Laparoscopic Cholecystectomy (Gallbladder Removal)
Laparoscopic cholecystectomy (pronounced kō'lĭ-sĭ-stěk'tə-mē) is the surgical removal of the gallbladder by laparoscopy. The gallbladder is a pear-shaped organ that sits beneath the liver in the right-upper abdomen. Its function is to store bile. It is attached to the bile ducts that come from the liver. These ducts carry bile from the liver to the gallbladder and intestine where the bile helps digest food. The gallbladder is not necessary to maintain good health.
Many women have heard of laparoscopy, also known as "bellybutton" or "band-aid" surgery. Gynecologists have long used this technique to tie the fallopian tubes and to inspect the female reproductive organs. Now the use of laparoscopy has been expanded to include removing a diseased gallbladder. With new video technology, the laparoscope has become a miniature television camera. Powerful magnification is now possible showing the intestinal organs in great detail.
Reasons for the Exam
Gallstones usually form in the gallbladder because of excessive cholesterol in bile. They are a very common medical problem. When they cause pain or other problems, treatment is usually needed. The removal of the gallbladder is one of the most common types of surgery done in this country. In the past, open abdominal surgery was the standard treatment. This procedure required a 3 to 7 day stay in the hospital and a 3 to 7 inch incision and scar on the abdomen.
Patient preparation for this procedure is the same as for general abdominal surgery, particularly in regard to the intake of food and liquids prior to the surgery. The physician will advise the patient accordingly.
Using advanced laparoscopic technology, it is now possible to remove the gallbladder through a tiny incision at the navel. The technique is performed as follows: The patient receives general anesthesia. Then a small incision is made at the navel and a thin tube carrying the video camera is inserted. The surgeon inflates the abdomen with carbon dioxide, a harmless gas, for easier viewing and to provide room for the surgery to be performed. Next, two needle-like instruments are inserted in the upper-right abdomen near the gallbladder. These instruments serve as tiny hands within the abdomen. They can pick up the gallbladder, move intestines around, and generally assist the surgeon. Finally, several different instruments are inserted to clip the gallbladder artery and bile duct, and to safely dissect and remove the gallbladder and stones. Then the gallbladder is freed, it is then teased out of the tiny navel incision. The entire procedure normally takes 30 to 60 minutes. The three puncture wounds require no stitches and may leave very slight blemishes. The navel incision is barely visible.
The main benefit of this procedure is the ease of recovery for the patient. There is no incision pain as occurs with standard abdominal surgery. The patient is up and about the same day. In fact, up to 90% of patients go home the same day. The remaining patients are usually discharged the next day. And within several days, normal activities can be resumed. So the recovery time is much quicker. Also, there is no scar left on the abdomen.
Depending on the size, number, and chemical makeup of gallstones, there is another way to treat the condition. If the stones are small, they may be dissolved with long-term drug therapy lasting 12 to 18 months. A problem with this option is that recurrence of gallstones is frequent, so the problem may not be permanently solved. When symptoms are bad, it is usually unwise to wait because a major complication may occur.
Side Effects and Risks
While the procedure seems very easy for the patient, it is still abdominal surgery. And, even though infrequent, it still carries the same risks as general surgery. Current medical reports indicate that the low complication rate is about the same for this procedure as for standard gallbladder surgery. These complications may include:
- In about 5% to 10% of cases, the gallbladder cannot be safely removed by laparoscopy. Standard open abdominal surgery is then immediately required.
- Nausea and vomiting may occur after the surgery.
- Injury to the bile ducts, blood vessels, or intestine can occur, requiring corrective surgery.
- Quite uncommonly, a diagnostic error or oversight may occur.
Surgeons are finding that cases previously felt to be unsuitable for laparoscopy can now be done safely with this technique. Still, there are instances in which the surgeon will not recommend the procedure. At times, pregnancy or previous surgery in the upper abdomen (which may cause adhesions) may require conversion to the standard surgery requiring a skin incision. In each instance, the surgeon will weigh the benefit for the patient against the risks, always considering other medical problems and always making the recommendation that is in the patient's best interest.
Gallbladder removal by laparoscopic surgery is an exciting development because it offers so much to the patient. The surgeon carefully evaluates each case and discusses it with the patient. While problems can occur with the procedure, they are unusual. In most instances, patients experience excellent results and resume their normal activities very quickly.