Laparoscopic treatment of gall-bladder disease

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Abstract
Summary. Laparoscopic cholecystectomy is now established as the treatment of choice for symptomatic gallstone disease and is applicable to 95% of cases. Residual controversial issues remain and these include the need or otherwise for routine operative cholangiography and the management of ductal calculi. There is a place for gall-bladder drainage by percutaneous or laparoscopic cholecystostomy in elderly poor risk patients with acute severe cholecystitis. The laparoscopic options for dealing with ductal calculi are extraction through the cystic duct and supraduodenal bile duct exploration. Most of the injuries sustained can be avoided by the adoption of safe techniques for inducing the pneumoperitoneum, by careful dissection and observation of the basic rules governing the use of endoscopic high frequency electrosurgery. Technical developments such as the argon beam spray coagulation will further reduce the incidence of electrocoagulation related complications.