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Cholecystectomy Laparoscopic:

Gallbladder Removal


What is the Gallbladder?


The gallbladder is a pear-shaped structure that is found attached to the liver. The bile duct is a tube that transports bile from the liver to the small intestine. The gallbladder is attached to the bile duct by a small tube called the cystic duct. Bile is collected in the gallbladder between meals and empties into the bile duct through the cystic duct during a meal.


What is the bile duct?


The bile duct is long tube-like structure that connects the liver to the intestine. The liver makes bile that is required for the digestion of food. The bile from the liver is transported to the intestine by the bile duct.


The top half of the bile duct is associated with the liver while the bottom half of the bile duct is associated the pancreas through which it passes on its way to the intestine. It opens in the part of the intestine called the duodenum into a structure called the Ampulla.


Blockage of the bile duct by a cancer or scarring from injury prevents the bile from being transported to the intestine and the bile accumulates in the blood. This condition is called jaundice and the skin and eyes becomes yellow from the accumulated bile in the blood. This condition also causes severe itchiness.


Reasons for Removal of Gallbladder (Cholecystectomy)


A cholecystectomy may be performed if the gallbladder contains gallstones (cholelithiasis), is inflamed or infected (cholecystitis), or is cancerous.


Gallbladder inflammation or infection may cause pain which may be described as follows:

  • is generally located on the right side of the upper abdomen
  • may be constant or may become more severe after a heavy meal
  • at times, may feel more like fullness than pain
  • may be experienced in the back and in the tip of the right shoulder blade

Other symptoms of gallbladder inflammation or infection include, but are not limited to, nausea, vomiting, fever, and chills.


The symptoms of gallbladder problems may resemble other medical conditions or problems. In addition, each individual may experience symptoms differently. Always consult your physician for a diagnosis.


There may be other reasons for your physician to recommend a cholecystectomy.


About the Laparoscopic Cholecystectomy Procedure


A cholecystectomy is the surgical removal of the gallbladder. Using advanced laparoscopic technology, it is now possible to remove the gallbladder through a tiny incision at the navel.


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The technique is performed as follows. The patient receives general anesthesia. Then a small incision is made at the navel (point A) and a thin tube carrying the video camera is inserted. The surgeon inflates the abdomen with carbon dioxide, a harmless gas, for easier viewing and to provide room for the surgery to be performed. Next, two needle-like instruments are inserted (points B). These instruments serve as tiny hands within the abdomen. They can pick up the gallbladder, move intestines around, and generally assist the surgeon. Finally, several different instruments are inserted (point C) to clip the gallbladder artery and bile duct, and to safely dissect and remove the gallbladder and stones. When the gallbladder is freed, it is then teased out of the tiny navel incision. The entire procedure normally takes 30 to 60 minutes. The three puncture wounds require no stitches and may leave very slight blemishes. The navel incision is barely visible.


What Are the Benefits?


The main benefit of this procedure is the ease of recovery for the patient. There is no incision pain as occurs with standard abdominal surgery. The patient is up and about the same day. In fact, up to 90% of patients go home the same day. The remainder are usually discharged the next day. And within several days, normal activities can be resumed. So the recovery time is much quicker. Also, there is no scar on the abdomen.


What is the recovery period and how soon can you go back to work?


Patients will probably be able to get back to normal activities within a week's time, including driving, walking up stairs, light lifting and work. Activity is dependent on how the patient feels. Walking is encouraged. Patients can remove the dressings and shower the day after the operation. In general, recovery should be progressive, once the patient is at home.


Most patients are fully recovered and may go back to work after seven to ten days. Often, this depends on the nature of your job since patients who perform manual labor or heavy lifting may require two to four weeks of recovery.


What Are the Complications?


While the procedure seems very easy for the patient, it is still abdominal surgery. And, even though infrequent, it still carries the same risks as general surgery. Current medical reports indicate that the low complication rate is about the same for this procedure as for standard gallbladder surgery. These complications may include:

  • In about 5 to 10% of cases, the gallbladder cannot be safely removed by laparoscopy. Standard open abdominal surgery is then immediately performed.
  • Nausea and vomiting may occur after the surgery.
  • Injury to the bile ducts, blood vessels, or intestine can occur, requiring corrective surgery.

Quite uncommonly, a diagnostic error or oversight may occur.


Are there Other Treatment Options?


Depending on the size, number, and chemical makeup of gallstones, there is another way to treat the condition. If the stones are small, they may be dissolved with long-term drug therapy lasting 12 to 18 months. A problem with this option is that recurrence of gallstones is frequent, so the problem may not be permanently solved. When symptoms are bad, it is usually unwise to wait because a major complication may occur.


Who Can't Have the Procedure?


Surgeons are finding that cases previously felt to be unsuitable for laparoscopy can now be done safely with this technique. Still, there are instances in which the surgeon will not recommend the procedure. At times, pregnancy or previous surgery in the upper abdomen (which may cause adhesions) may require conversion to the standard surgery requiring a skin incision. In each instance, the surgeon will weigh the benefit for the patient against the risks, always considering other medical problems and always making the recommendation that is in the patient's best interest.


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