Our Summary

This research paper discusses a study on a new method of gallbladder removal surgery, known as laparoscopic cholecystectomy (Lap-C), which is performed to prevent a rare and serious complication called Vasculobiliary injury (VBI).

The new method, called the “body-first approach”, involves removing the middle section of the gallbladder first, then the neck of the gallbladder. The goal is to avoid touching any connective tissue of the hepatic hilum, a part of the liver where there is a risk of injury.

The researchers studied this approach in 62 patients and found promising results. Five of these patients had abnormal biliary tracts, which usually makes gallbladder surgery risky. Seven patients had to undergo a subtotal cholecystectomy, which means that only part of the gallbladder was removed.

Despite these challenges, none of the patients needed to switch to open surgery, and no one developed VBI or any serious postoperative complications. This suggests that the “body-first approach” could be a safer way of performing gallbladder removal surgeries.

FAQs

  1. What is a Vasculobiliary injury (VBI) and how is it related to laparoscopic cholecystectomy?
  2. What is the “body-first approach” in laparoscopic cholecystectomy and how does it decrease the risk of VBI?
  3. What were the results of the study that evaluated the surgical outcome of patients who underwent Lap-C with a body-first approach?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laparoscopic cholecystectomy is to inquire about the use of the “body-first approach” during the procedure. This approach involves dividing the gallbladder body before the gallbladder neck from the gallbladder bed, which may decrease the risk of vasculobiliary injury. Patients can discuss this technique with their surgeon to ensure the safest possible outcome for their surgery.

Suitable For

Patients who are typically recommended for laparoscopic cholecystectomy include those with symptomatic gallstones, acute cholecystitis, chronic cholecystitis, and other gallbladder conditions that require surgical intervention. The body-first approach may be particularly beneficial for patients with anatomical anomalies of the biliary tract or other factors that may increase the risk of vasculobiliary injury during the procedure.

Timeline

Before laparoscopic cholecystectomy:

  1. Patient presents with symptoms of gallbladder disease, such as abdominal pain, nausea, and vomiting.
  2. Patient undergoes diagnostic tests, such as ultrasound, to confirm diagnosis of gallstones.
  3. Patient is scheduled for laparoscopic cholecystectomy after consultation with a surgeon.

After laparoscopic cholecystectomy:

  1. Patient undergoes preoperative preparation, including fasting and anesthesia.
  2. Laparoscopic cholecystectomy is performed using the body-first approach, where the gallbladder body is divided from the gallbladder bed before dividing the gallbladder neck and cystic duct.
  3. The surgery is successful, with no need for conversion to open surgery.
  4. Patient recovers in the hospital for a short period before being discharged.
  5. Patient experiences a quick recovery with minimal postoperative complications.
  6. Patient is advised on postoperative care, including diet and activity restrictions.

What to Ask Your Doctor

  1. What is the body-first approach for laparoscopic cholecystectomy and how does it differ from other techniques?
  2. What are the potential benefits of using the body-first approach for my specific case?
  3. Are there any potential risks or drawbacks associated with the body-first approach?
  4. How experienced are you in performing laparoscopic cholecystectomy using the body-first approach?
  5. What is the likelihood of complications such as vasculobiliary injury with the body-first approach compared to other techniques?
  6. How long is the recovery time expected to be with the body-first approach?
  7. Are there any specific post-operative care instructions or precautions I should be aware of if I undergo laparoscopic cholecystectomy with the body-first approach?
  8. Are there any alternative treatment options I should consider before proceeding with laparoscopic cholecystectomy using the body-first approach?
  9. What is the success rate of laparoscopic cholecystectomy with the body-first approach in terms of resolving gallbladder issues and preventing recurrence?
  10. Are there any specific factors or conditions in my medical history that may affect the decision to use the body-first approach for laparoscopic cholecystectomy?

Reference

Authors: Matsumura M, Seyama Y, Takao M, Okinaga H, Ogawa R, Nemoto S, Tani K. Journal: Asian J Endosc Surg. 2023 Jul;16(3):362-367. doi: 10.1111/ases.13164. Epub 2023 Jan 17. PMID: 36650019