An innovative technique with great advantages in gallbladder removal is one of the most commonly performed surgical procedures in the United States. Today, most gallbladder surgery is performed laparoscopically. The medical name for this procedure is laparoscopic cholecystectomy. Rather than a five- to seven-inch incision, the operation requires only four small openings in the abdomen. Patients usually have minimal postoperative pain. Patients usually experience faster recovery than traditional gallbladder surgery. Most patients go home on the day of surgery and enjoy a quicker return to normal activities.
What Is The Gallbladder?
The gallbladder is a pear-shaped organ that rests beneath the right side of the liver. Its main purpose is to collect and concentrate a digestive liquid (bile) produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through narrow tubular channels (bile ducts) into the small intestine. Removal of the gallbladder is not associated with any impairment of digestion in most people.
What Causes Gallbladder Problems?
Gallbladder problems are usually caused by the presence of gallstones, small hard masses 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. There is 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 (a yellowing of the skin) can occur. Other people with right upper quadrant pain and nausea following a meal may have gallbladder dysfunction without stones. Your surgeon will discuss evaluation for these problems during your appointment.
How Are These Problems Found And Treated?
After the patient has symptoms. Ultrasound is most commonly used to find gallstones. In a few more complex cases, other X-ray tests may be used to evaluate gallbladder disease. Gallstones do not go away on their own. Some can be temporarily managed with drugs or by making dietary adjustments, such as cutting down on fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue until the gallbladder is removed. Surgical removal of the gallbladder is the time honored and safest treatment of gallbladder disease.
What Preparation Is Required?
Prior to the operation, you will refrain from eating or drinking after midnight on the night before your operation. You should shower the night before or the morning of your operation. If you have difficulties moving your bowels, an enema or similar preparation should be used after consulting with your surgeon. Some preoperative testing may be required depending on your medical condition. If you take medication on a daily basis, discuss this with your surgeon as he may want you to take certain of your medications on the morning of your operation with a sip of water. If you take aspirin, blood thinners, or arthritis medication, you need to discuss with your surgeon the proper timing of discontinuing these medications before your operation.
How Is Laparoscopic Gallbladder Removal Performed?
Under general anesthesia, so the patient is asleep throughout the procedure. Using a canula (a narrow tube-like instrument), the surgeon enters the abdomen in the region of the navel. A laparoscope (a tiny telescope) connected to a special camera is inserted through the canula, giving the surgeon a magnified view of the patient’s internal organs on a television screen. Other canulas are inserted which allow your surgeon to delicately separate the gallbladder from its attachments and then remove it through one of the openings. Many surgeons perform an X-ray, called a cholangiogram, to identify stones which may be located in the bile channels or to insure that structures have been identified. If the surgeon finds one or more stones in the common bile duct, he may remove them with a special scope, may choose to have them removed later through a second minimally invasive procedure, or may convert to an open operation in order to remove all the stones during the operation. After the surgeon removes the gallbladder, the small incisions are closed with absorbable suture.
What Happens If The Operation Cannot Be Performed By The Laparoscopic Method?
In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication. It is sound surgical judgement. Factors that may increase the risk of converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, or bleeding problems during the operation. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open procedure is strictly based on patient safety.
How Long Will You Be In The Hospital?
Most Laparoscopic Cholecystectomy patients go home the same day or the day after surgery. This compares with a three to five day stay following the traditional procedure.
When Can You Go Back To Work?
Most patients can return to work within 7 to 14 days following the laparoscopic procedure. Of course, this depends on the nature of your job. Patients with administrative or desk jobs usually return in a few days while those involved in manual labor or heavy lifting may require a bit more time. Patients undergoing the traditional procedure usually cannot resume normal activities for four- to six- weeks.
Will You Have A Large Scar?
No. By using laparoscopic techniques, the surgeon can avoid a large incision, leaving the patient with only four small marks.
Is Laparoscopic Gallbladder Surgery Safe?
Numerous medical studies show that the complication rate for laparoscopic gallbladder surgery is comparable to the complication rate for traditional gallbladder surgery when performed by a properly trained surgeon.
Are There Risks Of Laparoscopic Cholecystectomy?
While there are risks associated with any kind of operation, the vast majority of laparoscopic gallbladder patients experience few or no complications and quickly return to normal activities. It is important to remember that before undergoing any type of surgery–whether laparoscopic or traditional–you should ask your surgeon about his/her training and experience. The risks of laparoscopic cholecystectomy are less than the risks of leaving the condition untreated. Complications of Laparoscopic Cholecystectomy are infrequent, but include bleeding, infection, pneumonia, blood clots, or heart problems. Unintended injury to an adjacent structure such as the common bile duct or duodenum may occur and may require another surgical procedure to repair it. Bile leakage into the abdomen from the tubular channels leading from the liver to the intestine has been described.
What Happens After The Gallbladder Surgery?
Gallbladder removal is a major abdominal operation and a certain amount of postoperative pain occurs. Nausea and vomiting is not uncommon. Once liquids or a diet is tolerated, patients leave the hospital the same day or day after the laparoscopic gallbladder surgery. Activity is dependent on how the patient feels. Walking is encouraged. Patients can remove the dressings and shower the day after the operation. 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. In general, recovery should be progressive, once the patient is at home. The onset of fever, yellow skin or eyes, worsening abdominal pain, distention, persistent nausea or vomiting, or drainage from the incision are indications that a complication may have occurred. Your surgeon should be contacted in these instances. You should make an appointment with your surgeon within 2 weeks following your operation, even if your post-operative course has been uneventful.
Is Laparoscopic Gallbladder Removal Right For You?
Although there are many advantages to laparoscopy, the procedure may not be appropriate for some patients who have had previous upper abdominal surgery or who have some pre-existing medical conditions. A thorough medical evaluation by your personal physician, in consultation with a general surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal is an appropriate procedure for you.
Palmetto Surgery Associates, PA
108 Nimmons Circle
Seneca, South Carolina 29672