by Urmila Parlikar, MS
Anatomy and Physiology
The gallbladder is a pear-shaped organ located underneath the right lobe of the liver. The gallbladder stores and concentrates bile produced by the liver, which helps the body to digest fatty foods.
When you eat a fatty meal, the gallbladder contracts, sending bile through the cystic duct and common bile ducts to the small intestine.
Reasons for Procedure
Gallstones, which may form in the gallbladder, can be passed through the bile ducts into the small intestine. Most gallstones are primarily made up of cholesterol.
Gallstones passing through the ducts often cause intermittent abdominal pain. Stones that block a duct can cause swelling, inflammation, and even infection of the gallbladder. This condition, called cholecystitis, may lead to more persistent pain, nausea, vomiting, and/or fever.
Most people with gallstones have no symptoms and do not require treatment. Gallstones that become symptomatic generally require surgery. In special situations, however, medications or shockwave therapy may be used as an alternative to surgery. Gallstones have a tendency to recur after these non-surgical treatments.
A cholecystectomy, or surgical removal of the gallbladder, is the most common way to treat symptomatic gallstones, which are removed with the gallbladder. It may also be performed in the event of cholecystitis. Most patients are able to resume their normal diet after having their gallbladder removed.
A traditional open cholecystectomy requires a large incision and usually entails a lengthy recovery period. Laparoscopic cholecystectomy is a newer technique that enables the surgeon to make only tiny "keyhole" incisions. This considerably shortens recovery time.
In the days leading up to your procedure: Arrange for a ride to and from the hospital and for help at home as you recover. The night before, eat a light meal and do not eat or drink anything after midnight. If you regularly take medications, your doctor may recommend temporarily discontinuing them. Do not start taking any new medications before consulting your doctor. You may be given antibiotics to take before coming to the hospital. You may be given laxatives and/or an enema to clean out your intestines.
Before the procedure, an intravenous line will be started. A cholecystectomy requires general anesthesia, which puts you to sleep for the duration of the procedure. A breathing tube will be inserted through your mouth and into your windpipe to help you breathe during the operation.
To gain access to your gallbladder, your surgeon will make four small openings, or ports, in your abdomen using sharp instruments called trocars.
Carbon dioxide gas will be pumped through the port nearest your navel to puff up your abdomen. This allows your surgeon to view its contents more easily.
Your surgeon will insert a laparoscope through the navel port. Images from the camera attached to the laparoscope will be magnified and projected onto a video monitor in the operating room.
Watching the video monitor, your surgeon will insert instruments through the other ports. He or she will grasp the gallbladder, place a surgical clip on its main artery and duct, cut these connections, drop the gallbladder into a specimen bag, and remove the bag through one of the ports.
If your surgeon suspects that you have a gallstone blocking the common bile duct, he or she may recommend a later procedure that uses an endoscope to explore the duct and remove the stone.
Before removing the laparoscope, your surgeon will carefully examine the abdomen for bleeding or other damage. A port valve will be left in place briefly to allow the carbon dioxide to escape. Finally, the keyhole incisions will be closed with sutures or staples and covered with bandages.
During the laparoscopic procedure, your surgeon may need to switch to a traditional open cholecystectomy. This does not happen often, but it may occur if: your gallbladder is severely diseased or inflamed, you have excessive scarring from previous surgeries, your surgeon is unable to remove gallstones blocking the bile duct, or your surgeon cannot adequately see your abdominal structures.
Risks and Benefits
Possible complications of laparoscopic cholecystectomy include: missed gallstones in the common bile duct, gallstones that are accidentally spilled into the abdominal cavity, bleeding, infection, hernia in the abdominal wall, injury to the bile duct or other nearby structures, bile leakage into the abdominal cavity, adverse reactions to general anesthesia, respiratory tract infection, blood clots in the legs that could travel to the lungs.
Benefits of a laparoscopic cholecystectomy include: no possibility of future gallstones or other gallbladder problems like cholecystitis, no need for a large incision or the lengthy recovery period associated with traditional open cholecystectomies, most patients find that they can soon return to their normal diet once their gallbladder has been removed.
In this or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.
After the Procedure
After your procedure, your breathing tube will be removed and you will be taken to a recovery area for monitoring. You will be given pain medication, and you will gradually progress from a liquid to a solid diet. Most patients go home 1-2 days after their surgery.
Once you are home, be sure to contact your doctor if you experience: signs of infection such as fever and chills, redness, swelling, increasing pain, excessive bleeding, or discharge at the site of your incisions, cough, shortness of breath, or chest pain, worsening abdominal pain, blood in the urine or stool, pain, burning, urgency, or frequency of urination, persistent nausea and/or vomiting, and/or pain and/or swelling in your feet, calves, or legs.
- About cholecystectomy (surgical removal of the gallbladder). American College of Surgeons website. Available at: http://www.medem.com/medlb/article_detaillb_for_printer.cfm?article_ID=ZZZHZGB4IWCâŠ‚_cat=193. Accessed October 21, 2003.
- Gallbladder removal: laparoscopic method. American Academy of Family Physicians website. Available at: http://familydoctor.org/handouts/114.html. Accessed October 21, 2003.
- Gallstones. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/index.htm. Accessed March 9, 2004.
- Laparoscopic cholecystectomy. Queensland Government website. Available at: http://126.96.36.199/informedconsent/PatientInformationSheets/lap_cholecystectomy.pdf. Accessed March 9, 2004.
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