Our Summary

The research paper discusses a surgical method used during laparoscopic cholecystectomy, a surgery to remove the gallbladder, which aims to reduce the risk of bile duct injuries (BDI). BDI is a common complication of this surgery. The method described is called posterior infundibular dissection, which involves an initial approach to the surgery that the authors have developed and refined over 30 years. They have used this technique regularly over the past decade and have not encountered any BDI.

The authors provide a detailed explanation of this surgical technique, including illustrations. They also share their experience with 1402 laparoscopic cholecystectomies performed using this method between 2010 and 2019. Of these surgeries, about 80% were elective, and about 20% were emergency procedures. They encountered one case of a posterior sectoral duct, which required an intra-operative cholangiogram (an X-ray procedure to visualize the bile ducts), one case of bleeding which led to conversion to open surgery, and four cases of bile leaks, which were managed with endoscopic retrograde cholangio-pancreatography (a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas). Importantly, no bile duct injuries were reported.

The authors conclude that using the initial posterior mobilization of the gallbladder infundibulum can make laparoscopic cholecystectomy safer, as it reduces the need for a more risky dissection procedure. They emphasize that the safety of this technique lies in the initial dissection of the lateral border of the infundibulum. They believe their method can eliminate the risk of BDI, as evidenced by their own experience. They also note that their approach doesn’t rule out the use of other intra-operative techniques or methods.

FAQs

  1. What is the posterior infundibular dissection method in laparoscopic cholecystectomy?
  2. How effective is the posterior infundibular dissection method in preventing bile duct injuries during laparoscopic cholecystectomy?
  3. Can other intra-operative techniques or methods be used in conjunction with the posterior infundibular dissection method?

Doctor’s Tip

A helpful tip a doctor might tell a patient about cholecystectomy is to discuss the surgical technique being used and ask about any methods being implemented to reduce the risk of bile duct injuries. Patients can inquire about the surgeon’s experience with the specific technique and inquire about any potential complications and how they would be managed. It is important for patients to have open communication with their healthcare provider and feel comfortable asking questions to ensure the best possible outcome for their surgery.

Suitable For

Patients who are typically recommended for cholecystectomy include those with symptomatic gallstones, acute cholecystitis (inflammation of the gallbladder), chronic cholecystitis, biliary dyskinesia, gallbladder polyps, and gallbladder cancer. Additionally, patients who have recurrent episodes of biliary colic (abdominal pain caused by gallstones) or complications from gallstones such as pancreatitis or cholangitis may also be recommended for cholecystectomy.

Timeline

Before cholecystectomy:

  • Patient experiences symptoms of gallbladder disease, such as abdominal pain, nausea, vomiting, and bloating.
  • Patient undergoes diagnostic tests, such as ultrasound or MRI, to confirm the presence of gallstones or other issues with the gallbladder.
  • Patient consults with a surgeon to discuss the need for cholecystectomy and the risks and benefits of the surgery.
  • Patient undergoes pre-operative preparations, such as fasting and medication adjustments.

After cholecystectomy:

  • Patient undergoes laparoscopic cholecystectomy surgery, during which the gallbladder is removed.
  • Patient is monitored in the recovery room and may stay in the hospital for a day or two for observation.
  • Patient experiences post-operative pain and discomfort, which can be managed with pain medications.
  • Patient is advised to follow a specific diet and activity restrictions to aid in the healing process.
  • Patient attends follow-up appointments with the surgeon to monitor the healing process and address any concerns.
  • Patient gradually resumes normal activities and diet as advised by the healthcare team.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cholecystectomy include:

  1. What is the surgical technique that will be used during my cholecystectomy?
  2. What are the potential risks and complications associated with this surgery, such as bile duct injuries?
  3. How experienced is the surgical team in performing laparoscopic cholecystectomies?
  4. What is the expected recovery time after the surgery, and what can I do to ensure a smooth recovery?
  5. Are there any alternative treatment options available for my condition?
  6. How will my symptoms be managed after the surgery, such as pain and nausea?
  7. What follow-up care will be needed after the surgery?
  8. How can I best prepare for the surgery, both physically and mentally?
  9. Are there any specific dietary or lifestyle changes I should make before or after the surgery?
  10. What are the long-term implications of having my gallbladder removed, and how will it affect my digestion and overall health?

Reference

Authors: Iskandar M, Fingerhut A, Ferzli G. Journal: Surg Endosc. 2021 Jun;35(6):3175-3183. doi: 10.1007/s00464-020-08281-1. Epub 2021 Feb 8. PMID: 33559056