RIGHT UPPER PAIN
Pain in the right upper or central abdomen.
חזרה לשירותיםSAFE LAPAROSCOPIC CHOLECYSTECTOMY
ניתוחי כיס מרה
From symptomatic gallstones to acute inflammation, with systematic anatomical identification and safety strategies.
CRITICAL VIEW OF SAFETYICG / NIRBAIL-OUT STRATEGY
לצפייה בניתוחיםלתשומת לב: הניווט בעמוד זמין בעברית. התוכן הרפואי המפורט בעמוד המקצועי מוצג בשלב זה באנגלית.
ELIXIS · ADVANCED CARE
The goal is not simply removal — it is safe identification
Biliary anatomy is confirmed before division. When inflammation obscures planes, the strategy changes early.
תסמינים
Symptoms that merit assessment
Many gallstones cause no symptoms. Temporary blockage of bile flow may cause biliary colic, while prolonged obstruction can lead to inflammation or other complications.
AFTER MEALS
Pain often follows a meal and may last from minutes to several hours.
TO BACK OR SHOULDER
Discomfort may travel to the back or right shoulder.
NAUSEA OR VOMITING
A pain episode may be accompanied by nausea or vomiting.
FEVER OR CHILLS
Fever or chills may indicate that inflammation has developed.
JAUNDICE
Yellow skin or eyes, dark urine and pale stools may indicate bile-duct obstruction.
Indigestion or bloating alone do not prove gallstone disease. Assessment combines history, examination, blood tests and usually ultrasound.
ניתוחים
Procedures and safety techniques
These are different clinical scenarios; not every option is used in every patient.
01GALLSTONES
SYMPTOMATIC GALLSTONE DISEASE
Before surgery is recommended, the symptoms are assessed to confirm that gallstones are the likely cause.
- מתי נשקל
- Biliary colic, gallstone complications or another established indication.
- מה כולל
- Ultrasound, blood tests and common-duct assessment guide the appropriate plan.
02LAP CHOLE
LAPAROSCOPIC CHOLECYSTECTOMY
Removal of the gallbladder through small incisions for symptomatic stones.
- מתי נשקל
- Symptomatic gallstones or a prior complication with a clear surgical indication.
- מה כולל
- Safe dissection, control of the cystic duct and artery, and protected specimen extraction.
03CVS
CRITICAL VIEW OF SAFETY
Three defined anatomical criteria before dividing the cystic duct and artery.
- מתי נשקל
- A core safety goal in standard laparoscopic cholecystectomy.
- מה כולל
- All three criteria are required: the hepatocystic triangle is cleared of fat and fibrous tissue, the lower one third of the gallbladder is separated from the liver to expose the cystic plate, and two —and only two— structures are seen entering the gallbladder.
04ICG · NIR
ICG FLUORESCENCE CHOLANGIOGRAPHY
Intravenous ICG displays biliary anatomy with near-infrared imaging and no ionising radiation.
- מתי נשקל
- Adjunctive mapping in selected laparoscopic procedures.
- מה כולל
- The fluorescence view is alternated with white light; it supports but does not replace safe dissection and surgical judgement.
05ACUTE
ACUTE CHOLECYSTITIS SURGERY
Early laparoscopic treatment of an inflamed gallbladder when clinically appropriate.
- מתי נשקל
- Acute inflammation confirmed by clinical, laboratory and imaging findings.
- מה כולל
- Decompression when needed, careful dissection and early use of a safer bail-out strategy or conventional cholangiography when indicated.
06BAIL-OUT
SUBTOTAL CHOLECYSTECTOMY
A bail-out strategy when safe anatomical identification is not possible.
- מתי נשקל
- Severe inflammation, fibrosis or hazardous anatomy in the hepatocystic triangle.
- מה כולל
- The safely accessible gallbladder and reachable stones are removed; the remnant and cystic duct are managed according to the anatomy. Bile leak and retained-stone risks remain.
הדמיה אנטומית מקורית וריאליסטית לצורכי לימוד — אינה צילום מטופל.
תכנון ובטיחות
Anatomy is confirmed before division
ICG and conventional cholangiography are distinct adjuncts. ICG uses no X-rays and does not reliably exclude common-duct stones; neither tool replaces the Critical View of Safety or surgical judgement.
TIME-OUT
A pause before division to confirm anatomy.
TWO STRUCTURES
Clear identification of cystic duct and artery.
IMAGING
ICG for adjunct anatomical mapping; conventional cholangiography when common-bile-duct imaging is needed.
BAIL-OUT
Early change of plan in hazardous anatomy.
שאלות
שאלות נפוצות
תשובות קצרות לפני הערכה כירורגית אישית.
01Is a minimally invasive approach always possible?
No. It is chosen when safe and meaningfully beneficial. Anatomy, previous surgery and complexity may require another approach or conversion.
02How long does recovery take?
Recovery varies with the procedure, disease severity and general health. The individual plan covers mobilisation, diet, work and exercise.
03Is ICG fluoroscopy?
No. It uses near-infrared fluorescence rather than ionising radiation. Contraindications and the possibility of a rare reaction must still be checked.
ראיות קליניות
ראיות קליניות
הבחירה הסופית מבוססת על התמונה הקלינית, האנטומיה וההנחיות העדכניות.
01SAGES · Safe Cholecystectomy GuidelineCritical View of Safety and injury-prevention strategiesמקור רשמי02SAGES · Fluorescence-Guided SurgeryClinical guidance for ICG fluorescenceמקור רשמי03SAGES · Intraoperative CBD ImagingICG fluorescence and conventional X-ray cholangiographyמקור רשמי04NIDDK · GallstonesSymptoms of gallstones and complicationsמקור רשמי
המידע מיועד להסברה ואינו מחליף בדיקה רפואית. יתרונות, סיכונים וחלופות נידונים באופן אישי.
הערכה כירורגית אישית
הניתוח הנכון מתחיל בהתווייה הנכונה.
בפגישה נבחנים התסמינים, הבדיקות והחלופות.
מרפאת REA MED והגעה