Cholecystectomy-Laparoscopic Surgery
(Gallbladder Removal; Lap Chole)
by
Rosalyn Carson-DeWitt, MD
Definition |
Reasons for Procedure |
Possible Complications |
What to Expect |
Call Your Doctor
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to view an animated version of this procedure.
Definition
Cholecystectomy is the surgical removal of the gallbladder organ. This organ lies near the liver. It stores bile that is made by the liver. Bile helps in the digestion of fatty foods. The gallbladder releases bile into a system of ducts that lead to the small intestine.
This procedure is most often done laparoscopically. Laparoscopy is a type of surgery done through several small incisions in the abdomen. Small tools and a laparoscope (tiny camera) are placed through the incisions and allow the doctor to see inside the belly and perform surgical tasks. In some cases, the doctor may switch to open surgery. In open surgery, the doctor makes a large incision in the abdomen to do the surgery.
Laparoscopic Cholecystectomy vs. Open Cholecystectomy
© 2009 Nucleus Medical Media, Inc.
Reasons for Procedure
This surgery is used to remove a diseased or damaged gallbladder. The damage is typically caused by infection or inflammation.
The damage is often due to
gallstones, which are crystals of bile that can form in the gall bladder. Sometimes, these get stuck in the ducts that bile normally flows through. This blockage in the ducts can damage the gallbladder and the liver.
Possible Complications
Complications are rare, but no procedure is completely free of risk. If you are planning to have a cholecystectomy, your doctor will review a list of possible complications, which may include:
- Gallstones that have accidentally spilled into the abdominal cavity
- Bleeding
- Infection
- Injury to other nearby structures or organs
- Reactions to general anesthesia
- Blood clots
Some factors that may increase the risk of complications include:
- Age: 60 or older
- Pregnancy
- Obesity
- Smoking
- Malnutrition
- Recent or chronic illness
- Diabetes
- Heart or lung problems
- Bleeding disorders
- Alcoholism
and use of street drugs
- Use of certain medicines
What to Expect
Prior to Procedure
Your doctor will probably do some or all of the following:
- Blood tests to evaluate liver function
- Ultrasound
to visualize gallstones
- HIDA scan (hepatobiliary iminodiacetic acid scan)-an x-ray test that uses a chemical injected into the gall bladder to create pictures of your liver, gallbladder, ducts, and small intestines
- Other radiological scans to better view the gallbladder
- EKG
and
chest x-ray
to make sure that your heart and lungs are healthy enough to withstand the stresses of surgery
Leading up to your procedure:
-
Talk to your doctor about your current medicines. Certain medicines may need to be stopped before the procedure, such as:
- Aspirin
or other anti-inflammatory drugs for up to one week before surgery
-
Blood-thinning drugs, such as
warfarin
(Coumadin)
- Clopidogrel
(Plavix)
- Arrange for a ride to and from the procedure.
- Arrange for help at home after returning from the hospital.
- The night before, eat a light meal. Do not eat or drink anything after midnight.
- You may be given laxatives and/or an enema to clean out your intestines.
- You may be given antibiotics.
- You may be asked to shower the morning before surgery. You may be given a special anti-bacterial soap.
Description of Procedure
Four small openings will be made in your abdomen. Carbon dioxide will be pumped in to the abdomen to give the doctor a better view.
The laparoscope will be inserted through one of the openings. It will provide images of the gallbladder and surrounding area. Special instruments will be inserted through the small openings. They will be used to grasp the gallbladder and clip off the main artery and duct. The gallbladder will be removed through one of the small openings. Dye may be injected into the duct to look for stones. The entire abdomen will be carefully examined for any problems. The incisions will be closed with a few sutures or staples each. They will be covered with bandages.
Your doctor may place a tiny, flexible tube into the area where the gallbladder was removed. This tube will exit from your abdomen into a little bulb. This is to drain any fluids that may build during the first few days after surgery. The tube is usually removed within one week after your operation.
Immediately After Procedure
The gallbladder will be examined by a pathologist. You will be taken to a room to recover where you will be monitored closely.
How Long Will It Take?
About 30-60 minutes
How Much Will It Hurt?
You will most likely feel some pain after the surgery. Most patients report less pain with the smaller incisions of laparoscopic surgery. Your doctor will arrange for pain medicines.
Average Hospital Stay
1-2 days
Post-procedure Care
At the Hospital
- You will be monitored for any problems.
- You may need medicines for nausea.
- You may have a nasogastric tube, which is a tube that will go from your nose, down your throat, and into your stomach. The tube will help to drain fluids and stomach acid. You will not be able to eat or drink until this is removed and you are no longer nauseated. You will continue to receive fluids and sugar through an IV.
- Once you are able to take things by mouth, you will be started on a liquid diet. Your diet will be progressed from soft foods to a regular diet.
At Home
Recovery takes about three weeks.
When you return home, do the following to help ensure a smooth recovery:
-
Be sure to follow your doctor's
instructions.
- You will get a diet and physical activity plan to help you through recovery. Following the plan will help your recovery.
- Your liver will take over the functions of the gallbladder. Some people notice that they have a little more trouble digesting fatty foods, particularly for the first month after surgery.
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
- Cough, shortness of breath, chest pain
- Increased abdominal pain
- Pain that you cannot control with the medicines you have been given
- Blood in the stool
- Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
- Bloating and gas that persist for more than a month
- Pain, burning, urgency or frequency of urination, or blood in the urine
- Pain and/or swelling in your feet, calves, or legs
-
Dark urine, light stools, or evidence of
jaundice
(yellowing of the skin or eyes)
In case of an emergency,
CALL 911.
RESOURCES:
American Gastroenterological Association
http://www.gastro.org/
National Digestive Diseases Information Clearinghouse
http://digestive.niddk.nih.gov/
CANADIAN RESOURCES:
The Canadian Association of Gastroenterology
http://www.cag-acg.org/
Canadian Digestive Health Foundation
http://www.cdhf.ca/
REFERENCES:
About cholecystectomy: surgical removal of the gallbladder. American College of Surgeons. Medem website.
Available at:
http://www.medem.c.... Accessed July 11, 2008.
Clayton ES, Connor S, Alexakis N, Leandros E. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder
in situ.
Br J Surg. 2006;93:1185-91.
Gallbladder removal. Baylor College of Medicine Department of Surgery website. Available at:
http://www.debakeydepartmentofsurgery.org/home/. Accessed July 11, 2008.
Gallbladder surgery: laparoscopic cholecystectomy. University of California at Davis website. Available at:
http://www.ucdmc.u.... Accessed July 11, 2008.
Laparoscopic surgery: bile, duct, and gallbladder. New York University School of Medicine website. Available at:
http://www.nyulaparoscopy.org/surgeries/gallbladder.html#stones.
Accessed July 11, 2008.
Martin DJ, Wernon DR, Toouli J. Surgical versus endoscopic treatment of bile duct stones.
Cochrane Database Syst Rev. Apr 2006;19(2):CD003327.
Townsend CM, Beauchamp RD, Evers BM, et al.
Sabiston Textbook of Surgery. 16th ed. Philadelphia, PA: WB Saunders; 2001;1076-1095.
What are the surgical procedures for gallstones and gallstone disease? University of California at Davis website. Available at:
http://www.ucdmc.ucdavis.edu/. Accessed August 16, 2003.
Last reviewed October 2009 by Igor Puzanov, MD
Last Updated: 12/8/2009
