Department of Surgery

Laparoscopic Gallbladder Removal
(Laparoscopic Cholecystectomy)

Gallbladder removal is one of the most commonly performed surgical procedures in the United States. Since 1991, most gallbladder surgery is performed laparoscopically. The medical name for this procedure is Laparoscopic Cholecystectomy.

• Rather than a five- to seven-inch incision, the operation requires only four small openings in the abdomen
• Patients usually have minimal postoperative pain.
• Patients usually experience a faster recovery period than with traditional "open" gallbladder surgery. Most patients go home the same day or within one day and enjoy a quicker return to normal daily activities.

What is a Gallbladder and What Does It Do?

• The gallbladder is a storage organ that rests beneath the right side of the liver. It is located on the right side of the abdomen.
• Its main purpose is to collect and concentrate bile produced by the liver. Bile is released from the gallbladder after eating and aids in digestion. Bile is released into the intestine through a tube, the common bile duct, connecting the liver and the small bowel.
• Removal of the gallbladder (cholecystectomy) is not associated with impairment of digestion in the vast majority of people.

What Leads To Trouble With a Gallbladder?

• Problems of the gallbladder are usually caused by the presence of gallstones. Gallstones consist of cholesterol and bile salts that form in the gallbladder or in the bile ducts.
• Risk factors associated with the formation of gallstones include:

• There are no effective ways to prevent gallstones.
• Gallstones cause problems when they block the flow of bile out of the gallbladder. This can result in abdominal pain, vomiting, and indigestion after eating. Occasionally this blockage leads to infection of the gallbladder resulting in the symptoms above, as well as, fever.
• When gallstones block the common bile duct, jaundice (a yellowing of the skin) can occur. This can also lead to infection.

How Are Problems With The Gallbladder Diagnosed?

• Ultrasound is the best tool used to evaluate for the presence of gallstones.
• Other tests may also need to be used to evaluate the gallbladder and its function.
• Gallstones do not go away on their own. The symptoms of gallstone disease can be temporarily managed with drugs or by making dietary adjustments, such as decreasing fatty foods. However, symptoms will eventually recur until the gallbladder is removed.
• Removal of the gallbladder is the most effective and safest treatment of gallbladder disease.

How Is It Done?

• General anesthesia is used. This means that the patient is asleep throughout the procedure.
• Through a 1/4 to 1/2 inch incision, a canula (a narrow tube-like instrument) is inserted into the abdomen in the region of the navel.
• A laparoscope (a tiny telescope) connected to a fiberoptic camera is inserted through the canula, giving the surgeon a magnified view of the patient's internal organs on a television screen.
• Other canulas are then inserted through the abdominal wall so that long, thin instruments can be used to delicately separate the gallbladder from its attachments. The gallbladder is then removed from one of the small incisions.

• Sometimes an X-ray, called a cholangiogram, is used during surgery to identify stones which may have moved from the gallbladder to the bile ducts. If gallstones are found in the common bile duct, other procedures may be needed to remove them.
• After the gallbladder is removed, the small incisions are closed with absorbable stitches and surgical tape. Band-Aids are usually the only dressing necessary.

Can All Gallbladders Be Taken Out Using A Laparoscope?

In a small number of patients, the gallbladder cannot be removed laparoscopically. This may be due to the inability to see or dissect the organ effectively. In this case, the "open" incision is used. Risk factors that may increase the chance of needing the "open" procedure include a history of prior abdominal surgery causing dense scar tissue, active infection, or bleeding problems during the operation. The decision to perform the open procedure is made by your surgeon either before or during the actual operation. The decision to convert to an open procedure is based on patient safety.

How Long Will I Be In The Hospital?

Most laparoscopic cholecystectomy patients go home the same day of their surgery. In some cases the patient may need to stay overnight for further monitoring. This compares with the three-to-five day stay following the traditional "open" procedure.

When Can I Go Back To Work?

Most patients return to work within seven to ten days following the laparoscopic procedure. However, this depends on the nature of your job. Patients with jobs not requiring physical labor usually return to work in a few days. Those involved in manual labor or heavy lifting may require more time to allow healing of their incisions. Patients undergoing the "open" procedure usually cannot resume normal work-related activities for three-to-six weeks.

Will I Have A Large Scar?

No. Large incisions are avoided by using laparoscopic techniques. This results in minimal scaring.

Is It Safe?

Studies have shown that the complication rate for laparoscopic gallbladder surgery is comparable to the complication rate for traditional "open" gallbladder surgery when performed by a properly trained surgeon. In fact, many complications are decreased with the use of laparoscopy.

What Are The Risks Of A Laparoscopic Cholecystectomy?

Whether undergoing laparoscopic or traditional "open" surgery, you should always ask your surgeon about the risks of the procedure.

Complications of laparoscopic cholecystectomy are infrequent. Possible complications may include bleeding, infection, pneumonia, blood clots, or heart problems. Unintended injury to structures such as the common bile duct occur in approximately 0.3 - 0.6% of surgeries. When this occurs, other procedures or other surgeries may be needed to repair the injury.

How Will I Feel After My Gallbladder Surgery?

Removal of the gallbladder is a major abdominal operation, and a certain amount of postoperative discomfort is expected. Pain and discomfort usually disappear over the following week. Pain is managed with prescription pain medication.

What Will I Be Able To Do When I Go Home?

• Activity, with the exception of heavy lifting, is encouraged. Resume normal daily activities as tolerated, including:
  
  Driving an automobile (when off pain medication)
  Climbing stairs
  Showering
  Exercising
  Returning to work
  Sexual Activity

• There are no specific diet restrictions. However, avoiding fatty foods in the first few weeks after surgery is suggested.

When Should I Call My Doctor?

• You should contact your surgeon if the following occur:
  
  Fever >101ºF
  Jaundice (yellowing of the skin or eyes)
  Worsening abdominal pain
  Increasing redness and tenderness of the incisions
  Persistent nausea or vomiting
  Drainage of pus from the incisions
• You should make an appointment with your surgeon within 2 weeks following your operation, even if your post-operative course is uneventful.