced Invasiveness: Traditional laparoscopic surgery requires multiple ports. Using a single port reduces the number of incisions, leading to less postoperative pain.

Improved Cosmesis: A single incision, often hidden within the umbilicus, provides excellent cosmetic results.

Shorter Hospital Stay: Combined procedures allow faster recovery and discharge compared to separate surgeries.

Lower Costs: Fewer instruments and shorter operative time can reduce overall treatment costs.

Surgical Technique

The surgery is performed under general anesthesia with the patient in the supine position. A detailed step-by-step technique is as follows:

Port Placement: A single 2–3 cm transumbilical incision is made, and a multi-channel port or single-port device is introduced. Pneumoperitoneum is established, and a laparoscope along with specialized instruments is inserted through the same port.

Exploration: The abdominal cavity is carefully examined to identify the gallbladder and appendix. Adhesions, if present, are gently released to create a clear operative field.

Laparoscopic Cholecystectomy: The gallbladder is mobilized by dissecting the Calot’s triangle. The cystic duct and artery are clipped and divided, and the gallbladder is separated from the liver bed using electrocautery. Careful attention is paid to avoid bile duct injury. The gallbladder is temporarily placed in a retrieval bag to prevent spillage.

Laparoscopic Appendectomy: Following cholecystectomy, the appendix is identified, usually in the right lower quadrant. The mesoappendix is divided with electrocautery or ultrasonic energy, and the appendiceal base is ligated or stapled. The appendix is removed through the same umbilical port using a specimen bag to prevent contamination.

Closure: After ensuring hemostasis and irrigation of the abdominal cavity, the single port is removed, and the fascia is closed with absorbable sutures. The skin incision is closed with subcuticular sutures or adhesive strips, leaving minimal visible scarring.

Intraoperative Considerations

Performing two procedures through the same port requires careful coordination and instrument handling. Surgeons should be skilled in single-incision laparoscopic surgery (SILS) techniques to avoid instrument collisions and ensure adequate visualization. Use of articulating instruments and flexible laparoscopes can greatly facilitate the procedure.

Postoperative Care

Patients generally tolerate same-port surgery well, experiencing minimal pain and early mobilization. Oral intake can usually be resumed within 6–12 hours postoperatively. Antibiotics are administered prophylactically, especially after appendectomy. Patients are monitored for complications such as bleeding, infection, or bile leakage. Most patients can be discharged within 24–48 hours, with complete recovery in one to two weeks.

Outcomes and Complications

Studies have shown that combined same-port laparoscopic cholecystectomy and appendectomy are safe and effective. Postoperative pain is reduced compared to conventional multiport surgery, and cosmesis is significantly improved. Complications, though rare, may include bile duct injury, port-site infection, or intra-abdominal abscess. These risks can be minimized with meticulous surgical technique and proper patient selection.

Conclusion

Laparoscopic cholecystectomy and appendectomy performed through the same port represent a significant advancement in minimally invasive surgery. This approach allows simultaneous management of two common abdominal conditions with minimal trauma, reduced postoperative pain, shorter hospital stay, and superior cosmetic outcomes. With appropriate patient selection, experienced surgical technique, and careful postoperative care, this combined procedure can provide excellent long-term results, improving patient satisfaction and overall quality of life.