Cholecystectomy is a surgical procedure performed with the goal of resecting and extracting the gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy. It is one of the most common abdominal surgeries performed in the Western world. Cholecystectomy is performed for symptomatic cholelithiasis Cholelithiasis Cholelithiasis (gallstones) is the presence of stones in the gallbladder. Most gallstones are cholesterol stones, while the rest are composed of bilirubin (pigment stones) and other mixed components. Patients are commonly asymptomatic but may present with biliary colic (intermittent pain in the right upper quadrant). Cholelithiasis, cholecystitis Cholecystitis Cholecystitis is the inflammation of the gallbladder (GB) usually caused by the obstruction of the cystic duct (acute cholecystitis). Mechanical irritation by gallstones can also produce chronic GB inflammation. Cholecystitis is one of the most common complications of cholelithiasis but inflammation without gallstones can occur in a minority of patients. Cholecystitis, gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy polyps > 0.5 cm, porcelain gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy, choledocholithiasis Choledocholithiasis Presence or formation of gallstones in the common bile duct. Cholelithiasis and gallstone pancreatitis Pancreatitis Inflammation of the pancreas. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of chronic pancreatitis. The two most common forms of acute pancreatitis are alcoholic pancreatitis and gallstone pancreatitis. Acute Pancreatitis, and rarely, for gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy cancer. Over 90% of cholecystectomies are now completed laparoscopically because of the procedure’s enhanced recovery time and decreased postoperative pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways. Cholecystectomy has a low-risk profile, but the most dreaded complications include vascular and biliary ductal injuries.
Last updated: 14 Mar, 2022
Cholecystectomy is the surgical removal of the gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy, which can be performed using either an open or a laparoscopic method.
Gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy:
Biliary tree Biliary tree The bile ducts and the gallbladder. Gallbladder and Biliary Tract: Anatomy:
Calot’s (hepatobiliary) triangle:
Anatomy of the gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy and the biliary tree Biliary tree The bile ducts and the gallbladder. Gallbladder and Biliary Tract: Anatomy
Image by Lecturio.Variations in the arterial supply to the
gallbladder
Gallbladder
The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile.
Gallbladder and Biliary Tract: Anatomy:
A: From the right
hepatic artery
Hepatic artery
A branch of the celiac artery that distributes to the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum.
Liver: Anatomy (most common: 90%)
B: From the right
hepatic artery
Hepatic artery
A branch of the celiac artery that distributes to the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum.
Liver: Anatomy arising from the
superior mesenteric artery
Superior mesenteric artery
A large vessel supplying the whole length of the small intestine except the superior part of the duodenum. It also supplies the cecum and the ascending part of the colon and about half the transverse part of the colon. It arises from the anterior surface of the aorta below the celiac artery at the level of the first lumbar vertebra.
Small Intestine: Anatomy
C: 2
cystic
Cystic
Fibrocystic Change
arteries
Arteries
Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles.
Arteries: Histology: from the right hepatic and common hepatic
arteries
Arteries
Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles.
Arteries: Histology
D: 2
cystic
Cystic
Fibrocystic Change
arteries
Arteries
Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles.
Arteries: Histology: from the right and left hepatic
arteries
Arteries
Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles.
Arteries: Histology
E: From the right
hepatic artery
Hepatic artery
A branch of the celiac artery that distributes to the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum.
Liver: Anatomy and running anterior to the common hepatic duct
F: 2
cystic
Cystic
Fibrocystic Change
arteries
Arteries
Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles.
Arteries: Histology from the right
hepatic artery
Hepatic artery
A branch of the celiac artery that distributes to the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum.
Liver: Anatomy
Variations of the
cystic
Cystic
Fibrocystic Change duct anatomy:
A: Long
cystic
Cystic
Fibrocystic Change duct joins the common hepatic duct behind the
duodenum
Duodenum
The shortest and widest portion of the small intestine adjacent to the pylorus of the stomach. It is named for having the length equal to about the width of 12 fingers.
Small Intestine: Anatomy.
B: Absence of
cystic
Cystic
Fibrocystic Change duct
C:
Cystic
Cystic
Fibrocystic Change duct crosses posteriorly to common hepatic duct and joins it anteriorly.
D:
Cystic
Cystic
Fibrocystic Change duct crosses anteriorly to common hepatic duct and joins it posteriorly.
E: Low junction between the
cystic
Cystic
Fibrocystic Change duct and common hepatic duct
F:
Cystic
Cystic
Fibrocystic Change duct adherent to the common hepatic duct
G: High junction between the
cystic
Cystic
Fibrocystic Change and the common hepatic ducts
H:
Cystic
Cystic
Fibrocystic Change duct drains into right hepatic duct.
The goal of surgical treatment is to remove the gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy and the stones it contains, while ensuring that no stones remain within the ductal system. The goals are the same for both the laparoscopic and the open approach.
Laparoscopic cholecystectomy is considered the gold standard, as it results in decreased postoperative pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, a shorter hospital stay, and an earlier return to work. Over 90% of cholecystectomies are performed laparoscopically. Conversion to an open approach is mandatory if anatomy is not clear.
Laparoscopic cholecystectomy:
Incisions for open and laparoscopic cholecystectomy
Image by Lecturio.Laparoscopic view of the
gallbladder
Gallbladder
The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile.
Gallbladder and Biliary Tract: Anatomy:
The grasper is on the
fundus
Fundus
The superior portion of the body of the stomach above the level of the cardiac notch.
Stomach: Anatomy of the
gallbladder
Gallbladder
The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile.
Gallbladder and Biliary Tract: Anatomy and is retracting it cephalad over the
liver
Liver
The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood.
Liver: Anatomy.
Open cholecystectomy:
Cholecystectomy has a low-risk profile; however, like any other surgical procedure, it has inherent risks and complications.