General Surgery

Cholecystectomy (Open)

OPERATION: Cholecystectomy (Open)
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: Co-amoxiclav at induction
POSITION: Supine

INDICATION:
Symptomatic gallstone disease / acute cholecystitis / common bile duct stones. [Reason for open approach: failed laparoscopy / anatomy / surgeon preference].

INCISION: Right subcostal (Kocher) incision.

PROCEDURE:
WHO Checklist performed. Peritoneum opened via right subcostal incision. Liver retracted superiorly. Hepatoduodenal ligament exposed.

Triangle of Calot dissected. Cystic duct and cystic artery individually identified. Critical view of safety achieved [or if not achievable due to inflammation, fundus-first dissection performed]. Cystic duct clipped / ligated twice proximally and once distally and divided. Cystic artery similarly secured and divided.

Gallbladder dissected from liver bed working from neck towards fundus. Bed haemostasis confirmed with diathermy.

On-table cholangiogram performed [if indicated] — results: [describe].

Peritoneal cavity irrigated. [Drain placed to subhepatic space if appropriate].

FINDINGS:
[Acutely / chronically inflamed] gallbladder. [Stones / mucocele / empyema]. Anatomy of Calot's triangle [normal / distorted by inflammation].

SPECIMEN: Gallbladder to histopathology.
EBL: [Volume] ml. COMPLICATIONS: None.

CLOSURE:
Abdominal wall closed in layers with absorbable suture. Skin clips / subcuticular suture.

POST-OPERATIVE INSTRUCTIONS:
Regular analgesia. Eat and drink as tolerated. Drain [if placed] emptied daily. Outpatient review.