Surgery

Laparoscopic Cholecystectomy (Removal of the Gallbladder)

Today, the standard of care is laparoscopic cholecystectomy. The laparoscope is a long tube with lenses at one end connected by fiber optics to a small television camera. This system allows the surgeon to operate within the abdomen while viewing a television screen.

The procedure is performed under general anesthesia. An intravenous (IV) is started and antibiotics are given prior to the surgery to reduce the rate of infection. Patients don't remember anything about the surgery because medication is given via the IV to make patients sleepy. After the anesthesia has begun, four small incisions (called port sites) are made on the abdominal wall. A special needle is inserted into the abdomen to inflate the abdomen with carbon dioxide gas. This distends the abdomen and creates space to insert the instruments. The laparoscope and laparoscopic instruments with long handles are inserted through the incisions and into the abdomen. The entire operation is then performed while viewing the organs magnified on a television screen.

The gallbladder is dissected off the surrounding structures. The cystic duct that attaches the gallbladder to the common bile duct is dissected and divided between metal clips. In some cases, a tiny catheter may be inserted into the cystic duct to inject dye and take X-rays to visualize any stones that may be blocking the common bile duct. If common bile duct stones are present, they may be removed with laparoscope common bile duct exploration by opening up the abdomen and exploring the duct or by ERCP. After the cystic duct is divided, the gallbladder is further dissected off of the liver bed and a tiny artery that supplies blood to the gallbladder called the cystic artery is divided between metal clips.

The gallbladder is then removed through one of the ports in the abdominal wall and the tiny incisions in the abdominal wall are closed after removing any gas left in the abdominal cavity. When there is spillage of bile, the local abdominal cavity is throughly cleansed with saline solution and a small drain may be left in place. This may be removed the same evening or the next day when drainage ceases. The operation usually takes less than an hour and the patient is discharged the following day.

Complications

The incidence of complications after cholecystectomy is relatively low, especially in experienced hands, but can include:

After Surgery

The patient usually has minimal pain that is well controlled with medication. Patients are discharged home with a prescription for pain medication. Patients eat a normal light diet on the day after surgery and may be able to return to light work in three to four days. It is preferable to avoid exertion and heavy work for a couple of weeks though one can take regular walks, showers, and ride in a car if necessary. Driving can be attempted several days post-operatively. Follow-up in Doctor Frost's office is in seven to ten days. Return to work varies, but can be as early as one week.

 

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