Cholecystectomy

Overview

Cholecystectomy, a surgical procedure aimed at removing the gallbladder, is commonly employed to address various gallbladder disease. Removing the gallbladder typically entails fewer drawbacks compared to the conditions it treats, making it a common treatment in medical practice.

Post-cholecystectomy, individuals can lead healthy lives with ease. The procedure is known for its uncomplicated recovery process. It’s one of the earliest procedures to be routinely conducted using minimally invasive surgery techniques, which encompass laparoscopic surgery and robotic surgery. By making small incisions, typically half an inch or less, surgeons reduce trauma, pain, and recovery time. While open surgery may be necessary in certain cases, laparoscopic cholecystectomy has become the preferred approach, surpassing traditional methods.

Types of cholecystectomy

If the gallbladder removal is necessary, potential options include:

• Open cholecystectomy
• Laparoscopic cholecystectomy
• Robotic cholecystectomy

Over 90% of cholecystectomy procedures in the United States are currently performed using laparoscopic techniques. This method is generally preferred by surgeons due to its minimally invasive technique, resulting in reduced pain and bleeding, and facilitating a quicker and smoother recovery process. Some hospitals may also offer robotic cholecystectomy as a variation of laparoscopic surgery, where the surgeon operates robotic instruments from a console.

On the other hand, an open cholecystectomy is the traditional method for gallbladder removal. This technique entails the surgeon making a single long incision in the abdomen to reach the gallbladder. While open cholecystectomy is considered safe and straightforward, it might be necessary in specific cases where surgeons need open access to address urgent or complex conditions.

Reasons for undergoing the procedure

Gallbladder removal surgery may be recommended in cases of gallbladder disease:

• Impacts your overall well-being.
• Presents notable health risks.
• Is anticipated to persist and/or worsen.

The majority of conditions that can impact your gallbladder, encompassing:

• Gallstone disease.
• Chronic cholecystitis.
• Gallbladder cancer.

Gallstones constitute the primary indication for cholecystectomy. While many individuals coexist with gallstones without encountering issues, those experiencing complications often undergo recurrent episodes. A gallstone lodged anywhere in the biliary tract can impede the normal flow of bile, resulting in pain and illness. It may obstruct the opening to the gallbladder, the common bile duct, or the pancreatic duct.

The prevalent and easily identifiable symptom of gallbladder disease is biliary colic, characterized by recurrent episodes of pain in the biliary tract, typically felt in the upper right abdomen, often accompanied by nausea. Biliary colic commonly serves as an early indication of biliary disease, with the potential for worsening over time. In cases where bile flow comes to a complete halt, individuals may experience severe and persistent gallbladder pain that necessitates prompt medical attention.

Additional indicators of potential gallbladder disease comprise:

• Jaundice (yellow discoloration of the skin and eyes).
• Swollen abdomen that is sensitive when pressed.
• Identification of sizable gallbladder polyps through ultrasound.

Should you exhibit any of these signs or symptoms, your doctor will conduct a thorough examination and perform the requisite tests to determine the underlying cause. Subsequently, they will communicate their findings and advise whether a cholecystectomy is recommended for your specific case.

Risks

Common general risks associated with surgical procedures include:

• Blood clots
• Infection
• Damage to the close by organs
• Anesthesia side effects

Particular risks associated with cholecystectomy encompass:

• Bile reflux (escape of bile into the stomach).
• Pancreatitis (inflammation of the pancreas).
• Bile duct injury, resulting in leakage of bile.
• Injury to adjacent blood vessels, leading to excessive bleeding.

Before the procedure

Cholecystectomy is often planned as an elective procedure, allowing ample time for proactive planning before it becomes an urgent necessity. Your doctor will explain your condition, reasons for recommending the procedure, and give you the chance to consider your options, select a suitable timing, and make necessary preparations. However, in some cases, cholecystectomy may become an emergency procedure, requiring swift action with little advance notice.

Your healthcare team will:

• Ensure your fitness for surgery through blood tests and general health screenings. If surgery is not advisable due to your health condition, an alternative procedure like cholecystostomy may be considered, with the possibility of a cholecystectomy at a later time.
• Provide a comprehensive explanation of the procedure, outlining the reasons for its recommendation. Your informed consent will be sought, and the planned approach, whether open or laparoscopic cholecystectomy, will be communicated, acknowledging the potential for changes in the plan. In some cases, a laparoscopic procedure may need to convert to open surgery.
• Assist in planning for the surgery, if scheduling allows. You may be instructed to refrain from smoking, eating, and certain medications in the hours leading up to the procedure to minimize potential complications and enhance the safety of the surgery.
• Conduct preparations for surgery, including the installation of an IV line in your arm for fluids and medications. General anesthesia will be administered, and once unconscious, a breathing tube will be inserted to maintain an open airway during the procedure.

During the procedure

In the course of a laparoscopic cholecystectomy, your surgeon will:

• Create a small incision, approximately 2 or 3 centimeters (cm) in length, near your belly button.
• Generate two to three additional “keyhole” incisions, each about 1 centimeter long, in your upper right abdomen.
• Introduce a small tube into one of the smaller incisions and infuse carbon dioxide gas to inflate your abdomen, facilitating the separation of abdominal walls from organs.
• Insert the laparoscope, a compact, illuminated camera, into the larger incision, projecting images to a video monitor positioned above the operating table.
• Guided by the video monitor, use narrow surgical tools through the remaining incisions to extract your gallbladder.
• Release the abdominal gas and close the incisions using stitches.

In the course of an open cholecystectomy, your surgeon will:

• Create a single incision, approximately 4 to 6 inches in length, beneath your right rib.
• Utilize surgical tools to extract your gallbladder.
• Introduce a surgical drain (Jackson Pratt drain) into the incision to facilitate the drainage of excess fluids.
• Close the incision with stitches, maintaining the placement of the drain.

A typical laparoscopic cholecystectomy typically lasts between 60 to 90 minutes, while an open cholecystectomy generally takes around one to two hours. The duration of your procedure may extend if your surgeon deems it necessary to incorporate additional steps to address your specific condition. For instance, there could be an inclusion of a bile duct exploration to examine for gallstones or other concerns in your bile ducts. This approach allows for the simultaneous treatment of any identified issues during the procedure.

After the procedure

After the surgery, you’ll spend a few hours in a designated recovery room as the anesthesia wears off. Pain medication will be provided as needed. If you had a laparoscopic cholecystectomy, there’s a chance you may be discharged on the same day. However, if an open cholecystectomy was performed, you’ll likely need to stay in the hospital for a few days. A surgical drain may be left in place for a few days, and in some cases, you might be sent home with it.

Outcome

Following a laparoscopic cholecystectomy, the recovery period usually lasts about two weeks, whereas recovery from an open cholecystectomy may extend to six to eight weeks. If a drain is still in place in your wound, it will be removed during your follow-up appointment with the doctor. Typically, individuals can return to work after one to two weeks. However, if your job involves strenuous physical activity, you may need to modify your routine until you fully recover.