Advances in minimally invasive surgery have revolutionized how surgeons approach common abdominal procedures. Traditionally, operations like cholecystectomy (removal of the gallbladder) and appendectomy (removal of the appendix) required separate incisions, sometimes even separate surgeries if performed at different times. However, with the evolution of laparoscopic techniques, it is now possible to perform both procedures simultaneously using the same port system. This combined approach not only reduces surgical trauma but also enhances patient comfort and cosmetic outcomes.

Background

The gallbladder and appendix are two of the most commonly removed organs in general surgery. Gallbladder removal is usually performed for gallstones, cholecystitis, or biliary dyskinesia, while appendectomy is most often required for acute appendicitis. Occasionally, a patient presents with conditions that require both operations, either simultaneously or incidentally discovered during surgery. Instead of creating additional incisions, surgeons can use the same laparoscopic ports to perform both procedures in a single sitting.

This technique reflects the principles of laparo-economy, which emphasizes minimizing the number and size of incisions without compromising surgical safety.

Indications

Cholecystectomy and appendectomy by the same port may be performed in the following situations:

Concomitant Diseases – When a patient has both gallbladder disease and appendicitis at the same time.

Incidental Findings – During laparoscopic cholecystectomy, the appendix may appear inflamed, prompting appendectomy.

Prophylactic Removal – In some cases, surgeons may choose to remove the appendix while operating on the gallbladder to prevent future appendicitis.

Resource-Limited Settings – Where minimizing surgical interventions and anesthesia exposure is beneficial.

Surgical Technique
Patient Preparation

The patient is placed under general anesthesia and positioned supine. Standard laparoscopic preparation and sterile draping are performed.

Port Placement

Typically, a three-port technique is used.

A 10 mm umbilical port is inserted for the camera.

Two 5 mm working ports are placed in the epigastric and right lower quadrant regions.

Importantly, the same port system is utilized to access both operative fields—the gallbladder in the right upper abdomen and the appendix in the right lower abdomen.

Laparoscopic Cholecystectomy

The gallbladder is dissected first in most cases. Key steps include:

Creating pneumoperitoneum for visualization.

Dissection of Calot’s triangle to clearly identify the cystic duct and artery.

Securing and dividing these structures.

Separating the gallbladder from the liver bed using electrocautery.

Retrieving the gallbladder through the umbilical port in a specimen bag.

Laparoscopic Appendectomy

After completing cholecystectomy, attention is directed to the right iliac fossa:

The appendix and mesoappendix are mobilized.

The mesoappendix is sealed and divided, typically with bipolar cautery or ultrasonic energy devices.

The appendix base is ligated with endoloops or staplers.

The appendix is retrieved through the same port as the gallbladder, often using the same retrieval bag.

Closure

After ensuring hemostasis, ports are removed, and small skin incisions are closed with sutures or surgical glue.

Advantages of Combined Procedure

Single Anesthesia Exposure – The patient avoids undergoing two separate surgeries and anesthetic risks.

Reduced Incisions – Only one set of ports is required, minimizing trauma.

Cosmetic Benefit – Fewer scars and smaller incisions enhance cosmetic outcomes.

Faster Recovery – Early mobilization and shorter hospital stay compared to separate procedures.

Cost-Effective – Reduced hospital charges and resource utilization.

Comprehensive Management – Both pathologies are addressed in one sitting.

Challenges and Considerations

While advantageous, combined cholecystectomy and appendectomy by the same port has some challenges:

Patient Selection – Not all patients are suitable. Severe sepsis, diffuse peritonitis, or unstable condition may warrant staged procedures.

Operative Time – Slightly longer than a single procedure, although still less than two separate operations.

Learning Curve – Requires skill in advanced laparoscopic techniques and precise port positioning.

Infection Control – The appendix is often inflamed or infected, raising concerns about contaminating the operative field after cholecystectomy. Surgeons typically use retrieval bags and meticulous irrigation to reduce this risk.

Postoperative Care

Patients recover similarly to those undergoing standard laparoscopic procedures. They may resume oral intake within 24 hours and mobilize early. Pain is mild to moderate and managed with oral analgesics. Most patients are discharged within 1–2 days.

Follow-up includes wound care, monitoring for infection, and evaluation for rare complications such as bile leak, abscess formation, or ileus.

Conclusion

Cholecystectomy and appendectomy performed by the same port system exemplify the efficiency and versatility of modern laparoscopic surgery. By combining two common procedures into one minimally invasive session, surgeons can reduce trauma, enhance patient satisfaction, and optimize healthcare resources. With proper patient selection, careful surgical technique, and adherence to infection-control measures, this approach offers excellent outcomes and represents the future of combined laparoscopic interventions.