Laparoscopic Cholecystectomy Without Cholangiography

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Presence of symptomatic gallstones
  • Acute or symptomatic cholecystitis
CONTRAINDICATIONS
  • Coagulopathy
  • Severe chronic obstructive pulmonary disease
  • Congestive heart failure
EQUIPMENT
  • Anesthetic equipment
  • Operating table
  • Laparoscopic instrument table including the 0-degree or 30-degree scope, toothed graspers, hook cautery, straight and curved dissecting forceps, as well as the suction-irrigator
  • Electrocautery device
ANATOMY
  • Regional anatomy
    • The gallbladder fundus and corpus join the neck of the gallbladder at the infundibulum and continue on to the cystic duct. The cystic duct typically courses to the common bile duct. The cystic artery arises from the common hepatic or right hepatic artery.
    • In the modern era, Calot's triangle is defined by the junction of the infundibulum of the gallbladder and cystic duct where it joins the common hepatic duct, and the edge of the liver.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Moderate oral analgesia for 1 to 4 days.
  • Slow ambulation and light oral intake are allowed the first day as tolerated.
  • Activity is progressively increased.
  • Skin dressings are usually removed within 2 days.
  • Patients are advised to avoid immersion for at least 1 week.
  • Brief showers are permitted on the first or second postoperative day.
  • Patients are advised to avoid heavy lifting or straining for at least 2 or 3 weeks.
COMPLICATIONS
  • Bile accumulation (e.g., from cystic duct stump)
  • Major or minor ductal injury
  • Intestinal perforation
  • Bleeding
  • Capsular hematoma of liver
  • Incisional hernia
  • Wound infection
RESULT ANALYSIS
  • At least 90% of patients with symptomatic cholelithiasis become pain free after cholecystectomy.
  • The risk of major bile duct injury is higher after laparoscopic cholecystectomy compared with open cholecystectomy.
  • Elective laparoscopic cholecystectomy can be safely performed as an ambulatory outpatient procedure.
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