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Indications

• Symptomatic gallstones: biliary colic, pancreatitis
• Cholecystitis
• Empyema of gallbladder
• Mucocoele of gallbladder

Laproscopic Procedure

1. Consent + permission to convert to open 5-10% cases
2. Establish pneumoperitoneum (open method) - 1cm incision under umbilicus, introduce trochar, insufflate air, then laproscope
3. Insert ports 10mm epigastrium; 5mm MCL; 5mm AAL
4. Identify Calot's triangle (Liver, cystic duct, hepatic duct) - contains cystic artery
5. Dissect cystic duct, artery and GB
6. Apply x3 clips on either side of structures, divide leaving 2 clips
7. Divide gallbladder from hepatic bed using diathermy hook to maintain haemostasis
8. Remove gallbadder (collect in endobag to prevent leakage)
9. Release pneumoperitoneum, close wounds

Open Procedure

1. Upper right transver incision (over lateral border or rectus muscle)
2. Skin, campers fat, scarpas fascia, anterior rectus sheath, rectus, posterior rectus sheath, transversalis fasicia, extraperitoneal fat, peritoneum

Complications

1. Bile duct injury
2. Haemorrhage - slipping of clips
3. Retained stone
4. Biliary stricture
5. Duodenal injury