GALL BLADDER – LAPAROSCOPIC CHOLECYSTECTOMY
Approximately 8% percent of the adult population or more than 5.5 million people in the United Kingdom have gallstones. About 50,000 of these patients undergoing gallbladder surgery each year. Cholecystectomy Is the surgical removal of the gallbladder. It is a common treatment of symptomatic gallstones and other gallbladder conditions. Surgical options include the standard procedure, called laparoscopiccholecystectomy, and an older more invasive procedure, called open cholecystectomy.
Indications for cholecystectomy include inflammation of the gall bladder (cholecystitis), biliary colic, risk factors for gall bladder cancer,and pancreatitis caused by gall stones.Cholecystectomy is the recommended treatment the first time a person is admitted to hospital for cholecystitis. Cholecystitis may be acute or chronic, and may or may not involve the presence of gall stones. Risk factors for gall bladder cancer include a “porcelain gallbladder,” or calcium deposits in the wall of the gall bladder, and an abnormal pancreatic duct.Cholecystectomy can prevent the relapse of pancreatitis that is caused by gall stones that block the common bile duct.
Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first-choice of treatment for gallstones and inflammation of the gallbladder unless there are contraindications to the laparoscopic approach. This is because open surgery leaves the patient more prone to infection. Sometimes, a laparoscopic cholecystectomy will be converted to an open cholecystectomy for technical reasons or safety.
Laparoscopic cholecystectomy requires several small incisions in the abdomen to allow the insertion of operating ports, small cylindrical tubes approximately 5 to 10 mm in diameter, through which surgical instruments and a video camera are placed into the abdominal cavity. The camera illuminates the surgical field and sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. The surgeon watches the monitor and performs the operation by manipulating the surgical instruments through the operating ports.
Recently, this procedure is performed through a single incision in the patient’s umbilicus. This advanced technique is called Laparoendoscopic Single Site Surgery or “LESS” or Single Incision Laparoscopic Surgery or “SILS”. In this procedure, instead of making 3-4 four small different cuts (incisions), a single cut (incision) is made through the navel (umbilicus). Through this cut, specialized rotaculating instruments (straight instruments which can be bent once inside the abdomen) are inserted to do the operation. The advantage of LESS / SILS operation is that the number of cuts are further reduced to one and this cut is also not visible after the operation is done as it is hidden inside the navel. A meta-analysis published by Pankaj Garg et al. comparing conventional laparoscopic cholecystecomy to SILS Cholecystectomy demonstrated that SILS does have a cosmetic benefit over convention four-hole laparoscopic cholecystectomy while having no advantage in postoperative pain and hospital stay.