Laparoscopic cholecystectomy

1. Laparoscopic cholecystectomy
consent checklist
Raimundas Lunevicius, MD, PhD, FRCS

2. Background
• Gallstones are ‘stones’ that form in the GB
• Common
• Increase with age
• Gallstones:
– asymptomatic & symptomatic
• Severe symptoms with repeated attacks of abdominal
pain being the most common
• Sympt. gallstone disease is treatable surgically

3. LC (key-hole surgery)
• What are the benefits of surgery?
– free of pain and able to eat a normal diet
– prevent the complications that stones can cause
• Are there any alternatives to surgery?
1. There are no reliable alternatives
2. It is possible to dissolve the cholesterol stones or shatter
them into small pieces
these techniques involve unpleasant drugs and side effects, have a high failure
rate (50%) and the gallstones usually come back (50%).
3. A low-fat diet may help to prevent attacks of pain

4. Cholecystectomy
• A general anaesthetic & takes about an hour
• The laparoscopic (‘keyhole’) technique is used
– Your surgeon will make several small cuts on your
abdomen.
– They will place surgical instruments, along with a
telescope, inside your abdomen and perform the
operation.
• Your surgeon will free up the gallbladder duct (cystic
duct) and artery. They will then separate the
gallbladder from the liver and remove it.

5. Conversion to laparotomy is not a complication but a continuation of operation
General and cholecystectomy specific risks:
Major: bleeding, leaking of bile due to CD stump , bily duct injury, bowel injury, peritonitis, abscess, dearterialization of part of the liver.
Minor: persistent postcholecysectomy pain, temporal postcholecystectomy diarrhoea (loose bowels / uncommon), wound infection / hernia.
Conversion & injuries For informed consent
Conversion:
Cholecystectomy
1:30 (3%)
Elective cholecystectomy
1:50 (2%)
Non-elective
cholecystectomy
1:10 (10%)
Injury of major bile
duct
Cholecystectomy
1:500 (0.2%)
Elective cholecystectomy
1:1000 (0.1%)
Non-elective
cholecystectomy
1:200 (0.5%)
Small bowel injury 1:5000 (0.07%)
Diaphragm injury 1:8000 (0.01%)
Aorta injury < 1:15000 (0.007%)
(for closed technics)

6. Recovery
• Day case/ over night stay
– go home later on the same day
– mild analgesia might be needed for 2 weeks
• Return to work after two to four weeks but this may vary
depending on the extent of surgery and your type of work.
– Regular exercise should help you to return to normal activities
– Drive car when you feel all right (in 2-4 weeks)
• You should make a full recovery in 4 weeks
• Be able to eat a normal diet,
– however, fat-free diet will be recommended for patients with higher
risk for pancreatitis for 6-12 weeks