Laparoscopic Cholecystectomy

Of all surgical procedures for which laparoscopy is an option, cholecystectomy - gallbladder removal - is the most widely recognised and accepted.

A cholecystectomy is the surgical removal of the gallbladder. Using advanced laparoscopic technology, it is now possible to remove the gallbladder through a tiny incisions in front of the abdomen.

A specialist trained in laparoscopic procedure will recognise any adjunct problems encountered, and be in a position to deal with them.

Indications for laparoscopic gall bladder removal (Cholecystectomy)

• If an attack hasn't settled after 12 hours
• If there are complications such as jaundice, pancreatitis
• If patient suffers recurrent pain or vomiting
• If patient suffers cholangitis

What are the benefits?

The main benefit of this procedure is that it is minimally invasive surgery. Minimally invasive surgery means "Lesser Pain" and "Faster Recovery".

There is no incision pain as occurs with standard abdominal surgery. So the recovery time is much quicker. Also, there is no scar on the abdomen.

Is laparoscopy always advised?

There are very few instances when laparoscopic surgery is not preferable to conventional surgery for cholecystectomy. This is especially true when the surgical and nursing team is well experienced in the procedures and post-operative care.

The only real contraindication is if the anaesthetic risk is too high. Other, lesser contraindications - such as during the first trimester of pregnancy - need not pose a problem to the experienced laparoscopic surgeon. 

• Obesity - there are fewer post-operative complications with laparoscopic surgery
• Previous surgery - adhesions can be dealt with successfully
• Common bile duct stones can be removed by laparoscopy, or by ERCP
• Severe cholecystitis is best dealt with acutely - one operation and recovery period - and can be done safely with laparoscopic technique

Risks & complications

Like any abdominal surgery, laparoscopic cholecystectomy carries some risks. Even though infrequent, it still carries the same risks as general surgery. Current medical reports indicate that the low complication rate is about the same for this procedure as for standard gallbladder surgery.

Complications are rare and may include:

• Bleeding & infection may occur but is rare with experienced surgeons
• In a few cases, the gallbladder cannot be safely removed by laparoscopy. Standard open abdominal surgery is then immediately performed
• Nausea and vomiting may occur after the surgery
• Injury to the bile ducts, blood vessels, or intestine can occur, requiring corrective surgery

Summary

The disposable instruments - used are more expensive but carry no risk of hepatitis or AIDS. There are hidden costs to using non-disposable instruments, in cleaning and handling.

Surgical skill speeds procedures and lessens time-related theatre and anaesthetic charges.

Fewer complications occur, a saving because they add to the expense, requiring more time off work, more medications and more time in hospital.

Routine use of X-ray adds costs to theatre time, also to equipment, radiographer, radiologists and chemicals.

An experienced laparoscopic nursing team - when staff are familiar with the equipment and procedures there will not be problems of inappropriate or unnecessary use of antibiotics or catheters.