Laparoscopic cholecystectomy is minimally invasive surgical procedure that involves the removal of the gall bladder. A minimally invasive procedure involves the assistance of a laparoscope and several specialised laparoscopic surgical tools.
Gall bladder removal is one of the most commonly performed surgical procedures. The gall bladder is an internal organ that is pear-shaped and it is located beneath the liver on the right side. The gall bladder serves the purpose of collecting and concentrating the bile juice that is usually produced by the liver. During digestion this bile juice is released by this internal organ to aid in the digestion process.
What causes the removal of the gall bladder?
The gall bladder can develop some problems which contribute to its removal. This problem is mainly caused by the formation of gallstones. These stones are usually hard and they are made of cholesterol and bile salts which usually form or settle in the bile duct or the gall bladder.
The gallstones block the flow of bile from the gall bladder making it impossible for the gall bladder to release the bile juice for digestion. When this happens the gall bladder swells and this leads to severe abdominal pain, vomiting, indigestion and sometimes even fever. Studies have not yet given any means on how the gallstones can be prevented from occurring. It is noted that gallstones are very common when people are getting older and females are more prone to this condition. Severe gallstones can lead to the yellowing of the skin which is commonly known as jaundice.
The removal of the gall bladder by surgery is the most effective way to treat gallstones. There are two main methods that are used in the removal of the gall bladder:
· Laparoscopic cholecystectomy. Here small incisions are made in your abdomen and specialised laparoscopic surgical tools are inserted through the ports in order to perform the surgery.
· Open cholecystectomy. Involves the making of a large incision in your abdomen in order to access and remove the gall bladder.
Laparoscopic cholecystectomy is most rapidly used method for the treatment of the gall bladder. Initially laparoscopic cholecystectomy was reserved for the thin and young people, today it can be done even on the older and obese patients.
How laparoscopic cholecystectomy is performed
Laparoscopic cholecystectomy has become the most preferred surgical procedure for the removal of gall bladder. Everyone is shifting from the traditional open cholecystectomy to this minimally invasive procedure.
Just like any other laparoscopic surgery laparoscopic cholecystectomy is performed under general anaesthesia. A Small incision approximately half inch in size is made in the abdomen around the umbilicus. Three other incisions are made and through the incisions the laparoscopic surgical tools are inserted in order to allow the surgery to be performed.
A laparoscope is inserted through one of the ports and this instruments sends images of the internal organs to a monitor. This monitor enables the surgeon to view the patient’s internal organs and he is also able to move the surgical tools accurately.
The special laparoscopic surgical tools that are inserted through the other ports are controlled by the surgery and they separate the gall bladder from its surrounding tissues or its attachments from the liver and the bile duct. Once it is separated it is removed through the one of the ports form the inside of the abdomen. After the gall bladder is successfully removed from the abdomen, the incisions are sutured close and well dressed.
Advantages of laparoscopic cholecystectomy
Laparoscopic cholecystectomy is a minimally invasive procedure thus its advantages are similar to those of other minimally invasive procedures.
Here are some of the advantages:
· Shorter hospital stay. Laparoscopic cholecystectomy can be done as an outpatient procedure. Patients really don’t need to stay are hospital for longer times. Some can leave the hospital one day after the surgery and others may even leave the same day the surgery is done. Open cholecystectomy is usually associated with a longer hospital stay.
· Reduced recovery periods. The recovery period is often very short since only small incisions are made unlike in the standard open cholecystectomy. These incisions take a very short period to heal and thus patients can get back to their normal lives within a very short time. Patients can remove the dressings in on the incisions a day after the procedure is done. This is so different with the open cholecystectomy since a large incision is made in the abdomen. This large incision could take a longer time to heal and thus patients especially those who do manual and heavy jobs would require a longer time to heal.
After the surgery walking is always encouraged and patient can walk up and down the stairs. However, this would depend on how the patient is feeling. The healing while at home is generally progressive. Appointment with the doctor within two or three weeks after the operation is also necessary in order to ensure that the healing has happened without any complications.
Complications of laparoscopic cholecystectomy
Laparoscopic cholecystectomy has rapidly replaced the conventional open cholecystectomy over the years. However, this procedure is associated with some complications in some occasions. There are risk associated with any surgical procedure and thus patients should always be aware of the risks before undergoing any type of the surgery, laparoscopic cholecystectomy is no exception. Patients should always know the experience of the surgeon before undergoing this procedure.
Laparoscopic cholecystectomy is considered as a relatively safe procedure but there are some small risks of complications.
The complications may include:
1. Technical difficulty
While performing the operation the surgeon can be faced by some technical difficulties. This depends on several factors including shrunken fibrotic gall bladder and the presence of cirrhosis in the liver. The degree of difficulty can be so high that the surgeon will be forced to complete the surgery using the conventional open cholecystectomy. Also if the patient has undergone several previous abdomen surgeries, it may become difficult for the surgeon to perform laparoscopic cholecystectomy due to many scars on the tissues.
2. Intra operative complications
Internal accidents or incidents may occur during the surgery. This can lead to injuries in the internal organs that can lead to internal bleeding or haemorrhage.
The intra operative complications include:
· Bleeding or inter-operative haemorrhage.
The bleeding complication occurs from different sites in the internal organs. This can be from the arteries, the liver or the incision sites. More bleeding comes occurs at the liver bed. This bleeding is very common during the final stages of the removal of the gall bladder. The gall bladder has to be separated from its attachments to the liver and during the removal from the hepatic fossa. Sometimes if the haemorrhage is too much, the surgery is immediately converted to the open cholecystectomy in order to control the bleeding through stitch ligation.
Bleeding from the arterial sites can be controlled by use of clips. The bleeding from the arterial sites should be identified immediately in order to avoid too much loss of blood which would require the patient to have blood transfusion.
The incision sites can also bleed, this can be so due to removal of the trocar at the end of the operation. Surgeons should always ensure direct visualization of the trocar removal to avoid bleeding.
· Gall spillage
This occurs in patients with a shrunken fibrotic gall bladder. The gall bladder can be perforated during its dissection and removal. If this happens the gallstones can be lost in the internal organs and looking for them can prolong the operation. This can even call for immediate conversion to open cholecystectomy.
· Bowel injury
The dissections of the gall bladder from the duodenum can lead to perforation. The small intestine and the colon can also be perforated as the surgical tools are being moved. If these injuries are not detected during the surgery the patient may develop certain complications including peritonitis within a very short time usually two days. These injuries need to be repaired and conversion to an open procedure could be the best way to repair the injuries if the repairs cannot be repaired through the laparoscopic procedures.
3. Port site complications
This can be in form of hernia and it happens if the port sites were not closed well.
4. Post cholecystectomy syndrome
Post cholecystectomy syndrome is collection of the persistent symptoms following cholecystectomy. The symptoms include, persistent abdominal pain and dyspepsia. These persistent symptoms are linked to presence of long cystic duct remnant, gallstones in the remnant cystic duct and also incomplete cholecystectomy.
Laparoscopic cholecystectomy when done well can be a very effective method for the treatment of gall bladder. The complications that are associated with this method can be reduced and most of them depend on the skills of a surgeon. If the surgeon is not skilled enough and without adequate experience, there is a high likelihood of occurrence of complications. Most of these complications occur during the surgery and are known as intra-operative complications. These intra-operative complications can be in form of haemorrhage and injuries to the internal organs. Every surgeon should advocate for enhance visualization in order to avoid perforations of the various internal organs surrounding the gall bladder. The incisions should properly sutured close to avoid all the defective closures that can lead to post-operative complications later.
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