Anatomy

Description: Cholecystectomy is the surgical removal of the gallbladder. The gallbladder is a small, pear-shaped organ that lies on the underside of the liver, in the upper right portion of the abdomen. It is connected by ducts (or tubes) to the liver, and with the upper portion of the small intestine (duodenum). The liver produces bile (a substance that is essential for digesting fats) and secretes it into the gallbladder where it is concentrated and stored. When food is eaten, especially fatty or greasy foods, the gallbladder contracts and forces bile out the ducts leading into the intestine. When the gallbladder is removed, this function is taken over by the liver and its ducts. removal of the gallbladder.

Indications: Sometimes, persons with gallbladder. disease have few or no symptoms. Others, however, will eventually develop one or more of the following symptoms: 1. Frequent bouts of indigestion, especially after eating fatty or greasy foods, or certain vegetables such as cabbage, radishes, or pickles. 2. Nausea and bloating. 3. Attacks of sharp pains in the upper right part of the abdomen. This pain occurs when a gallstone causes a blockage that prevents the gallbladder from emptying (usually by obstructing the cystic duct). 4. Jaundice (yellowing of the skin) may occur if a gallstone becomes stuck in the common bile duct, which leads into the intestine, blocking the flow of bile from both the gallbladder and the liver. This is a serious complication and usually requires immediate treatment.

Preoperative Evaluation: Because the majority of patients who have gallbladder disease also have gallstones, the diagnosis can usually be confirmed through the use of ultrasound: a safe, painless, and non-invasive technique that uses high frequency sound waves to create an image of the gallbladder and gallstones. There are some occasions, however, when ultrasound cannot confirm a diagnosis in patients who have symptomatic gallbladder disease. Therefore, other diagnostic methods may be used, such as X rays or various types of scanning methods.

Method: In this procedure, the surgeon uses a digital video camera and highly specialized instruments to remove the gallbladder without making a large surgical incision. Instead, the surgeon creates four very small incisions. One of these holes is made in or near the patient’s navel so that the surgeon can insert a special instrument called the laparoscope (lap’ah-ro-skop”). The laparoscope is a long, rigid tube that is attached to a tiny video camera and a light. Before the laparoscope is inserted, the patient’s abdomen is distended with an injection of carbon dioxide gas, which allows the surgeon to see inside the body. Once the laparoscope has been inserted, the surgeon then guides the laparoscope while watching the view it provides on a video monitor. The other small incisions are made in the abdomen; two of them are on the right side below the ribcage, and one is in the upper portion below the sternum, or breast- 7 During laparoscopic cholecystectomy, the surgeon makes four very small incisions of less than half an inch each. bone. Other specialized instruments are placed through each of these three incisions. Two instruments are used to grasp and retract the gallbladder and the third to free the gallbladder from its attachments. The surgeon will use an electrocautery device to cut free the gallbladder. Once the gallbladder has been cut free, the surgeon collapses the organ and removes it through the incision at the navel.

Risks: Complications of laparoscopic cholecystectomy are infrequent, but include bleeding, infection, pneumonia, blood clots, or heart problems. Unintended injury to adjacent structures such as the common bile duct or small bowel 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 may rarely occur.

Options: There are currently no effective alternatives. The patient may opt for symptomatic treatment of an episode or attack. The symptoms may be treated with pain and nausea medications. The risk of not removing the gallbladder may be damage to the liver, rupture, abscess, gangrene and death. If the gallbladder disease progresses too far, it may no longer be removable by a laparoscopic surgery and open surgery maybe required. The risks of surgery maybe increased by advanced or neglected gallbladder disease.

Hospitalization: Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.

Post Op: For most patients this is an outpatient surgery. However, your doctor may advise admission under some circumstances. Many return to work within a week to 10 days. Once healed, the

Recovery: Most patients can return to normal within seven days following the laparoscopic procedure. Patients with desk jobs usually return in a few days while those working in manual labor or heavy lifting may require more time. Patients undergoing the open procedure usually resume normal activities in four to six weeks.

Follow Up: Make an appointment with your surgeon within 2 weeks following your operation. Call your surgeon if you develop any of the following: Persistent fever over 101 degrees F (39 C) Bleeding Increasing abdominal swelling Pain that is not relieved by your medications Persistent nausea or vomiting Chills Persistent cough or shortness of breath Purulent drainage (pus) from any incision Redness surrounding any of your incisions that is worsening or getting bigger You are unable to eat or drink liquids.