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Cholecystectomy

Laproscopic Cholecystectomy

Cholecystectomy (koh-luh-sis-TEK-tuh-me) is a surgical procedure to remove your gallbladder — a pear-shaped organ that sits just below your liver on the upper right side of your abdomen. Your gallbladder collects and stores bile — a digestive fluid produced in your liver.

Cholecystectomy may be necessary if you experience pain from gallstones that block the flow of bile. Cholecystectomy is a common surgery, and it carries only a small risk of complications. In most cases, you can go home the same day of your cholecystectomy.

The gallbladder is removed through a 5 to 8 inch long incision, or cut, in your abdomen. The cut is made just below your ribs on the right side and goes to just below your waist. This is called open cholecystectomy.

Cholecystectomy is most commonly performed by inserting a tiny video camera and special surgical tools through four small incisions to see inside your abdomen and remove the gallbladder. Doctors call this laparoscopic cholecystectomy. In some cases, one large incision may be used to remove the gallbladder. This is called an open cholecystectomy.

What are the indications for Cholecystectomy?

Cholecystectomy is used to treat gallstones and the complications they cause. Your doctor may recommend cholecystectomy if you have:

  • Gallstones in the gallbladder (cholelithiasis)
  • Gallstones in the bile duct (choledocholithiasis)
  • Gallbladder inflammation (cholecystitis)
  • Pancreas inflammation (pancreatitis)

What are the risks of Cholecystectomy?

Cholecystectomy carries a small risk of complications including:

  • Bile leak
  • Bleeding
  • Blood clots
  • Death
  • Heart problems
  • Infection
  • Injury to nearby structures, such as the bile duct, liver and small intestine
  • Pancreatitis
  • Pneumonia

Your risk of complications depends on your overall health and the reason for your cholecystectomy.

Procedure:

Before the Surgery:

To prepare for cholecystectomy, your surgeon may ask you to:

  • Drink a solution to clean out your intestines. In the days before your procedure you may be given a prescription solution that flushes stool out of your intestines.
  • Eat nothing the night before your surgery. You may drink a sip of water with your medications, but avoid eating and drinking at least four hours before your surgery.
  • Stop taking certain medications and supplements. Tell your doctor about all the medications and supplements you take. Continue taking most medications as prescribed. Your doctor may ask you to stop taking certain medications and supplements because they may increase your risk of bleeding.

During the Surgery:

Cholecystectomy is performed using general anesthesia, so you won’t be aware during the procedure. Anesthesia drugs are given through a vein in your arm. Once the drugs take effect, your health care team will insert a tube down your throat to help you breathe. Your surgeon then performs the cholecystectomy using either a laparoscopic or open procedure.

Minimally invasive (laparoscopic) cholecystectomy

During laparoscopic cholecystectomy, the surgeon makes four small incisions in your abdomen. A tube with a tiny video camera is inserted into your abdomen through one of the incisions. Your surgeon watches a video monitor in the operating room as special surgical tools are inserted through the other incisions in your abdomen and your gallbladder is removed.

Next you’ll undergo an imaging test, such as X-ray or ultrasound, to check your bile duct for abnormalities. If your surgeon finds gallstones or other problems in your bile duct, those may be remedied. Then your incisions are sutured, and you’re taken to a recovery area. Laparoscopic cholecystectomy takes one or two hours.

Laparoscopic cholecystectomy isn’t appropriate for everyone. In some cases your surgeon may begin with a laparoscopic approach and find it necessary to make a larger incision because of scar tissue from previous operations or complications.

Traditional (open) cholecystectomy

During open cholecystectomy your surgeon makes a 6-inch (15-centimeter) incision in your abdomen below your ribs on your right side. The muscle and tissue are pulled back to reveal your liver and gallbladder. Your surgeon then removes the gallbladder. The incision is sutured, and you’re taken to a recovery area. Open cholecystectomy takes one or two hours.

After the Surgery:

Plan ahead for your recovery after surgery. For instance:

  • Plan for a hospital stay. Most people go home the same day of their cholecystectomy, but complications can occur that require one or more nights in the hospital. If the surgeon needs to make a long incision in your abdomen to remove your gallbladder, you may need to stay in the hospital longer. It’s not always possible to know ahead of time what procedure will be used. Plan ahead in case you need to stay in the hospital by bringing personal items, such as your toothbrush, comfortable clothing, and books or magazines to pass the time.
  • Find someone to drive you home and stay with you. Ask a friend or family member to drive you home and stay close the first night after surgery.

What are the prognoses of this Surgery?

Cholecystectomy can relieve the pain and discomfort of gallstones. Conservative treatments, such as dietary modifications, usually can’t stop gallstones from recurring. Cholecystectomy is the only way to prevent gallstones.

Some people experience mild diarrhea after cholecystectomy, though this usually goes away with time. Most people won’t experience digestive problems after cholecystectomy. Your gallbladder isn’t essential to healthy digestion.

How quickly you can return to normal activities after cholecystectomy depends on which procedure your surgeon uses and your overall health. People undergoing laparoscopic cholecystectomy may be able to go back to work in a matter of days. Those undergoing open cholecystectomy may need a week or more to recover enough to return to work.

What is laparoscopic cholecystectomy?

A less invasive way to remove the gallbladder is called laparoscopic cholecystectomy. This surgery uses a laparoscope (an instrument used to see the inside of your body) to remove the gallbladder. It is performed through several small incisions rather than through one large incision.

What is a laparoscope and how is it used to remove the gallbladder?

A laparoscope is a small, thin tube that is put into your body through a tiny cut made just below your navel. Your surgeon can then see your gallbladder on a television screen and do the surgery with tools inserted in three other small cuts made in the right upper part of your abdomen. Your gallbladder is then taken out through one of the incisions.

Are there any benefits of laparoscopic cholecystectomy compared with open cholecystectomy?

With laparoscopic cholecystectomy, you may return to work sooner, have less pain after surgery, and have a shorter hospital stay and a shorter recovery time. Surgery to remove the gallbladder with a laparoscope does not require that the muscles of your abdomen be cut, as they are in open surgery. The incision is much smaller, which makes recovery go quicker.

With laparoscopic cholecystectomy, you probably will only have to stay in the hospital overnight. With open cholecystectomy, you would have to stay in the hospital for about five days. Because the incisions are smaller with laparoscopic cholecystectomy, there isn’t as much pain after this operation as after open cholecystectomy.

Is there any reason why I wouldn’t be able to have a laparoscopic cholecystectomy?

If you have previously had surgery in the area of your gallbladder, if you tend to bleed a lot or if you have any problem that would make it hard for your doctor to see your gallbladder, an open surgery may be better for you. Your doctor will decide which type of surgery is best for you.

What are the complications of laparoscopic cholecystectomy?

Complications may include bleeding, infection and injury to the duct (tube) that carries bile from your gallbladder to your stomach. Also, during laparoscopic cholecystectomy, the intestines or major blood vessels may be injured when the instruments are inserted into the abdomen. All of these complications are rare.

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