Prologue: Biliary System - History and Background

*Sam Koruth and Sooraj Sankar*

## **1. Introduction**

Cholecystectomy is one of the most common surgeries performed all around the world; over 600,000 people in the US undergo cholecystectomies each year. It is the treatment of choice for inflammation of the gallbladder (cholecystitis), pain and inflammation related to gall stones (calculus cholecystitis) and pancreatitis caused by gall stones.

Carl Johann August Langenbuch, a 27-year-old director of the Lazarus Hospital in Berlin, first practiced cholecystectomy on a cadaver, and then in the year 1882, he performed a cholecystectomy on a man who had suffered from gallstones for 16 years and cured his painful condition overnight. He was initially frustrated and disturbed that his patients continued to suffer after minor procedures to drain or clean the gallbladder, and then he became determined to give these patients a cure rather than temporary relief, and thus the first open cholecystectomy captured the history books.

By 1897, over 100 cholecystectomies had been performed, and it turned out that the removal of the gallbladder not only would not take life but could in fact provide a pain-free future. Then in 1985, the modern era of cholecystectomies began when the surgeon Erich Mühe of Böblingen, Germany, did the first endoscopic cholecystectomy. Thereafter the pioneers in France and the US surgeons attached a CCD video camera to a laparoscope allowing the surgical team to view the operative field and perform with laparoscopic instruments. A French gynecologic surgeon performed a laparoscopic gallbladder removal in 1987. Soon after that in just 2 years, demand for the laparoscopic approach transformed surgical practice in the US and other countries and subsequently recognized laparoscopic cholecystectomies as the gold standard treatment for gallstone disease. The benefits of the laparoscopic approach were ultimately codified in the new National Institutes of Health (NIH) guidelines in 1992, and they stated that it provided a safe and effective treatment for most patients with symptomatic gallstones.

To date, it is documented that more than 80% of the cholecystectomies are done via laparoscopic approach. The advantages of laparoscopic over open surgeries are quite clear. These advantages include shorter length of hospital stay, very less operative pain, avoiding a big scar over the abdomen, earlier return of bowel function, improved cosmesis, earlier return to normal activities and overall decreased cost. The rates of cholecystectomies have increased subsequently with the introduction of laparoscopic procedures accompanied by evidence of lower clinical thresholds for operative therapy of gallstone diseases.
