Surgical Procedures/Abdominal Surgery/Cholecystectomy/Open
Introduction:
edit- Cholecystectomy performd by Open method.
Indication:
edit- If laparoscopic cholecystectomy is contraindicated
- Intra operative conversion during laparoscopic cholecystectomy
- Gallbladder carcinoma
- Cholecystitis
- Cholelithiasis
- ?Biliary dyskinesia.
Contraindication:
edit- Contraindicated if laparascopic cholecystectomy is indicated and can be performed.
Advantages:
edit- Better exposure during surgery
- Less risk of wound infection
- Less days off work
Disadvantages:
edit- Larger incision is made and leaves large scar.
- Longer hospital stay
- ≥ 5 days.
- Longer recovery time.
- Post-operative pain.
PreOperative management:
edit- Glucose Drink 150mg/Day x 3 days.
- If NPO:
- 5% Dextrose I.V.
- If NPO:
- PreOP. BroadSpectrum Antibiots.
- Preop Investigations:
- Oral Cholangiogram.
- If Charcot's Triad present:
- I.V cholangiography.
Anaesthesia
edit- Commonly:
- Endotracheal Sedation.
(Anaesthesia will not be mentioned here.)
Simplified steps:
editStep I
editIncision.
editTypes of Incision:
- Upper Right SubCostal Incision.
- Kocher's Incision.
- Modified Kocher's Incision.
- Transverse Incision.
Step II
editMop placement
edit- 2 wet mops are placed.
- One Wet Mop is placed to displace the duodenum, the transverse colon and coils of small intestine.
- Second Wet Mop is placed slightly to the left of the Common Bile Duct (CBD) to displace the stomach to the left.
Step III
edit(After 2 wet mop placement.)
Exposure of GallBladder:
editExposure of GallBladder is done by:
- Retraction of liver.
- Inferior surface of the right lobe of the liver is retracted upwards by the most appropriate retractor available.
- e.g Deaver's retractor or most commonly the harrington retractor (aka the sweetheart).
- Inferior surface of the right lobe of the liver is retracted upwards by the most appropriate retractor available.
Step IV
editRemoval of GallBladder.
edit2 common methods for removal of GB:
Duct first method:
edit- Cystic Duct and Artery are dissected first and divided, after which GallBladder is removed.
- Indication:
- Indicated if no presence of adhesions or exudates in CBD, CHD, CD.
- Contraindication:
- Contraindicated in the presence of adhesions or exudates in CBD, CHD, CD.
- Advantages:
- Less chance to injure:
- CBD.
- Right Heptic Artery.
- Less chance to injure:
- Disadvantages:
- Indication:
Fundus First method:
edit- Dissection is started from Fundus of the GallBladder and gradually proceeded towards the Cystic Duct, which is divided last of all.
- Indication:
- Indicated in the presence of adhesions or exudates in CBD, CHD, CD.
- Contraindication:
- Contraindicated in no presence of adhesions or exudates in CBD, CHD, CD due to disadvantages.
- Advantages:
- Gallbladder can be removed in the presence of adhesions or exudates in CBD, CHD, CD.
- Disadvantages:
- More chance to injure:
- CBD.
- Right Heptic Artery.
- More chance to injure:
- Indication: