Alternative Names cholecystectomy , laparoscopic cholecystectomy
Definition Cholecystectomy is the medical term for removal of a gallbladder. Gallbladder disease, or cholecystitis, is a common health problem today. Operations to remove abnormal gallbladders have been done for more than 100 years with excellent results.
Who is a candidate for the procedure? Those who are having gallbladder problems may consider this procedure. There are several reasons that the gallbladder can become inflamed. Sometimes stones form in the gallbladder. They are called gallstones. These stones block the drainage of bile. Bile is a fluid that concentrates in the gallbladder before it is poured into the small intestine to help digest fat, among other things. If this happens, a person will usually feel severe pain in the upper right part of the abdomen.
Other people have silent gallstones or only mild symptoms. Some people will have a gallbladder that does not have stones but still does not drain well. This is called biliary dyskinesia. It is also treated by removing the gallbladder. If a person has other diseases such as diabetes or heart problems, he or she may be a poor candidate for emergency surgery. In this case, the doctor may recommend an elective cholecystectomy.
How is the procedure performed? Gallbladder removal is one of the most frequently performed operations in Australia. It can be done either as open surgery or with a laparoscope. With a laparoscope, a scope is put through a small incision near the belly button to examine the gallbladder. Tools are inserted to perform procedures through separate small incisions. It can be performed safely in most hospitals with little risk to the individual.
Open surgery is the older way to remove a gallbladder. An incision is made in the right upper part of the abdominal cavity a few inches below the rib cage. The surgeon cuts all the way through the abdominal wall. This lets the doctor look at the abdominal cavity for any other problems. The liver is lifted up toward the chest so that the underside can be seen. The gallbladder is attached to the liver by filmy tissue. A tube called the cystic duct and blood vessels also connect it.
The cystic duct is at the narrow bottom of the gallbladder. This is where the contents of the gallbladder drain into another slightly larger tube called the common bile duct. This structure drains the liver and pancreas into the bowel. The surgeon is careful not to injure it during the operation. Once the surgeon checks the situation, the cystic duct and blood vessels are tied off and divided. The gallbladder is then cut away from the liver and removed. The abdominal wall is stitched together and bandaged.
Most gallbladder surgery is done using the laparoscopic technique. Like open surgery, this approach requires general anaesthesia, which puts the person to sleep. The belly button is opened with a 1-cm incision. The abdominal cavity is filled with carbon dioxide gas. A video camera built like a tiny rod is inserted through the incision. Three smaller incisions are made in the abdomen. The same process is then used as in the open procedure. However, the surgery is done using tiny instruments. Once the gallbladder is removed from the liver, it is drained of stones. It is then brought through one of the small incisions and removed from the body. The air is removed from the abdominal cavity. The cuts are stitched and bandaged.
Surgeons try to use the laparoscopic approach whenever possible. This procedure is much easier on the person. Open surgery may be needed if the gallbladder is severely inflamed or infected. This may make it too swollen to be grasped by the tiny instruments. If the person has internal scarring or has had extensive surgery, the abdomen may not inflate well when the gas is put in. This makes it difficult to see the gallbladder well. Sometimes the anatomy of bile ducts or blood vessels makes them difficult to operate on through the laparoscope. These reasons may make it necessary for the surgeon to change from a laparoscopic approach to an open approach during the operation. This happens in about 5% of cases.
What happens right after the procedure? After the operation, the individual is monitored in a recovery area. After a laparoscopic procedure, about 50% of people are stable enough to go home directly from the recovery area. Some people will be kept overnight for observation. They may also need more time to recover from the effects of the anaesthesia. Most people will be given pain and anti-nausea medications to take home.
If the open approach is used, a person will need to spend a few days in the hospital. The difference between the two approaches is the amount of pain produced by the bigger incision. Open surgery usually needs stronger painkillers. These medications are best delivered in the hospital. Open surgery also creates a longer period of recovery before returning to normal activities.
Once at home, the individual can expect to be tired for several days to a few weeks. This is true for either type of operation. Most people find it easier to eat small meals of bland food for the first few days. Eventually they will be able to return to a normal diet. Often, people find that they can eat things that caused discomfort before the surgery. The body compensates well for not having a gallbladder.
What happens later at home? Activity is important after any surgery. In this case, short walks are very helpful in re-establishing normal eating and sleeping patterns.
What are the potential complications after the procedure? The biggest potential problem from gallbladder surgery is injury to the bile ducts. The area where the cystic duct comes together with the common bile duct is the place where the cutting is done. There can be infection and scarring from gallbladder disease in this region. Inability to easily see this area is the main reason that surgeons switch to an open technique from a laparoscopic approach.
There are few complications after cholecystectomy. Infection at the incision site is rare. Some people will have loose bowel movements for a few weeks. This is because more bile reaches the large bowel than before the operation. It has an irritating effect. This problem goes away once the body has adapted to the change.
Author: Michael Peetz, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 12/06/2005 Contributors Potential conflict of interest information for reviewers available on request
