Gallbladder Removal: Laparoscopic Cholecystectomy


What is the gallbladder?

Gallbladder

The gallbladder is a small pear shaped sac attached to the underside of the liver. It is in the upper right hand side of the belly, underneath the ribs. It is a storage area for a digestive fluid called bile. The gallbladder stores bile between meals, and releases it into the stomach after meals to help with digestion; particularly digestion of fats and oils.

Sometimes the relative concentrations of chemicals in the bile becomes abnormal, and stones form. These stones may stay in the gallbladder and not cause any problems. However, often they do cause symptoms of pain, loss of appetite, bloating, heartburn, nausea or vomiting. When these symptoms occur we recommend removal of the gallbladder along with the stones. If this is not done there is a risk that the stones could cause jaundice or infection.

At the present time there are two available procedures for removal of the gallbladder:

Open Cholecystectomy: This operation consists of making an incision through the muscles of the abdominal wall, and directly removing the gallbladder.

Laparoscopic Cholecystectomy: Instead of an incision over the gallbladder area, there is a small incision by the belly button, and three smaller incisions near the gallbladder. A viewing scope attached to a video monitor is inserted through the belly button incision. Various other instruments are inserted through the other incisions to remove the gallbladder. This operation has less postoperative discomfort, and is done much shorter hospital stay than the open cholecystectomy.

After the gallbladder has been removed, the bile will drain into the stomach continuously, rather than only after meals. This will not impair digestion. In fact, you may find that foods that disagreed with you before the surgery, will be more acceptable after the gallbladder has been removed.

Pre-operative preparations
This is considered a major operation, and it must be done in the operating room of a hospital. Depending on the details of your medical problems and gallbladder disease we will decide to do your surgery either as an outpatient, or with an overnight stay. Either way, you will most probably report to the hospital the morning of the operation. Some insurance companies require that this procedure be done as an outpatient unless there is a medical reason that it is not safe.

It is important that you not eat anything after midnight the night before the operation; your can have clear liquids up to three hours before the surgery. Right before surgery you will get a chance to talk to the anesthesiologist. He will be in charge of putting you to sleep. Feel free to ask the anesthesiologist any questions you may have about the anesthetic.

Surgery

What is the operation like?
The laparoscopic procedure begins with the insertion of a small hollow tube called a trocar into the abdomen just beneath the belly button. We insert this initial trocar using "open technique", which means that a small incision is made, and a smooth, rounded, blunt tipped trocar is gently inserted into the abdomen under direct vision. This is in contrast to other techniques where a sharp needle and trocar are placed into the abdomen. The open technique almost completely eliminates the chance of injury to blood vessels or other organs.

The abdominal cavity is then filled with carbon dioxide gas. This inflates the abdomen to make space for the viewing scope and instruments. The laparoscope is then inserted into the abdomen and the internal organs visualized on a color, high definition monitor. Additional instruments are inserted into the upper abdomen through very small incisions. There are usually three incisions, but occasionally an additional one is needed. These instruments are used to find and divide the artery and duct to the gallbladder. Sometimes, an x-ray of the bile ducts called a cholangiogram is done during the operation to help define the anatomy and check for small stones in the bile ducts. An electrocautery machine is used to remove the gallbladder and cauterize the surface of the liver where the gallbladder was attached. The gallbladder is pulled out of one of the small incisions in the upper abdomen and removed. Once the gallbladder and stones have been removed the carbon dioxide is removed from the abdomen and the incisions are sutured closed. Occasionally, it is necessary to insert a small drain (plastic tube), to remove blood, serum or bile. If this was necessary it would stay in for a few days and be removed in the office.

After the operation
Some patients notice nausea for the first 24 hours after the operation. This can usually be controlled with medication. The nausea is from the anesthetic medications as well as the procedure itself. In addition, some patients experience discomfort in the right upper abdomen and right shoulder. The right shoulder pain is a "referred" pain related to the carbon dioxide that has to be put into the belly during the operation. This stretches and irritates the diaphragm (the layer of muscle between the abdomen and chest). The diaphragm has the same nerve supply as the shoulder-so you feel shoulder pain when the diaphragm is irritated. These symptoms usually resolve quickly over the first 24-48 hours.

Once at home, most patients need to rest for the first few days, then slowly resume normal activity, and return to completely normal activity, including work, in one week.

Because of our extensive experience with this procedure at Evergreen Surgical, we have been offering laparoscopic cholecystectomy to healthy individuals as an outpatient procedure. These patients have their surgery and go home the same day. We have done this procedure as an outpatient for several years and feel that it is very safe, and is preferred by many patients.

If you are having gallbladder problems and would like a surgical consultation, you may call our office directly, and can usually be seen by one of our surgeons within 1-2 days. With most insurance plans and PPO's no referral is necessary.