The indications for cholecystectomy in Laparoscopic Era
The indications for cholecystectomy remain the same and should not be liberalized because the laparoscopic procedure is viewed as lower in morbidity than its open counterpart. Conditions for which the procedure is used include the symptomatic cholelithiasis. Ultrasound con formation of gallstones in conjunction with a classic history is sufficient to make the diagnosis. The most common symptom pattern consists of episodic epigastric or right upper quadrant pain occurring several after meals. Patients with nonspecific symptom, such as nausea, bloating, indication and flatulence, are sometimes benefited by cholecystectomy however, the more the symptoms differ from the classic pattern of biliary pain, the less likely the patterns of biliary pain, the less likely the patient is to experience relief after cholecystectomy.
Acute cholecystitis, typically causing constant right upper quadrant discomfort accompanied by objective signs of right upper quadrant tenderness with or without a Murphy’s sign or a palpable mass, fever and leukocytosis are common but not necessary for cholecystitis to be present. Despite inflammation, laparoscopic cholecystectomy may be accomplished in most patients without conversion to an open procedure. Calculous biliary tract disease causes most acute cholecystitis and stones are seen on ultrasound examination.
Acute acalculous cholecystitis occurs in critically ill patients, those on prolonged total parentereral nutrition, and some immune suppressed patients. The diagnosis is suggested by thickening of the gallbladder wall on ultrasound, pericholecystic fluid or delayed empting. Although laparoscopic cholecystectomy may management option for critically ill patients.
Individuals with asymptomatic cholelithiasis may be appropriate candidates for laparoscopic objective test under specific circumstances such as candidacy for renal transplant. Patients with episodes of right upper quadrant pain, which are “classic” for biliary pain without evidence of cholelithiasis on objective test such as ultrasound or endoscopic retrograde cholangio pancereatography (ercp) may also be referred for laparoscopic cholecystectomy, but sustained resolution of symptoms is less likely in these patients. Biliary dyskinesia, determined by objective measurement of gallbladder emptying after fatty meal or cholecystokinin infusion, may be presenting some of these patients. Gallstone pancreatitis occurs when small stones pass through the cystic duct. To prevent recurrence, Cholecystectomy should be performed after the pancreatitis has resolved, cholangiography is prudent to exclude small stones in the common duct.
Contraindications to laparoscopic cholecystectomy include the inability to tolerate general anesthesia, significant portal hypertension and uncorrectable coagulopathy. The patient must be a suitable candidate for the equivalent open surgical procedure, since conversion to an open procedure, may be necessary. Multiple prior operations inflammation from acute cholecystitis, or pancreatitis or unclear anatomy may preclude safe laparoscopic dissection and may require conversion to an open procedure. Conversion to an open procedure represent under these circumstances.
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