Essay On Acalculous Cholecystectomy

LAPAROSCOPIC CHOLECYSTECTOMY

Background:
Whereas it is true that no operation has been more profoundly affected by the advent of laparoscopy than cholecystectomy has, it is equally true that no procedure has been more instrumental in the laparoscopic age than LC has. LC has rapidly become the procedure of choice for routine GB removal and is currently the most commonly performed major abdominal procedure in western countries (Litwin and Cahan, 2008).
A National Institutes of Health consensus statement in 1992 stated that LC provides a safe and effective treatment for most patients with symptomatic gallstones and has become the treatment of choice for many patients. This procedure has more or less ended attempts at non invasive management

In these situations, percutaneous cholecystostomy guided by CT or US is advised. Ninety percent of these patients demonstrate clinical improvement. Once the patient has recovered, the cholecystostomy tube can be removed without sequelae; this usually takes place at about 6 weeks. Interval cholecystectomy is not necessary (Elwood, 2008).
• Incidental gallbladder cancer:
GB cancer may be an incidental finding at LC, with an incidence ranging from 0.3% to 5.0%. Uncertainty about the diagnosis, lack of clarity regarding of the degree of tumor spread, or postoperative identification of cancer on pathologic examination of a routine cholecystectomy specimen should warrant early reoperation (Rakić, et al. 2014).
National Comprehensive Cancer Network (NCCN) guidelines advocate simple cholecystectomy as definitive treatment for patients with mucosal (T1a) disease and a negative CD margin; all other patients (ie, those with involvement of muscle or beyond, a positive CD margin, or a positive cystic lymph node) should undergo repeat operation for extended cholecystectomy (which includes hepatic resection, lymphadenectomy and, possibly, bile duct excision) (Eil, et al.