Cholecystectomy procedure (open and laparoscopic)

Cholecystectomy procedure (open and laparoscopic)

Cholecystectomy is a surgical OPERATION to remove the GALLBLADDER. Cholecystectomy is the most common treatment in the United States for GALLBLADDER DISEASE including gallstones (cholelithiasis), cholecystitis (INFLAMMATION or INFECTION of the gallbladder), and biliary dyskinesia (diminished ability of the gallbladder to eject BILE). About 500,000 Americans undergo cholecystectomy each year.

Cholecystectomy - Surgical Procedure

There are two methods for performing cholecystectomy, laparoscopic and open. About 95 percent of cholecystectomies surgeons perform in the United States are laparoscopic. Surgeons perform open cholecystectomy, once the standard, only when there are contraindications for laparoscopic cholecystectomy (such as extreme OBESITY) or laparoscopic cholecystectomy cannot successfully remove the gallbladder (such as when there are many stones or there is extensive scarring from long-standing gallbladder disease or repeated infections). Both operations require general ANESTHESIA and an overnight stay in the hospital.

Laparoscopic cholecystectomy

In laparoscopic cholecystectomy the surgeon makes four or five small incisions and inserts a laparoscope and tiny instruments through them. The surgeon operates by visualizing the gallbladder via closed-circuit television display. The operation takes 45 to 60 minutes. Most people then stay several hours in the recovery room and overnight in the hospital. After surgery, many people returning to regular daily activities (except strenuous physical exercise) within three weeks, though full recovery takes six to eight weeks.

Open cholecystectomy

This procedure is major surgery. The surgeon makes an incision 5 to 8 inches long through the abdominal muscles to expose the LIVER and the gallbladder beneath it. The operation takes about two hours. Most people then stay five to seven days in the hospital. Many people can return to light activity in about four weeks. Full recovery after open cholecystectomy takes about 12 weeks.

Risks and Complications of Cholecystectomy

The primary risks of either operation are bleeding, anesthesia reaction, damage to the bile ducts and other adjacent organs and structures, and postoperative infection. The surgeon often administers preoperative and postoperative doses of ANTIBIOTIC MEDICATIONS as a prophylactic measure for infection. Factors that can complicate or slow recovery include DIABETES, OBESITY, and bleeding or clotting disorders. For reasons doctors do not fully understand, 15 to 20 percent of people who undergo cholecystectomy (either laparoscopic or open) continue to experience symptoms similar to those of gallbladder disease even after surgery, called postcholecystectomy syndrome. Occasionally gallstones can escape from the gallbladder during surgery and become trapped in the common bile duct or cystic bile duct, requiring a follow-up procedure, typically ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP), to remove them. Rarely, gallstones can form in the bile ducts months to years after cholecystectomy.

Postoperative infection is a significant risk with open cholecystectomy and in people who have diabetes or obesity, as these conditions can impair HEALING. Warning signs of infection include

  • increased PAIN at the incision site
  • pain elsewhere in the abdomen
  • drainage from the incision site
  • FEVER (temperature above 101ºF)
  • NAUSEA and VOMITING

Prompt antibiotic therapy successfully treats most postoperative infections. Persistent infection or delayed treatment may result in an ABSCESS that requires additional surgery to open and drain the infection.

BENEFITS AND RISKS OF CHOLECYSTECTOMY
BenefitsRisks
  • ends symptoms
  • restores normal digestion
  • averts symptom-related complications
  • intraoperative or postoperative bleeding
  • ANESTHESIA reaction
  • postoperative PAIN
  • postoperative INFECTION
  • inadvertent damage to LIVER and other structures
  • scarring and adhesions
  • postcholecystectomy syndrome

Outlook and Lifestyle Modifications

Cholecystectomy eliminates symptoms in about 80 percent of people who have gallbladder disease. Most people return to the same lifestyle habits as before surgery, including eating. The liver continues to manufacture bile, which flows directly into the small intestine. The body adapts to the weaker concentration of this bile within a few weeks of the cholecystectomy, and digestion returns to normal. Some people find that high-fat meals generate mild to moderate gastrointestinal distress or mimic gallbladder disease symptoms for several months after surgery. People who undergo open cholecystectomy may be unable to participate in strenuous physical activities for up to six months while the abdominal muscles regain STRENGTH.

See also HEPATIC ABSCESS; JAUNDICE; SURGERY BENEFIT AND RISK ASSESSMENT.

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The Gastrointestinal System

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