Open Cholecystectomy for Gallbladder Disease
Jacob C. Mesiti1; Yoko Young Sang, MD2; Peter F. Rovito, MD2;
1Lake Erie College of Osteopathic Medicine
2World Surgical Foundation
Gallbladder diseases are a subset of a spectrum of pathologies of the biliary system and are a particularly common etiology of abdominal pain encountered in modern medicine. These pathologies most often share a similar underlying mechanism of disease: obstruction of a portion of the biliary tree by cholelithiasis, or gallstones.
Gallstones, for the most part, form initially in the gallbladder with the exception of primary common bile duct (CBD) stones that form primarily in the CBD. Risk factors include a wide variety of conditions both pathologic and physiologic, including hyperlipidemia, hemolysis, and pregnancy. The resulting obstruction creates a state of biliary stasis, eventually leading to inflammation, pain, and an increased risk of infection. The anatomical location of the obstruction contributes greatly to both the clinical presentation and the ultimate treatment of the disease.
A hallmark of the treatment of gallbladder disease, ranging from simple biliary colic to life-threatening emphysematous cholecystitis, is the cholecystectomy. In modernized countries, this procedure is almost invariably performed laparoscopically. However, in certain clinical scenarios, such as when a patient cannot tolerate the pneumoperitoneum associated with laparoscopic surgery or when the procedure takes place in a developing country with limited access to laparoscopic capabilities, an open approach is preferred.
Open Cholecystectomy for Gallstone Disease
Liborio “Jun” Soledad, MD; Enrico Jayma, MD; Ted Carpio, MD
World Surgical Foundation
Gallstone disease is one of the most common disorders affecting the digestive tract. Most individuals with gallstones are asymptomatic and do not require treatment. For symptomatic patients, however, cholecystectomy is recommended.
Cholecystectomy is one of the most common abdominal surgeries performed worldwide. Indications include moderate-to-severe symptoms, stones obstructing the bile duct, gallbladder inflammation, large gallbladder polyps, and pancreatic inflammation due to gallstones.
Here, we report the case of a 53-year-old male with stones in his biliary duct. Despite having uncomplicated disease, the patient was treated with a primary open cholecystectomy because laparoscopy was not available.
Open Lobectomy
Massachusetts General Hospital
Christopher R. Morse, M.D.
Assistant Professor of Surgery, Harvard Medical School
Co-Director, Gastroesophageal Surgery Program
An adult male with cystic fibrosis (CF) presents with a chronically damaged left upper lung lobe that Dr. Christopher Morse decides to treat with an open lobectomy given that the patient was not going to heal from antibiotic therapy and still had mild preserved pulmonary function. Two unusual things in this procedure are the dense inflammatory changes at the hilum and the use of muscle from chest wall to reinforce the bronchial closure because of the patient’s recurrent and chronic pulmonary infections due to CF.
Distal Gastrectomy (Open)
John T. Mullen, MD
Director, General Surgery Resident Program
Massachusetts General Hospital
An 80-year-old patient with anemia undergoes an upper endoscopy that reveals inflammation in the distal stomach. Biopsies identify it as an early intramucosal adenocarcinoma while an endoscopic ultrasound shows the tumor invading the muscle of the stomach. Given that there are no signs of metastasis, the patient presents for a potentially curative gastrectomy where Dr. John Mullen removes the distal two-thirds of the stomach, performs a D1 lymph node dissection and a partial D2 lymph node dissection, and reconstructs in a Billroth II fashion.
Thoracoabdominal Aortic Aneurysm Repair – Part 2
Virendra I. Patel, MD, MPH
Associate Program Director, General Surgery Residency; Department of Vascular and Endovascular Surgery
Massachusetts General Hospital
Dr. Patel continues repairs on this thoracoabdominal aortic aneurysm in Part 2 of this two part series. Watch as he works against the clock during visceral ischemia time until blood flow from the graft is restored to all the dependent organs! (Pre-print, Part 2 of 2).
This article follows a previously released Part 1.
Thoracoabdominal Aortic Aneurysm Repair – Part 1
Virendra I. Patel, MD, MPH
Associate Program Director, General Surgery Residency; Department of Vascular and Endovascular Surgery, Massachusetts General Hospital
Watch Dr. Patel as he performs a Type 1 thoracoabdominal aortic aneurysm repair with distal aortic perfusion through an atriofemoral bypass circuit. (Pre-print, Part 1 of 2).
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