Open cholecystectomy; Laparoscopic cholecystectomy; Gallbladder removal
Surgery is done to remove the gallbladder if it is inflamed, blocked, filled with gallstones, or cancerous.
Gallbladder removal (cholecystectomy) is done while the patient is under general anesthesia (unconscious and pain-free). It can be done through an abdominal incision (open cholecystectomy) or through smaller incisions using a small video camera on a tube called a laparoscope (laparoscopic cholecystectomy).
In very complex or complicated cases, open cholecystectomy is usually recommended. An incision is made just below the ribs on the right side of the abdomen. The liver is moved to expose the gallbladder. The vessels and ducts to and from the gallbladder (cystic duct and artery) are cut and tied off, and the gallbladder is removed. The incision is closed.
The common bile duct, which drains the digestive fluid (bile) from the liver to the small intestine (duodenum), is examined for bile blockages or for the presence of stones. A small flat tube may be left in for several days to drain out fluids if there is any inflammation or infection.
In laparoscopic surgery, the abdomen is inflated with carbon dioxide to provide more room for the procedure. Through a small incision made at the navel, a laparoscope is inserted into the abdomen. Three small additional holes are made to allow the entry of surgical instruments. The gallbladder is located and the cystic duct and artery are cut and tied off. The gallbladder is removed. The incision is closed.
Laparoscopic surgery has a lower rate of complications, a shorter hospital stay, and a better cosmetic results than the open procedure. However, in some cases the complexity of the situation requires use of the open technique.
Gallbladder removal is usually done to treat the following conditions:
- Gallbladder disease o Gallstones (cholelithiasis) o Infection or inflammation (cholecystitis) o Gallbladder cancer
- Severe abdominal pain due to gallbladder disease (biliary colic)
- Blockage of the bile drainage tubes (biliary obstruction)
Risks for any anesthesia include the following:
- Reactions to medications
- Problems breathing
Risks for any surgery include the following:
Additional risks include damage to the bile ducts and blood vessels.
Expectations after surgery
The outcome of cholecystectomy is usually good. Symptoms are relieved completely in about 90% of patients who undergo gallbladder removal.
Allow about 3 weeks for recovery from open gallbladder removal.
Laparoscopic gallbladder surgery requires a shorter hospital stay - usually the patient is home within 24 hours. Recovery time is much shorter as well.
by Armen E. Martirosyan, M.D.
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