**2. Tips for a safe cholecystectomy**

I have personally penned down certain points in my personal experience which can be used as a guide or may be even as a checklist before the young talented surgeons place their hands on cholecystectomies:


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*Prologue: Biliary System - History and Background DOI: http://dx.doi.org/10.5772/intechopen.88400*

22.All stumps should be carefully examined.

cases via a laparoscopic approach.

etiopathogenesis, disease severity and management.

histopathology.

**3. Gallstone pancreatitis**

**3.1 Etiopathogenesis**

20.Partial cholecystectomies are an option for difficult cases.

23.Bile spillage and stone spillage should be sucked out or removed.

21.Do not hesitate to open the abdomen in case of bleeding or difficult anatomy.

24.Conversions are not failures, and surgeons should not have an ego to finish all

25.Whatever taken out of the body including all gallbladders should be sent for

Acute pancreatitis is now the most common reason for hospital admission among all gastrointestinal disorders [1]. Population-based studies indicate that the incidence of acute pancreatitis is rising from 14.8 in 100,000 (1990–1994) to 31.2 in 100,000 (2010–2013) among British males [2]. The most common (about 30–50%) preventable cause of pancreatitis in the United Kingdom is gallstones [3]. Recurrent attacks of gallstone pancreatitis (GSP) carry a mortality rate of 10% and a major morbidity rate of 30–40%. Most of these cases follow a mild course and are selflimited with supportive care, but approximately 20% progress to severe disease, requiring a prolonged hospital stay and intensive care, and are associated with a mortality rate approaching 30%. Three key areas in the management of patients with gallstone pancreatitis are diagnosis, risk stratification with predictors of severity and the type and timing of definitive intervention. In this chapter we have attempted to cover all relevant clinical aspects of gallstone pancreatitis regarding its

Considering all non-malignant gastrointestinal diseases, currently acute pancreatitis has become the most frequent reason for hospital admission. An overall mortality of 4.3% within 90 days and a 1-year mortality of 7.9% make it a lethal disease [2]. Gallstone disease is becoming more common along with heavy alcoholism as the cause of pancreatitis. Population-based studies indicate that the prevalence of gallstones in some Western countries surpasses 20% of the adult population [4].The continuous rise in gallstone prevalence is much more likely to be due to nutritional and life style factors, though genetic predisposition plays an important part in formation of gallstones [5, 6]. When a patient develops pancreatitis due to gallstones, the disease is likely to recur until the migrating bile duct stones are removed or their impaction at the duodenal papilla is prevented. According to a study involving some 5000 patients admitted with first episode of acute gallstone-associated pancreatitis, the recurrence rate was reduced from 30 to 6.7% with endoscopic sphincterotomy done during the first week; an elective interval cholecystectomy reduced it to 4.4%, and it was further reduced to 1.2% by performing endoscopic sphincterotomy combined with elective cholecystectomy during the same hospital admission [7]. The manipulation of the papilla while removing a gallstone or during a sphincterotomy, the consequent swelling can obstruct the pancreatic duct, and triggers pancreatitis in some patients. A way *Digestive System - Recent Advances*

**2. Tips for a safe cholecystectomy**

surgeons place their hands on cholecystectomies:

I have personally penned down certain points in my personal experience which

can be used as a guide or may be even as a checklist before the young talented

sions and would be a task to dissect during the initial days.

5.A good first assistant and a qualified and trained surgeon.

injuries to bile duct or other nearby structures.

3.Proper cleaning and sterilization of instruments.

4.Good quality equipment and instruments.

9.Urine to be evacuated just before the surgery.

10.Fundus should be retracted towards the right shoulder.

instruments and the technique.

8.Open technique of first port.

7. 30° telescope.

person to person.

dissection.

mon bile duct.

control the bleed.

1.Selection of initial cases—female thin built patients with short history of biliary colics and especially no history of cholecystitis as there would be adhe-

2.Informed consent including chances of conversion and high risk of various

6.Formal training in laparoscopic surgeries to have a basic knowledge about the

11.Vascular anatomy and biliary tract anatomies are different and vary from

13.Hydrodissection and suction cannula can be a good instrument for blunt

14.It is safer to leave a few mm of cystic duct than to shave it off near to the com-

18.Bleeding seen on the screen will usually be less as they are magnified versions.

19.All bleedings will stop with pressure except the physiological menstrual bleed. So in case if there is bleeding, avoid panic, give pressure with gauze piece and

12.Consider cystic lymph node of Lund as a guide for the cystic duct.

15.Double clips are always safer on the patient side of the structures.

17.Fundus-first techniques can be adopted for difficult cases.

16.Cystic ducts can be wider, longer, tortuous, double or even very short.

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