laparoscopic gallbladder surgery

Cholecystectomy complications
complications that can occur include bleeding, infection, leakage of bile in the abdomen, pneumonia, blood clots, or heart problems.

Surgical injury to an adjacent structures such as the common bile duct, duodenum or the small intestine may occur rarely and may require another surgical procedure to repair it. If the gallbladder is accidentally or deliberately opened during the procedure stones may fall out of the gallbladder and in to the abdomen that may give rise to later scarring.

Indications for cholecystectomy
Patients who are immunocompromised, are awaiting organ allotransplantation, or have sickle cell disease are at higher risk for the development of complications and should be treated irrespective of the presence or absence of symptoms.
Additional reasons to consider prophylactic laparoscopic cholecystectomy include the following:
Calculi greater than 3 cm in diameter, particularly in individuals in geographic regions with a high prevalence of gallbladder cancer
Chronically obliterated cystic duct
Nonfunctioning gallbladder
Calcified (porcelain) gallbladder
Gallbladder polyp larger than 10 mm or showing a rapid increase in size
Gallbladder trauma
Anomalous junction of the pancreatic and biliary ducts

Biliary colic with sonographically identifiable stones is the most common indication for elective laparoscopic cholecystectomy. [8, 12]
Acute cholecystitis, if diagnosed within 72 hours after symptom onset, can and usually should be treated laparoscopically. Beyond this 72-hour period, inflammatory changes in surrounding tissues are widely believed to render dissection planes more difficult. This may, in turn, increase the likelihood of conversion to an open procedure to 25%. Randomized control trials have not borne out this 72-hour cutoff and have shown no difference in morbidity. Other options include interval laparoscopic cholecystectomy after 4-6 weeks and percutaneous cholecystostomy. [13, 14, 15]

CI
Absolute contraindications for laparoscopic cholecystectomy include an inability to tolerate general anesthesia and uncontrolled coagulopathy. Patients with severe obstructive pulmonary disease or congestive heart failure (eg, cardiac ejection fraction <20%) may not tolerate carbon dioxide pneumoperitoneum and may be better served with open cholecystectomy if cholecystectomy is absolutely necessary. Gallbladder cancer must be considered a contraindication for laparoscopic cholecystectomy. If gallbladder cancer is diagnosed intraoperatively, the operation must be converted to an open procedure.

complications
Trocar/Veress needle injury
Hemorrhage
Postcholecystectomy syndrome
CBD injury or stricture
Wound infection or abscess
Ileus
Gallstone spillage
Deep vein thrombosis

bladder polyps are classified as benign or malignant.
pseudotumors (cholesterol polyps, inflammatory polyps; cholesterolosis and hyperplasia), epithelial tumors (adenomas) and mesenchymatous tumors (fibroma, lipoma, and hemangioma). Malignant GPs are gallbladder carcinomas. The poor prognosis of gallbladder carcinoma patients means it is important to differentiate between benign polyps and malignant or premalignant polyps.

free portion of callots triangle to free:
cystic duct
cystic artery
common bile duct

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