Single Incision Laparoscopic Cholecystectomy for Complex Gallstone Disease in a Young Obese Patient

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Patient Information

Age

28 years

Gender

Female

Occupation

Software professional

City

Bangalore, Karnataka

Presenting Complaint

Recurrent right upper abdominal pain with intolerance to fatty meals

Diagnosis

Symptomatic cholelithiasis with multiple gallstones and chronic cholecystitis

Duration of Issue

Approximately 10 months of progressive symptoms

Previous Treatment

Symptomatic management with antispasmodics and dietary modification

Date of Procedure

April 2025

Outcome

Excellent. Uncomplicated same-day discharge

Patient identity withheld in accordance with confidentiality guidelines.

The Problem

Condition

The patient presented with recurrent episodes of right hypochondrial pain radiating to the right shoulder, frequently triggered by fatty meals and accompanied by nausea. Ultrasonography of the abdomen revealed a thickened gallbladder wall measuring 4.2 millimetres with multiple calculi, the largest measuring approximately 14 millimetres, and no evidence of common bile duct dilatation. Magnetic resonance cholangiopancreatography subsequently confirmed the absence of choledocholithiasis. The patient had a body mass index of 32.6, classifying her in the Class I obesity category, with no other significant comorbidities. The case was managed by a Laparoscopic Surgeon in Bangalore through a transumbilical single incision approach.

Functional Impact

The recurrent episodes had progressively affected the patient’s professional commitments, with two emergency department visits in the preceding three months. Cosmetic concerns were also expressed, given her age and the potential visibility of multiple port scars on the abdomen. By the time of consultation at the clinic, she requested a minimally invasive technique that would deliver a definitive cure with the least possible scarring and the shortest recovery interval.

Consultation and Treatment Plan

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Pre-Operative Assessment

A comprehensive evaluation was undertaken by Dr. Rajeev Premnath, encompassing clinical examination, imaging review, and structured anaesthetic risk assessment in view of the patient’s elevated body mass index.

Abdominal examination, with confirmation of localised right hypochondrial tenderness and a negative Murphy’s sign in the asymptomatic interval
Ultrasonography and magnetic resonance cholangiopancreatography to confirm calculus burden and exclude common bile duct involvement
Liver function profile, complete blood count, and coagulation studies within normal limits
Cardiac and anaesthetic fitness through electrocardiography and physician clearance, with attention to body habitus
Discussion of patient priorities, specifically cosmetic outcome and rapid return to work

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Clinical Rationale

Following deliberation, single incision laparoscopic cholecystectomy through a transumbilical approach was selected. The case fell within the scope of mini laparoscopy for gall stones, and the decision was supported by the following considerations:

The single transumbilical incision is concealed within the natural umbilical fold, supporting a favourable cosmetic outcome consistent with the patient’s priority
Reduction in the number of port sites lowers the cumulative risk of port-site bleeding, hernia formation, and chronic incisional discomfort, which is of particular relevance in patients with a higher body mass index
Single-port access permits direct working triangulation onto the Calot’s triangle once articulating instruments are deployed, allowing safe dissection in the presence of chronic inflammation
Final wound closure with tissue adhesive skin glue, in place of conventional sutures, supports a suture-free closure and eliminates the requirement for a subsequent removal visit

Procedure Details

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Surgical Overview

General anaesthesia administered with endotracheal intubation; prophylactic antibiotics delivered at induction
Single 2.5 centimetre transumbilical incision created, with placement of a multi-channel single-port access device
Pneumoperitoneum established and maintained at 12 millimetres of mercury throughout the procedure
Articulating laparoscopic instruments introduced through the single port to establish working triangulation
Calot’s triangle dissected with meticulous identification of the cystic duct and cystic artery, confirming the critical view of safety
Cystic duct and artery clipped and divided; gallbladder dissected from the liver bed using monopolar diathermy
Gallbladder retrieved within an endobag through the single port; haemostasis confirmed
Fascia closed with absorbable suture; skin approximated with tissue adhesive, leaving no external suture line

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Procedure Facts

Duration	Approximately 60 minutes
Anaesthesia	General anaesthesia with endotracheal intubation
Approach	Single incision laparoscopic cholecystectomy, transumbilical
Incision	Single 2.5 centimetre concealed transumbilical port
Skin Closure	Tissue adhesive skin glue, suture-free
Intraoperative Complications	None
Hospital Stay	Same day discharge, six hours post-procedure

Post-Operative Results

The procedure achieved complete removal of the diseased gallbladder through a single concealed incision, with no requirement for conversion to a multi-port technique. The patient was ambulated within three hours, tolerated oral intake without difficulty, and was discharged the same evening. This outcome is consistent with the results typically observed in gall bladder stone removal performed through single incision techniques. At the six-week follow-up, the umbilical site demonstrated complete primary healing with the wound effectively imperceptible within the natural skin fold.

Outcome Metric	Result
Procedural Completion	✔ Successful single-port completion without conversion
Cosmetic Outcome	✔ Incision concealed within the natural umbilical fold
Wound Healing	✔ Primary closure without complication
Symptom Resolution	✔ Complete resolution of right hypochondrial pain
Patient Satisfaction	✔ Very high. Full activity restored within one week
Complications	✔ None. No port-site infection, hernia, or bile leak

Post-Procedure Care and Recovery

Oral analgesia for three days, with no antibiotic continuation required given an uncomplicated procedure
Low-fat diet for two weeks, with gradual reintroduction of regular dietary composition thereafter
Avoid lifting beyond five kilograms for two weeks, and no strenuous abdominal activity for four weeks
Daily inspection of the umbilical site. The tissue adhesive permits early showering and requires no removal
Scheduled follow-up at one week and six weeks

Recovery Timeline

Timeframe	Expected Milestones
Day 1 to 2	Mild discomfort managed with analgesia. Oral diet resumed. Light ambulation.
Day 3 to 7	Return to sedentary work. Full resumption of routine domestic activity.
Week 2 to 4	Reintroduction of light physical exercise. Dietary restrictions relaxed.
Week 6	Final review confirms complete healing and full symptom resolution.

Patient Feedback

The following feedback was recorded during the six-week clinical follow-up. It represents a verified clinical observation and is not derived from any public review platform.

“The recurrent pain had become a serious disruption to my work, and the prospect of visible scars on my abdomen was a real concern at my age. The procedure was explained to me in clear terms before I agreed to it, and the recovery was quicker than I had expected. I returned to work within a week, and the small incision within the navel is not noticeable.”

Frequently Asked Questions

What is single incision laparoscopic cholecystectomy?

It is an advanced minimally invasive technique in which the gallbladder is removed through a single concealed port placed within the umbilicus, in place of the conventional four-port approach.

Is the procedure suitable for obese patients?

Yes, provided a thorough pre-operative anaesthetic and surgical assessment confirms fitness. Fewer port sites lower the cumulative risk of port-site morbidity, which is advantageous in patients with a higher body mass index.

How long does recovery take after the procedure?

Most patients resume sedentary work within five to seven days and return to full physical activity by the fourth week.

Does the procedure leave a visible scar?

No. The single incision is placed within the natural umbilical fold and closed with tissue adhesive, leaving a virtually imperceptible result.