Safe Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy for Gangrenous and Perforated Gallbladder w...

Laparoscopic Cholecystectomy has been a gold standard for removal of a diseased gallbladder. Conversion to Open Cholecystectomy is indicated for gross gallbladder pathology that makes laparoscopic approach significantly hazardous. Gangrenous gallbladder, Perforated gall bladder and Empyema gallbladder are three such extreme pathologies that usually warrant a conversion. This video shows how successful laparoscopic cholecystectomy may still be successful in such hazardous conditions.

Laparoscopic Cholecystectomy - Aberrant Structures

Laparoscopic cholecystectomy is a common surgical procedure. Theoritically, there can be up to 25% of structures variations to the biliary tree. Surgeons will always have to keep in mind this brute anatomical fact in order to avoid biliary tree injury

Should the Appendix be removed as well

Quite often a surgeon is faced with a decision making dilemma during laparotomy for any surgical indications whether to remove the appendix at the same time.

There is no one answer to all patients.

If the appendix appears inflammed, then it has to be removed.This is quite often the case since the incidence of Appendicitis of various degrees are very common in humans. It is said that the annual incidence of Appendicitis in any community is 0.002%.....ie.2 people in every 1000 will suffer Appendicitis sometimes in their lives.

Sometimes,Appendicitis is so mild that it can mimick as nonspecific stomach aches or even mild gastroenteritis.

Patients who have undergone any form of laparotomy and laparoscopy should ask their surgeons whether the appendix is removed as well if they are not already informed.

The picture above shows a large loop of small bowels and an inflammed appendix forming the contents of a large Right Inguinal Hernia. The appendix was removed by standard Open Appendectomy technique and the bowels were reduced into the abdominal cavity before the large hernia defect is repaired with a prosthetic mesh.

Open Cholecystectomy for Gangrenous gallbladder

Although the gold standard for the removal of diseased gallbladder(especially gallstones-related cholecystitis) is Laparoscopic Cholecystectomy, I always tell patients that the chance of successfully completing the operation laparoscopically is only 90%, there is always about 10% chance of converting to open surgery.



The more severe the inflammation, the higher the chance of converting to open surgery.



The above patient suffered from Gangrenous Cholecystitis which failed laparoscopic attempt and had to be converted to open operation.