Cholecystectomy

About Cholecystectomy

Cholecystectomy is the surgical removal of the gallbladder and is one of the most common abdominal operations. It is most often performed for symptomatic gallstones, which can cause biliary colic, acute cholecystitis, gallstone pancreatitis and stones in the common bile duct. The first cholecystectomy was performed by the German surgeon Carl Langenbuch in 1882. Laparoscopic cholecystectomy, developed in the mid to late 1980s, rapidly became the standard approach and is used in the large majority of operations, typically through four small ports. The key safety principle is achieving the critical view of safety, clearly displaying the cystic duct and cystic artery in the hepatocystic triangle, also called the triangle of Calot, before they are clipped and divided, in order to avoid injury to the common bile duct. The gallbladder is then dissected from the liver bed and removed in a retrieval bag. Bile duct injury is uncommon but is the most feared complication and may require complex reconstruction such as a Roux en Y hepaticojejunostomy; other complications include bile leak, bleeding, infection and retained bile duct stones. Open cholecystectomy, usually through a right subcostal Kocher incision, is now mainly performed when the laparoscopic approach is unsafe or cannot be completed, for example because of severe inflammation, unclear anatomy, uncontrolled bleeding or suspected bile duct injury. Conversion is more likely with acute cholecystitis, older age and obesity. Single incision and robotic techniques are also used. Some people experience persistent abdominal symptoms afterward, sometimes called post cholecystectomy syndrome.