Safe Cholecystectomy in Gallbladder Surgery

Safe Cholecystectomy in Gallbladder Surgery Gallstones, which can develop due to genetic predisposition, pregnancy, prolonged use of oral contraceptives, excessive weight gain and rapid weight loss, can cause obstruction when they fall into the bile duct, leading to jaundice and liver dysfunction. To prevent this condition, gallbladder removal using the laparoscopic method, which is considered the gold standard in surgical procedures, is necessary. Laparoscopic cholecystectomy is defined as the insufflation of the abdominal cavity with gas, visualization of abdominal organs with a camera, and removal of the gallbladder with the aid of surgical instruments. Assoc. Prof. Dr. Türkmen Bahadır Arıkan from the General Surgery Department of Memorial Kayseri Hospital provided detailed information about the 'safe cholecystectomy' technique applied in bile duct surgery. In safe cholecystectomy procedures performed closed with 1-centimetre incisions today, while the gallbladder is removed, preservation of the integrity of the main bile duct is of vital importance. To minimize the risk of bile duct injuries, the 'safe cholecystectomy' technique is used.  

Not All Gallstones Require Intervention

  Gallstones are left in the body if they do not cause a significant health problem. Gallstones are present in 15% of the population. In 20% of these individuals, gallstones cause disease. For stones that show no symptoms and are incidentally detected by imaging methods (except for cases such as stones larger than 3 centimetres, gallbladder completely filled with stones, or porcelain gallbladder), gallbladder surgery is not recommended.  

Problems Worsen When Symptomatic Stones Are Not Removed

  Laparoscopic cholecystectomy has replaced open surgery since the early 1990s worldwide. A stone in the gallbladder, especially after eating fatty foods, can cause intense pain and discomfort in the right upper quadrant of the abdomen, above the navel or radiating to the back, particularly to the right shoulder blade. This condition can also occur at night independent of meals. Pain is often accompanied by sweating, nausea and vomiting. In this case, laparoscopic (closed) gallbladder surgery should be performed without delay. If surgery is postponed, gallstones can lead to acute gallbladder inflammation, jaundice from the stone blocking the main bile duct, bile duct inflammation disease, or scenarios where the stone blocks the pancreatic duct. Obstruction of the pancreatic duct causes pancreatic inflammation, which unfortunately is life-threatening.   Advantages of Closed Surgery   Between 150,000 and 200,000 gallbladder surgeries are performed annually in our country. Most of these are performed laparoscopically, that is, by closed method.

• Thanks to the laparoscopic technique, there is less pain after surgery.
• Since recovery time is shortened, patients stay in hospital for a shorter period.
• More cosmetic results are achieved as procedures are performed with small incisions.

Two Factors in Bile Duct Injuries

  As in the rest of the world, in our country, unwanted bile duct injuries can be observed after surgery in 3-8 out of 1,000 patients undergoing laparoscopic cholecystectomy. In the management of bile duct injuries, endoscopic additional procedures, reoperation and additional treatments ranging to liver transplantation in patients not improving with these methods may be required. The occurrence of bile duct injuries may be related to various risk factors.

• The most important patient-related risk factor is that bile duct anatomy can be very different in structure. To this can be added severe obesity, previous surgeries in areas close to the bile ducts, underlying liver disease, and frequent previous gallbladder infection episodes.
• Lack of experience of the surgical team performing the operation and misinterpretation of anatomy have been identified.

Safe Cholecystectomy Technique Stands Out

Since the introduction of closed surgery, the 'infundibular' technique has been used for gallbladder surgery. Today, to minimize the risk of bile duct injury in laparoscopic cholecystectomy, the 'safe cholecystectomy' technique (critical view of safety) is recommended instead of the 'infundibular' technique. The American Gastroenterological and Endoscopic Surgeons Association promotes the use of this technique.