Laparoscopic cholecystectomy

Laparoscopic cholecystectomy has become the standard treatment for gallstones. It has advantages over open cholecystectomy and medical therapies. During laparoscopic cholecystectomy, either routine or selective cholangiography is acceptable treatment. Bile duct injury is a serious problem in laparoscopic cholecystectomy, but it seems to be decreasing in incidence. One of the main mechanisms of bile duct injury is when there is an aberrant right hepatic duct present. Bilomas are another problem and endoscopic retrograde choledochopancreatography and endoscopic sphincterotomy are useful in dealing with this problem. The results of laparoscopic cholecystectomy for acute cholecystitis are improving and the incidence of treating choledocholithiasis by laparoscopic means is also increasing. However, there are no comparative clinical trials with standard therapies. Radical resection of gallbladder carcinoma is increasing in frequency with some good results. Surgery for bile duct carcinoma is continuing to improve in association with more precise methods of staging the disease. An association has been reported between cholangiocarcinoma and hereditary nonpolyposis colorectal carcinoma. Such patients should be followed by abdominal ultrasound and liver function tests in order to make an early diagnosis.