Laparoscopic Gall Bladder Surgery

When someone is diagnosed with having gallstones or disease of the gall bladder, it is usually necessary to remove the gall bladder. The most common method now used is laparoscopic gall bladder removal or what is called a laparoscopic cholycystectomy. During a laparoscopic cholycystectomy, a surgeon and an assistant use instruments inserted through small holes in the abdomen to remove the gall bladder. The procedure for a laparoscopic gall bladder is no different than an open laparotomy. The gall bladder needs to be identified, as well as the structures leading into it, the cystic duct and cystic artery. Once those structures are identified, they are clipped and transected and the gall bladder is removed. Errors can occur during a laparoscopic gall bladder removal when the cystic duct and cystic artery are not properly identified and there are inadvertent injuries to the common bile duct, the common hepatic duct, hepatic arteries, the right or left hepatic ducts, as well as the right or left hepatic arteries. These structures are adjacent to the cystic duct and lead into the liver and stomach. If these structures are clipped and transected, serious injuries can occur such as the bile from the liver being unable to drain, causing jaundice and pain. Other injuries can occur when the gallbladder is dissected from the liver bed. Injuries to the common hepatic duct and common bile duct which occur during laparoscopic gall bladder surgery are usually the result of negligence. Surgeons are trained in how to identify the anatomy. They are also taught that if they have any concerns to perform an intra operative chalangiogram which injects dye into the billary tract or to convert the procedure from laparoscopic to an open procedure.

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