Laparoscopic cholecystectomy; Cholecystectomy
Laparoscopic cholecystectomy is keyhole surgery to remove the gallbladder. The surgery is usually performed if the organ is inflammed or obstructed, if gallstones are causing pancreatitis, or if cancer is suspected.
The surgery is performed while the patient is under general anesthesia (unconscious and pain-free). The procedure is most commonly carried out using a small video camera telescope called a laparoscope. The surgeon usually makes 4 small cuts on the abdomen. The laparoscope is passed through tubes (ports) which in turn have entered the abdominal cavity through these small cuts. Carbon dioxide is then passed into the abdominal cavity so that the abdomen is lifted up. This provides space for the surgeon to work.
The surgeon identifies the blood vessels and duct going from the gallbladder to the common bile duct (the pipe from the liver to the small intestine). My usual practice is to perform a cholangiogram, a special x ray, that gives a road map of the whole duct system and helps detect stones outside the gallbladder in the common bile duct. Once a satisfactory demonstration of the anatomy has been performed the duct and vessels can be divided and the gallbladder removed from its bed on the under surface of the liver.
In complicated cases, an open cholecystectomy may be performed. A larger surgical cut is made just below the ribs on the right side of the abdomen or in the midline. As with laparoscopic surgery, the vessels and ducts going to the gallbladder are identified, clipped, and cut. The gallbladder is then removed.
After surgery, the wounds are closed usually with absorbable sutures.
Laparoscopic surgery often has a lower rate of complications, a shorter hospital stay, and better cosmetic results than the open procedure.
Why the Procedure is Performed
Gallbladder removal is usually done to treat the following conditions:
- Gallbladder disease
- Infection or inflammation (cholecystitis)
- Gallbladder cancer
- Biliary dyskinesia (abnormal gallbladder function)
The risks of any anaesthesia include:
- Reactions to medications
- Problems breathing
- Cardiac complications
The risks of surgery include:
- Injury to the common bile duct
- Intra abdominal collections
This is a straightforward procedure and patients generally do very well and recover rapidly.
For open gallbladder removal, you will generally need about 2 weeks for recovery.
For laparoscopic gallbladder surgery, your hospital stay is likely to be shorter, and you may be home within 24 hours. Your recovery time is likely to be shorter as well.