Laparoscopic cholecystectomy (LC) has become the “gold standard” for the treatment of benign gallbladder lesions because of its light trauma, low impact on the body’s internal environment, mild postoperative pain, rapid return to normal activities, and aesthetic appearance.
Indications for laparoscopic cholecystectomy (LC)
1, symptomatic gallbladder stones.
2, Symptomatic chronic cholecystitis.
3.Gallbladder stones >3cm in diameter.
4, Filled gallbladder stones.
5, Symptomatic and surgically indicated gallbladder augmentation lesions.
6.Acute cholecystitis with symptom relief after treatment with surgical indication.
7.Single polyp of gallbladder with diameter more than 1.0cm; thick tip, especially located in the neck of gallbladder, aged more than 50 years.
8.Gallbladder polyps combined with gallbladder stones; symptomatic, older than 50 years old.
9, gallbladder polyps with clinical symptoms.
10.Gallbladder polyp-like lesions with obvious symptoms and recurrent occurrence.
11.Single polyp of gallbladder, less than 10mm, asymptomatic, age less than 50 years, allowed to observe and follow up; if the lesion increases or changes in morphology then surgery should be performed.
12, Gallbladder polyps less than 5mm in diameter asymptomatic patients should be followed up and examined at intervals of 3 to 5 months. Once the lesion increases rapidly or the symptoms are obvious, surgery should be performed.
Contraindications to laparoscopic cholecystectomy (LC).
Relative contraindications.
1. Acute attacks of calculous cholecystitis.
2. Chronic atrophic calculous cholecystitis.
3, common bile duct stones with obstructive jaundice
4, Mirizzi’s syndrome, gallbladder neck stone impaction.
5.Extra-abdominal hernia.
6, Morbid obesity.
7, History of previous upper abdominal surgery.
Absolute contraindications.
1, with severe cardiopulmonary insufficiency and unable to tolerate anesthesia, pneumoperitoneum and surgery.
2.Patients with coagulation disorders.
3.Acute cholecystitis with serious complications, such as gallbladder gangrene and perforation.
4.With acute severe cholangitis or acute gallstone pancreatitis.
5.Gallbladder cancer or gallbladder bulge-like lesion suspected to be gallbladder cancer.
6, chronic atrophic cholecystitis, gallbladder volume <4.5cm×1.5cm, wall thickness >0.5cm .
7.Severe cirrhosis of the liver with portal hypertension.
8.Patients with middle or late pregnancy.
9, with abdominal infection, peritonitis.
10, with diaphragmatic hernia.
With the increasing maturity of LC technology, the scope of application of LC is also expanding. According to the technical characteristics of LC, some foreign medical centers began to explore the feasibility and safety of outpatient laparoscopic cholecystectomy from the early 1990s and achieved good results. in the late 1990s, Kehlet et al. proposed the concept of accelerated rehabilitation surgical treatment and recommended a series of measures and techniques to speed up the recovery of postoperative patients, and minimally invasive techniques were one of the important elements.
Based on this concept, we performed rapid recovery + single- or three-hole laparoscopic cholecystectomy, which significantly reduced the patient’s recovery time and surgical discomfort while ensuring safety. Preoperative gastric and urinary catheters are routinely not placed.
Preoperative tests include routine urine and stool, routine blood, liver and kidney function, coagulation function, infectious diseases and other laboratory tests such as chest X-ray, electrocardiogram, hepatobiliary and pancreatic ultrasound. Some patients may also require preoperative endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) to rule out the possibility of bile duct stones within and outside the liver. Intraoperatively, depending on the patient’s condition, a 1-hole or 3-hole LC technique is used, with an additional hole for particularly difficult cases (traditional 4-hole method). A low-pressure pneumoperitoneum was used as much as possible. The operative field is carefully inspected before the end of surgery to stop bleeding thoroughly and confirm that there is no blood leakage or bile leakage. No abdominal drainage tube is placed without special circumstances. The skin of the surgical incision can be closed with intradermal sutures or bio-glue application, without having to return to the hospital for stitch removal.
Advantages include: (1) Significantly shortens the hospital waiting time and treatment time for LC surgery, effectively increasing hospital bed turnover and enabling more patients who need treatment to receive timely treatment. (2) Significantly reduce patient discomfort in the hospital and the chance of hospital-acquired infections and other related complications, better reflecting the concept of human-centered treatment. (3) Reduces medical costs to a certain extent. (4) Implementing the medical concept of rapid recovery, the patient suffers less perioperative pain, recovers quickly after surgery, and can return to normal work and living environment sooner.