Cholecystectomy

Cholecystectomy is the surgical procedure performed to remove gallbladder. The primary purpose of gallbladder is bile storage. Bile is a digestive fluid that the liver creates to help the body digest fats. When we eat, our hormones send a signal to our gallbladders to release bile. Sometimes bile creates blockages if it contains excess amount of cholesterol or liver pigment leading to the several gall bladder problems like gallstones, bile duct stones and inflammation of gallbladder. If these problems do not subside but instead become too uncomfortable to manage, gallbladder removal surgery may be necessary.

Cholecystectomy is the first line therapy for gallstones. The surgery will involve either laparoscopic surgery or open surgery. The laparoscopic surgery involves the removal of gallbladder while making only five small incisions whereas in open surgery one very large incision around 10cm is given.

Symptoms

Most patients with gallstone experience a constant and severe pain in the right upper abdomen lasting four to six hours. This is caused by brief impaction of gallstone in the neck of gallbladder.

Why is cholecystectomy performed?

You can have a gallbladder removed for several reasons, including:

• Choledocholithiasis: It refers to gallstones that have migrated from the gallbladder into the common bile duct.
• Cholecystitis: It is an inflammation of gallbladder that usually occurs due to the obstruction of the cystic duct by gall stones.
• Biliary dyskinesia: It is a disorder that affects the functioning of gallbladder.
• Gallbladder trauma
• Gallbladder cancer

Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy or minimally invasive cholecystectomy involves the removal of gallbladder through a laparoscopic approach. A laparoscope is a small, thin tube with a camera that is put into the body through a tiny cut made just below the navel. This allows the doctor to see the gallbladder on the screen.

It is usually carried out when the patient has gallstones. Gallstones are generally small, hard deposits inside the gallbladder that are formed when stored bile crystallizes. Gallstones cause no symptoms until it reaches a certain size or if the gallstones obstruct the bile duct.

How is it performed?

Laparoscopic cholecystectomy is performed under general anesthesia so the patient is asleep and pain-free throughout the procedure. The surgeon makes 3-4 incisions usually less than 2.5cm each in length in the abdomen. The abdomen is then gently inflated with carbon dioxide, followed by the insertion of the laparoscope through the cut. The laparoscope is connected to a special camera through which the surgeon will get a magnified view of the gall bladder on screen. Other instruments are then inserted through additional small incisions to separate the gallbladder from its attachments. The blood supply is tied off and divided. Once the gallbladder is dissected off the liver, it is removed through any one incision. Sometimes an x-ray called cholangiogram may be performed to check for stones in the common bile duct. After the surgeon removes the gallbladder, the small incisions are closed with absorbable stitches.

Recovery

After laparoscopic surgery patient can leave hospital on the same day as the surgery. Because the incisions are small, there isn’t much pain after the operation.

Patient might feel a little sore for about a week but it will fade away within two to three weeks. Patient will be able to return to most of the normal position within 2 weeks. Surgeon will provide aftercare instruction on taking care of wound. It is important not to take shower for one or two days following surgery. Doctor may recommend having a liquid diet for the first few days.

Advantages of Laparoscopic cholecystectomy:

• Patient have minimal post operative pain
• Patient experience faster recovery than open surgery
• Patients are left with smaller scars than with an open procedure.
• Instead of five to seven inch incisions, it requires only four small openings.
• It involves less tissue damage
• It reduces the risk of infection
• It is safe and has the lowest risk of recurrence.

Complications of Laparoscopic cholecystectomy:

Complications after laparoscopic cholecystectomy are rare but can be serious when structures near the gallbladder such as common bile duct, colon or small intestine are damaged. This may require another surgical procedure to repair it.

Open cholecystectomy

Open cholecystectomy is the removal of gall bladder through a large incision (around 10cm) in abdomen.

Sometimes when laparoscopic cholecystectomy is not possible or cannot be completed safely, then open cholecystectomy is indicated. Some factors that increase the possibility of choosing or converting to open procedure may include inflamed gallbladder, failure of identification of anatomical landmarks, obesity, bleeding and adhesion caused by previous operations.

How is it performed?

The surgery is performed while the patient is under general anesthesia so the patient is asleep and pain-free throughout the procedure. It usually takes about an hour. After the anesthesia is administered, the surgeon makes a 5 to 7 inch incision in the upper right part of the abdomen, just below the ribs or in the center of the abdomen. Next, the liver is lifted out of the way and the gallbladder is carefully removed. Sometimes a cholangiogram is done to check for stones in common bile duct. The incision is then closed and sutured. After surgery, the bile flows directly from the liver through the common bile duct into the small intestine.

Recovery

The open surgery results in the longer hospital stay. A person can expect to stay in hospital for three to five days after the operation. It might take six to eight weeks to make a complete recovery and return to normal activities. It involves more pain afterward and a longer recovery period than laparoscopic surgery.

Complications

The surgery is safe and carries a low risk for complications. The possible complications include:

• Injury to the related structures such as liver, common bile duct or intestine.
• Excessive bleeding.
• Risk of general anesthesia
• It leaves a large scar.

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