Details of Laparoscopic Cholecystectomy

Cholecystectomy, or surgical removal of the gallbladder, has been the treatment of choice because it is a generally safe and permanent cure for gallbladder stones. In the past there have been attempts at using medications to dissolve stones or methods of stone crushing techniques, such as shock wave lithotripsy. Unfortunately, these techniques haven't been shown to work. Changes in diet or the use of vitamins has not been successful in dissolving gallstones.

Laparoscopic cholecystectomy is the standard technique for complete removal of the gallbladder that greatly reduces postoperative pain, hospitalization time, disability, and cost. During conventional cholecystectomy, the abdomen is opened by cutting a four to six inch incision in the upper abdominal muscle. After surgery, the patient often remains in the hospital on pain medications for two to five days, and may be off of work three to six weeks. There can be no strenuous exercise for at least six weeks. A gallbladder surgeon can use the laparoscopic technique and allow some patients to go home the same day and often return to work within a week.

Laparoscopic cholecystectomy is much less traumatic. Because the gallbladder is removed with the help of a one-half inch telescopic camera and instruments inserted through several tiny punctures, the procedure can be performed on an outpatient basis. Minimal narcotics are needed and the patient can return to work within a week and light activities in two to four weeks. No blood transfusions are necessary. Thus, the laparoscopic approach to cholecystectomy offers total permanent relief of gallbladder stone problems with minimal discomfort and disability, and at greatly reduced hospital cost. Call us today to talk to a gallbladder surgeon and learn more about your options.

Treatment Options

Preoperative Care: The patient arrives at the hospital the morning of the procedure on an empty stomach. No bowel preparation is necessary. Lab work has been done during an earlier office visit.

Laparoscopic Cholecystectomy: Under general anesthesia the abdomen is gently inflated with carbon dioxide gas. The expanded space allows room to perform the operation. A small 5mm incision is made in the lower portion of the umbilicus, so that a laparoscope (a thin telescope) can be inserted into the abdominal space. The laparoscope is attached to a video camera, allowing the surgical team to work together watching a magnified TV picture.

Two grasping forceps are then inserted into the right side of the abdomen through two small 5mm incisions. These forceps are used to position the gallbladder through the remainder of the procedure. Finally, a 11mm incision is made in the mid upper abdomen. A variety of manipulating and cutting instruments can be inserted through this site. The blood vessels to the gallbladder and the cystic duct that attaches the gallbladder to the bile duct are freed of surrounding tissues. A fine tube can be inserted into the bile duct, so that x-rays can identify additional stones that may have migrated from the gallbladder to the bile duct, if needed. Next, the cystic duct and blood vessels are closed with surgical clips and cut. The gallbladder is then separated from the liver, using electrocautery then placed in a bag and removed from the abdomen. The gallbladder, containing its stones, is now free in the abdomen. Sutures are used to close the abdominal wall incisions and a "skin glue" placed over the puncture sites. Then patient is then transferred to the recovery room.

It should be noted that it may occasionally be necessary to convert the laparoscopic cholecystectomy to an open cholecystectomy. The abdomen would be opened, for instance, if there were marked scarring or inflammation of the gallbladder or if there were technical difficulties with bleeding or proper positioning of the internal organs.

Postoperative Care: Discharge from the hospital may occur following recovery from anesthesia or the next day, depending on how the patient feels and on his home circumstances. Diet consists of starting with liquids and advance diet as tolerated. Removal of the gallbladder does not cause problems with digestion or bowel function. Thus, there are no dietary restrictions. Postoperative pain is described as a stretching soreness of the abdominal wall, occasional referred shoulder pain from the stretching of the diaphragm, and very localized discomfort at the skin puncture sites. A pain shot may be needed immediately after cholecystectomy. Then you will use oral pain medication for the next few days.