Biliary duct surgery – cholecystectomy
Indications for the surgery are symptomatological cholecystolithiasis and cholecystitis (and related repeated biliary colics) and cancer of the gallbladder and biliary ducts – for more information see liver surgery.
Currently, the gold standard is laparoscopic cholecystectomy (LCHE), which is preferred to classical cholecystectomy. Besides being minimally invasive, laparoscopy entails the benefits of more rapid recovery of the patient after the procedure and thus also shorter hospitalisation and faster return of the patient to work. Capnoperitoneum is established upon inserting the first port (usually subumbilically). Optic instruments are inserted, which are used to view the peritoneal cavity , and 3 additional ports are inserted for the trocars. Two methods can be used to remove the gallbladder: retrograde (preparation from the hilar structures) or anterograde (preparation from the fundus to the hilar structures – usually if the finding is unclear). Cholecystectomy consists in preparing the gallbladder from the lower edge of the liver and in ligating and interrupting ductus cysticus and arteria cystica (in the Calot triangle circumscribed by ductus cysticus, ductus hepaticus comunis and the lower edge of the liver). Metallic clips are used to interrupt the artery and the duct.. The gallbladder is usually removed from the peritoneal cavity in a sac through the supraumbilical port. A drain is then inserted in the bed of the gallbladder. The most serious complications of laparoscopic cholecystectomy include: injury to biliary ducts, bleeding, post-operative perforation of the gallbladder, subcutaneous emphysema, hernia in the scar or possible conversion of the procedure to open surgery.
Classical (laparotomic) cholecystectomy (CHE)
Currently, given the trend of preferring minimally invasive procedures, laparotomic cholecystectomy is reserved for patients indicated for an advanced disease or cancer of the gallbladder and for cases where the procedure cannot be completed using the laparoscopic technique. Access is obtained by making an incision in the right upper abdomen or upper midline laparotomy, as the case may be. The mode of preparing the gallbladder is analogical to that used in laparoscopic surgery (anterograde or retrograde). Complications of the laparotomic surgery are identical to those of laparoscopy.
The surgery usually lasts about one hour. Early mobilisation and gradual realimentation are initiated after the surgery. Liver function tests are done on the first post-operative day; and based on the condition, the drain is extracted. The total length of stay is 2-5 days on average for uncomplicated surgeries.