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Gallbladder, gallbladder, gallbladder stones, cholelithiasis

Laparoscopic cholecystectomy: what is it?

Laparoscopic cholecystectomy is one of the most frequently and ubiquitously performed surgeries today. It was also the first laparoscopic surgery whose technique has been standardized since Philippe Mouret first performed it in 1987, thus ushering in the era of minimally invasive surgery.

The reason for its prevalence is related to the high frequency of the main disease of the gallbladder, calcinosis, also called cholelithiasis. The pathogenesis of this disease is multifactorial; it is typically described as "the disease of the 4 Fs"(female, forthy, fatty, fertility), being more frequent in women who are overweight or obese, around 40 years old and fertile. The use of oral contraceptives, diet rich in animal fats and calcium salts, and certain diseases such as diabetes, cirrhosis of the liver or Crohn's disease are also associated with an increased incidence of gallbladder stones.

Cholelithiasis, gallbladder stones

Gallbladder disease and laparoscopic cholecithectomy

Often cholelithiasis is asymptomatic, or it presents with nonspecific signs of dyspepsia (intolerance to fatty foods, postprandial feeling of heaviness, nausea...); or it can give very intense painful episodes - biliary colic - localized mainly in the epigastrium ("the mouth of the stomach") or right hypochondrium (the abdominal region located just below the right costal border), not infrequently with irradiation to the right scapula. A biliary colic is generally an expression of an inflammatory event of the gallbladder, cholecystitis, which, if of particularly high intensity, may require emergency surgery. Stones from the gallbladder may pass into the choledoch, the channel that transports bile from the liver to the intestines: in this case, the bile can no longer be eliminated and accumulates in the blood and tissues, resulting in a yellowish pigmentation of the skin, mucous membranes, and sclerae known as cholestatic jaundice.

Choledochal stones are usually treated endoscopically by introducing through a kind of gastroscopy probes into the biliary tract and thus removing the stones.

laparoscopic cholecystectomy, laparoscopyThe treatment of the cholelithiasis is instead surgical and consists of the cholecystectomy; this can be performed via open, with an incision of the abdomen, or laparoscopically. The laparoscopic cholecystectomy is now considered the "gold standard" in the treatment of gallbladder disease: it is made by making 4 small incisions in the abdomen (2 12 mm and 2 5 mm) and introducing, through these, a camera and suitable instruments with which to ligate and dissect the gallbladder hilum (consisting of the cystic duct e from the cystic artery). The cholecyst is then detached from its "bed" on the infero-posterior surface of the liver and extracted from one of the incisions used for surgical instrumentation.

Laparoscopic cholecystectomy: one of the most performed surgeries in the world...

Laparoscopic cholecystectomy, as mentioned above, is among the most performed surgeries in the world (there are more than 500,000 per year in the U.S. alone) and, if the cholelithiasis is not complicated (e.g., due to the presence of adhesions between the gallbladder and surrounding organs, or chronically flare-up inflammation that can make the gallbladder very hard and difficult to handle...), it is relatively simple and quick. Hospitalization is usually one night; after discharge, the patient should observe a low-fat diet for at least 4 weeks, then can gradually resume his normal eating habits.

In the case of complex pictures such as those mentioned before - adhesions, "porcelain" cholecysts, hydrops, previous abdominal surgeries, especially those involving the stomach or duodenum... - the performance of laparoscopic cholecystectomy surgery should be entrusted to experienced surgeons, such as those of the team of Cuccomarino, MD. They will be able to carefully and at all times assess the operative situation and successfully address all possible difficulties, ensuring the patient the best available treatment option for his or her specific case.

 

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