Our Summary

This research paper presents a surgical method for removing the gallbladder (laparoscopic cholecystectomy) that can reduce the risk of injury to the bile duct, a common complication of this procedure. The technique, called posterior infundibular dissection, is the first step in this surgery and was developed over 30 years. The researchers have used it for the last decade with no instances of bile duct injury.

Between 2010 and 2019, they performed 1402 surgeries using this method. The majority of the surgeries were planned, while about 20% were emergency procedures. Only one procedure had to be converted to an open surgery due to bleeding, and four patients had bile leaks that were managed using a different procedure. There were no injuries to the bile duct.

The researchers conclude that by starting with the dissection of the gallbladder infundibulum (a part of the gallbladder), the need to dissect other areas is reduced, making the surgery safer. This approach doesn’t rule out the use of other methods during surgery.

FAQs

  1. What is the surgical method for removing the gallbladder that can reduce the risk of injury to the bile duct?
  2. What is the success rate of the posterior infundibular dissection method in preventing bile duct injuries?
  3. Can other surgical methods be used in combination with the posterior infundibular dissection technique during surgery?

Doctor’s Tip

A helpful tip a doctor might give to a patient undergoing laparoscopic cholecystectomy is to ask their surgeon about using the posterior infundibular dissection technique to reduce the risk of bile duct injury during the procedure. This technique has been shown to be effective in preventing such complications and can make the surgery safer overall. It’s important for patients to be proactive in discussing this option with their healthcare provider to ensure the best possible outcome for their surgery.

Suitable For

Patients who are typically recommended for laparoscopic cholecystectomy include those with symptomatic gallstones, gallbladder inflammation (cholecystitis), gallbladder polyps, or gallbladder cancer. Additionally, patients who have recurrent episodes of biliary colic, pancreatitis caused by gallstones, or complications related to gallstones such as bile duct obstruction or cholangitis may also be recommended for this procedure.

Overall, laparoscopic cholecystectomy is considered a safe and effective treatment option for patients with these conditions, and the use of techniques such as posterior infundibular dissection can further reduce the risk of complications during the surgery.

Timeline

Before laparoscopic cholecystectomy:

  1. Patient experiences symptoms of gallstones such as abdominal pain, nausea, and vomiting.
  2. Patient undergoes diagnostic tests such as ultrasound or CT scan to confirm the presence of gallstones.
  3. Patient consults with a surgeon to discuss the need for surgery and the risks and benefits of laparoscopic cholecystectomy.
  4. Surgery is scheduled and patient undergoes preoperative preparation such as fasting and medical evaluation.

After laparoscopic cholecystectomy:

  1. Patient undergoes general anesthesia and small incisions are made in the abdomen for the insertion of surgical instruments and a camera.
  2. Surgeon performs posterior infundibular dissection to remove the gallbladder without injury to the bile duct.
  3. Gallbladder is removed and incisions are closed with sutures or surgical tape.
  4. Patient is monitored in the recovery room and may experience some pain and discomfort.
  5. Patient is discharged home the same day or after a short hospital stay.
  6. Patient follows postoperative instructions for pain management, diet, and activity restrictions.
  7. Patient attends follow-up appointments to monitor recovery and address any complications.

What to Ask Your Doctor

  1. What is laparoscopic cholecystectomy and why is it recommended for me?

  2. How experienced are you in performing laparoscopic cholecystectomy surgeries?

  3. What are the potential risks and complications associated with this procedure?

  4. Can you explain the posterior infundibular dissection technique and why it is being recommended for my surgery?

  5. How long will the surgery take and what is the expected recovery time?

  6. What can I expect in terms of pain management after the surgery?

  7. Are there any dietary or lifestyle changes I should make before or after the surgery?

  8. Will I need to stay in the hospital after the surgery, and if so, for how long?

  9. What are the signs of a complication that I should watch for after the surgery?

  10. Will I need any follow-up appointments or tests after the surgery?

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