Laparoscopic Cholecystectomy (gall bladder)
Laparoscopic Cholecystectomy
What is it?
Laparoscopic Cholecystectomy, or removal of the gallbladder using multiple small incisions and a camera rather than a large incision, is performed for symptomatic cholelithiasis or cholecystitis, typically caused by gall stones.
What are the symptoms?
Symptomatic cholelithiasis happens when stones form in the gallbladder, an organ under the liver that stores bile. The stones can intermittently block the duct from the gallbladder which causes pain with eating in the upper right side of the belly. The pain occurs most often after eating meals high in fat. Patients can also have nausea or vomiting. If the stone completely blocks the opening of the gallbladder, bacteria can become trapped in the gallbladder causing inflammation or cholecystitis. With cholecystitis, patients often have fever in addition to pain and nausea.
What causes it?
Gallstones form when cholesterol and other things found in bile make stones. They can also form if the gallbladder does not empty as it should. People who are overweight or who are trying to lose weight quickly are more likely to get gallstones.
How is it diagnosed?
A complete history and physical exam is performed, as well as blood work and an ultrasound. The ultrasound will show if stones are present in the gallbladder as well as any thickening of the wall of the gallbladder, indicating the presence of infection.
Treatment Options
Patients with symptomatic cholelithiasis can try decreasing the amount of fat in their diet to control the symptoms. Often, they need to have their gallbladder removed. Most cholecystectomies, or removal of the gallbladder, are performed using four small incisions. The largest incision is at the belly button, with three additional incisions in the right upper part of the belly. A camera and special instruments are used to remove the gallbladder from under the liver. The gallbladder is then completely removed from the abdomen. Patients usually have no residual symptoms once they recover from cholecystectomy. Occasionally patients will have some residual nausea or diarrhea, which usually will resolve within a month or so.
Laparoscopic cholecystectomy is a safe and effective treatment for cholelithiasis. However, in the presence of infection, adhesions, or variations in anatomy, this method may become dangerous and your surgeon may need to make the prudent decision to continue by making the traditional incision to safely complete the operation. This should not be seen as a failure, but as a wise decision by your surgeon to prevent dangerous complications.
In an otherwise healthy person, little is required to prepare for surgery. Depending on your age, gender, and health problems, some routine blood tests, an EKG and a chest x-ray may or may not be needed. Your surgeon or family doctor will order these tests as needed. You will be asked to refrain from eating 8 hours before surgery. Be sure to let your doctor know what medications you are taking, as some will need to be stopped before surgery. In general, all blood thinners need to be stopped for several days. These include aspirin, Ibuprofen or Motrin, Coumadin and Plavix.
This operation is performed with general anesthesia. An IV line will be placed in your arm for fluids and you will be brought into the operation room. The anesthesiologist and nurses will use monitors to check your heart rate and breathing during the procedure. These may include EKG leads, a blood pressure cuff, an oxygen mask and sleeves on your legs to prevent clots from forming.
Once you are asleep, the operating room team will work together to perform your operation. When your operation is complete, you will be awakened from anesthesia in the operating room but you may not remember this. After a few hours in the recovery room, the nurses will help you out of bed and give you something to drink. It is common to feel groggy and nauseated soon after surgery and medication is available to help with these discomforts. A family member or friend should be available to take you home the same day of surgery.