From the Guidelines
Commonly Asked Questions Regarding Laparoscopic Cholecystectomy
The most common questions regarding laparoscopic cholecystectomy include when to consider conversion to open cholecystectomy, the risks and benefits of the procedure, and the experience and qualifications of the surgeon.
- Conversion to open cholecystectomy should be considered in cases of severe local inflammation, adhesions, bleeding from the Calot’s triangle, or suspected bile duct injury, as recommended by the 2020 World Society of Emergency Surgery guidelines 1.
- Risks and benefits of laparoscopic cholecystectomy include a decreased convalescent period compared to open cholecystectomy, but also a potential higher risk of bile duct injury, especially if the surgeon is not experienced in the procedure 1.
- Surgeon experience and qualifications are crucial in determining the success and safety of the procedure, and patients should consider the surgeon's experience and qualifications before choosing the laparoscopic route 1.
Key Considerations
- Bile duct injury is a potential complication of laparoscopic cholecystectomy, and patients should be aware of this risk before undergoing the procedure 1.
- Convalescent period is generally shorter for laparoscopic cholecystectomy compared to open cholecystectomy, but patients should still expect some recovery time 1.
- Surgeon training and experience are essential in preventing complications and ensuring a successful outcome, and patients should prioritize finding a qualified and experienced surgeon 1.
From the Research
Commonly Asked Questions Regarding Laparoscopic Cholecystectomy
- What are the optimal steps for laparoscopic cholecystectomy? 2
- Is the laparoscopic technique really superior to the open procedure according to the criteria of evidence-based medicine? 2
- How should we proceed in case of an occult choledocholithiasis? 2
- Is intraoperative cholangiography mandatory? 2, 3
- What are the complications associated with laparoscopic cholecystectomy? 4, 5, 3
- What are the benefits and drawbacks of single-incision laparoscopic cholecystectomy (SILC) compared to conventional laparoscopic cholecystectomy? 5, 3
- What are the indications for subtotal cholecystectomy? 6
- How should the gallbladder be retrieved during laparoscopic cholecystectomy? 6
- What are the advantages and disadvantages of using a retrieval bag for gallbladder extraction? 6
Complications and Risks
- Biliary leaks and bile duct injuries are common complications of laparoscopic cholecystectomy 4
- Bleeding from trocar sites and vascular injury are potential risks 4
- Bowel injuries can occur during laparoscopy 4
- Incisional hernia and wound infections are possible complications of single-incision laparoscopic cholecystectomy 3
- Bile leak is a potential complication of laparoscopic cholecystectomy 3
Surgical Techniques
- The critical view of safety should be obtained for identification of the cystic duct and artery 6
- Fundus-first dissection and augmented with cholangiography or ultrasound can be used to obtain the critical view of safety 6
- Harmonic-shear, clipless ligation, and clip ligation of the cystic duct and artery are different techniques used during laparoscopic cholecystectomy 6
- Stump closure during subtotal cholecystectomy may reduce rates of bile leak and reoperation 6