Case Review

Single-Incision Laparoscopic Gall Bladder Removal Helps Get Patient Back to Normal Activities Quickly After Resection for Gallstone

In July 2009, a patient contacted Aria’s Division of General Surgery for pain due to a gallstone.  In March of that year, the patient had an ultrasound for the discomfort, which revealed the stone.  The patient wanted to gauge both pain level and timing of treatment before scheduling his care.  After the symptom became more intense, and after additional lab studies and a visit with his family doctor on July 14, he elected to pursue treatment.

Luca Giordano, MD, FACS, head of Aria’s Section on Minimally Invasive Surgery evaluated the patient and his history on July 20, at the section’s Torresdale offices.  This 42-year-old man from Northeast Philadelphia was suffering from increasing upper abdominal pain, exacerbated after mealtime.  He had mild hypertension but was otherwise healthy.  After receiving results from additional preoperative testing including blood work, Giordano recommended gallstone removal for biliary pain caused by cholecystitis.  Due to the patient’s schedule – and the fact that he had only moderate pain and no other symptoms – the patient requested a September or October surgical date. 

>> Learn more about single-incision laparoscopy. 

Elective surgery to prevent complications
Not all patients with gallstones require surgery, but based on this patient’s pattern of increasing symptoms and his radiologic study, the patient stood a good chance for worsening and debilitating symptoms, including even more persistent abdominal pain, likely with nausea and vomiting especially after eating and especially when consuming fatty food.  If the stone was to pass incompletely, the patient would be at danger of such serious complications as biliary duct infection or gallstone pancreatitis. 

Brief hospital stay, fast recovery, no scar.

Undergoing laparoscopy instead of an open surgical procedure would afford the patient all of the advantages of minimally invasive surgery, including faster recovery. The laparoscopic approach also provided the greatest safety, with the least chance for complications such as hernia.

The Aria team felt that the patient was a strong fit to additionally benefit from an improved form of laparoscopy to which Giordano brought extensive training.  Making a single small incision across the navel in which to insert several ports, would permit the team to avoid making multiple incisions around the abdomen for individual access for these ports, which are required for inserting the laparoscope and surgical tools into the body.

Good training, good team, brings success
Undertaking the procedure on October 1, Giordano led an experienced Aria O.R. team.  Giordano had undergone the extensive training necessary to provide a safe and effective single-incision laparoscopy – a procedure that would be a first for the Aria community.  

With the patient under general anesthesia, the team made a single, two-inch incision vertically across the navel and, through this opening, gained all required access, readily reaching the gallbladder, which the team resected, bagged, and removed.  Giordano divided the cystic duct and artery and closed them with titanium clips that remain permanently in place.  The team closed the incision with absorbable, subcuticular sutures, completing the procedure in approximately 45 minutes.

Fast, scarless recover
In the hospital, the patient appreciated less post-operative discomfort than he would have from a multiple-incision laparoscopy.  Though removal of the gallbladder by laparoscopy can offer patients same-day discharge, this patient stayed one night in the hospital to fully recover from the affects of anesthesia.

Almost as soon he arrived home, he was active again.  Returning to normal activities, he experienced little or no discomfort.

The patient returned to Aria’s Section on Minimally Invasive Surgery for follow-up on October 9.  Pathology had revealed a routine gallstone-impacted gallbladder with no evidence of chronic cholecystitis from other cause or other disease.

Patient and physician noted no additional concerns, and the wound from the incision was already barely visible.  The treatment was deemed curative with no additional follow-up necessary.