Laparoscopic cholecystectomy

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Contents

History

The first laparoscopic cholecystectomy was performed by Erich Muhe in 1985.[1] Several other surgeons have also been credited with pioneering the operation inclding Phillipe Mouret (1987), Perissat, Berci, Cuschieri and Dubois.[2] [3] In 2010 Iain Jourdan introduced practicable 3D laparoscopic cholecystectomy.

Indications

Pre-operative Considerations

  • Exclude other causes of dyspepsia/upper GI discomfort
  • Liver function tests
  • Ultrasound

Complications

Complications mentioned during consent vary between surgeons,[4] but include:

  • Conversion to open (1:20 = 4-5%)
  • Bile duct injury (1:400 to 1:2000) - uncommon, but may require further surgery
  • Retained common bile duct stones
  • DVT/PE
  • Bleeding
  • Wound infection
  • Damage to other viscera
  • Port site hernia (rare)

Procedure

Look for 1) Free flow of contrast into the duodenum, 2) Absence of filling defects, 3) Normal intra-hepatic ducts (implying bile duct undamaged)
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T-tube cholangiogram

If CBD exploration required, it may require a T-tube for subsequent exclusion of

Bile Duct Injuries

See http://www.medscape.com/viewarticle/506432 for cognitive factors in making and recognising errors.

  • Less common and more likely to be recognised if intra-operative cholangiogram performed
  • 20-30% associated with vascular injuries, e.g. hepatic artery damage
  • If immediately recognised - refer to specialist for treatment, e.g. primary repair or hepaticojejunostomy + Roux-en-Y
  • If delayed, laparoscopic wash-out and place drains.

Complications

  • Biliary peritonitis
  • Biloma
  • Associated

References

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