Cholelithiasis is a very frequent condition characterized by the presence of stones in the gall bladder.

Obesity, multiple pregnancies, age >40 years, female gender, sudden loss of weight, hereditary predisposition, etc. are predisposing factors.

Gallstones (calculi) form out of different substances such as cholesterol, bile pigments (bilirubin), and calcium.

Cholelithiasis may be asymptomatic (70%) or present with symptoms and serious complications, e.g. colic, cholecystitis, choledocholithiasis, pancreatitis, gallbladder hydrops, empyema, or even gangrene or perforation.

Acute cholecystitis occurs in 95% of cases due cystic duct obstruction from a gallbladder, which causes edema, inflammation and thickening of the gallbladder wall. Pain is the main symptom, notably in the gallbladder area (right hypochondrium) while jaundice (yellowish pigmentation of the conjunctiva of the eyes) may also be present as well as nausea, vomiting, and fever. Acute cholecystitis may be treated conservatively with feeding interruption and intravenous antibiotics or surgically (during the acute phase or subsequently).

The surgical treatment of choice for cholelithiasis is laparoscopic cholechystectomy. This method consists of introducing air into the abdomen (pneumoperitoneum) and insterting surgical tools through incisions of 0.5-1cm in diameter. The gallbladder is prepared, the main elements such as the cystic duct and the cystic artery are identified and prepared. These are ligated with the use of specific clips. Then, the gallbladder is detached from the liver bed and removed through one of the small incisions performed. Postoperative morbidity is clearly lower versus open surgery, postoperative pain is minimal and usually the patient leaves hospital within 24 hours.

Currently, most cholechystectomies are performed laparoscopically. Latest trends in surgery make it increasingly less invasive which led to the invention and application of single-incision laparoscopic surgery cholecystectomy see Advanced Single Incision Cholechystectomy SILS). At Evangelismos Hospital we perform the first single incision laparoscopic surgical procedures with spectacular results.