Laparoscopic Cholecystectomy

What is a laparoscopic cholecystectomy?

Laparoscopic cholecystectomy is a procedure in which the gallbladder is removed by laparoscopic techniques. Laparoscopic surgery also referred to as minimally invasive surgery or Keyhole surgery describes the performance of surgical procedures with the assistance of a video camera and several thin instruments.

What Causes Gallbladder Problems?

• Gallbladder problems are usually caused by the presence of gallstones which are usually small and hard, consisting primarily of cholesterol and bile salts that form in the gallbladder or in the bile duct.
• It is uncertain why some people form gallstones but risk factors include being female, prior pregnancy, age over 40 years, and being overweight. Gallstones are also more common as you get older and some people may have a family history of gallstones.
• There are no known means to prevent gallstones.
• These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting, indigestion, and, occasionally, fever.
• If the gallstone blocks the common bile duct, jaundice (yellowing of the skin) can occur.

How Are These Problems Found and Treated?

• Ultrasound is most commonly used to find gallstones.
• In a few more complex cases, other X-ray tests such as a CT scan or a gallbladder nuclear medicine scan may be used to evaluate gallbladder disease.
• Gallstones do not go away on their own. Some can be temporarily managed by making dietary adjustments, such as reducing fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue unless the gallbladder is removed. Treatments to break up or dissolve gallstones are largely unsuccessful.
• Surgical removal of the gallbladder is the time-honored and safest treatment of gallbladder disease.

What are the Advantages of Performing Laparoscopic Gallbladder Removal?

• Small 3 to 4 openings in the abdomen.
• Patients usually have minimal post-operative pain.
• The risk of complications in cholecystectomy is very minimal.
• Patients usually experience faster recovery than open gallbladder surgery patients.
• Most patients go home the same day of the surgery and enjoy a quicker return to normal activities.

What happens during the surgery?

A general anesthetic is given to relax your muscles, prevent pain, and help you fall asleep. Your abdomen is inflated with carbon dioxide, a harmless gas. A cholangiogram (a special X-ray) is done to check for stones in your common bile duct. The laparoscope is then inserted through an incision in your navel, so your doctor can look inside.

Other instruments are then inserted through additional small incisions. Your gallbladder is removed through one of these incisions.

What are the potential risks and complications?

The risk of complications is very low, however, potential risks might include:

• Bleeding
• Infection
• Common bile duct injury
• Minor shoulder pain (from the carbon dioxide gas)
• Bile leakage

What is the benefit of laparoscopic cholecystectomy?

• Less discomfort than regular surgery
• Shorter hospital stay, with a quicker recovery time compared to regular surgery
• Smaller scars than regular surgery

Call your physician if you experience:

• Increasing pain and redness at an incision site
• Fever higher than 101 degrees
• Draining at the incision site that increases or becomes foul smelling

What is an open cholecystectomy?

A cholecystectomy is the removal of your gallbladder through an incision in the upper abdomen.

An open cholecystectomy might be required instead of a laparoscopic cholecystectomy because of:

• Major scarring from a previous surgery
• A bleeding disorder
• A condition that would make it difficult to see through the laparoscope

What happens during an open cholecystectomy?

A general anesthetic is given to relax your muscles, prevent pain, and help you fall asleep. A single incision is made below the right side of your rib cage or in the center of the abdomen. Through the incision, your gallbladder and surrounding anatomy can be seen. The gallbladder is detached from its attachments, and the blood supply is tied off and divided. Sometimes a cholangiogram (a special X-ray) is conducted to check for stones in the common bile duct. If there are stones in the common bile duct, they are removed at this time. The skin is closed using surgical clips and sutures