Cholecystectomy-Definition.Incisions and the Acute Cholecystitis

CHOLECYSTECTOMYDefinitioncholecy stectomy is theSurgical removal of the gallbladder.Hepatic dactQCBDIndication :Aute cholecystitis due totyphoid not responding antibodies.Emphysema of the gallladder.volvulus Ctorsion of aloop of intestine causing obstruction)chronic cholecystitis andcho lecrthiasis. cholesterosis (Abnormaldeposition of chollesteronin tissue)Recurrent biliary coli C.CA gall bladder.charrco tis triad - attack ofbiliary colic followed bysaundice and fever.Advantage of cholecy stationes :It removes the gallstone terming machine 30.00chance of recurrent ofgall stone.only way to. get ridof istra muscular instection.Eliminates the possibilityof future carci noma to developa result of irritation fromasStones. Incision :ko chers subcostal incisionin person with wide costalangle.Right para median [upper]incision in subject with narrowcostal angle.Advantage of Rt. upper paramedian incisionIt gives an access tothe . appendin as well throughwith difficultyVto position of the patient [supineposition]The operating table shouldhave an adjustable "bridge"tolitt lower thoracic region tothat the gall bladder andthe bile . Duct are thrown forwardsto facilitate their enposure / overdown the "bridge" before woundclosureDraw back:pulmonary complicationBackache.obstructive of Ivd and mayprevent correct placing of then-ray plates for operativecholargio graphy.chalongiography Radiographyof the bile duct. Acute cholecystitis:conservative treatmentElective cholecy stectomy aftersweetingIndications of immediate cholecy-1 tectomy :when the cystic ductis blocked by a calculus. Theinstection progresses up toemphysema of the gall bladderfulminating chole cystitis.Gangrene of the wall.clinical features :Det orioration of the generalcondition even after H8 hours ofconservative treatment. painT endernessvomiting persistsPRTT gradually Tl to 103" orion Fcontra indication of conservativetreatment:1). typhoid chalecystitisEarly perforationsugar is advised2) when the surgeon is not,very sure of his diagnosis andfulminating appendicitis or aportorating duodenal ulcer isalso probable diagnosisshould proceed forexploration. selection of operation:toincholocytectomy :histortIn patients with Fundiceinterdor old age patient+Unqcho lecy stectomy :when the gall bladderis tense , distend and surroundingby dense , vascular adhesion.General preoperative measures :Glevose drink - 150 gmdaily x 3 days before operative[to cope with live function].5% glucose IV if oralin take is not allowed .B road spectrum antibioticsshould be standed before operationto cope with cholang itis[Inflammation G+ the bileduct]. An : oral chalecys togramshould always be done anytime before the operation -USE NtiIV cho lengiography if,the patient is having" characto tetriod [H+ V ,jaundicePP ewith acute pain and fever)DNSprepatioductcysticarterycysticductCBDGall Bladder.methods of cho lacy stectomyDuctus first method:-The cystic duct and theartery are dis sected first anddioided after which gall bladderis removed. Les schance of injury toCBD I or Rt - Hepati C artery.Fundus first method :The dissection is startedfrom the fendus of the gallpre iebladder and gradually pro rocededtoward the cystic duct which isdivided last of all. .procedure.pre liminary explorationopening the abdomencareful examination of biliarysystem and stomach and dewdenumonclude any uker palpation ofthe to pancreas enclude pancreatitiscalcelli or CA -observation of the gallbladder blue from greenis h blueto yellowish white Due to tickeningof its wall & deposition of subscrous dat)