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gall bladder removal
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Alternative Names
cholecystectomy, laparoscopic cholecystectomy
Definition
Gallbladder removal, or cholecystectomy, is surgical removal of the gallbladder.
Gallbladder disease, or cholecystitis (inflammation and infection of the gall bladder) and/or gall stones (called cholelithiasis) , are a common health problem. Operations to remove abnormal gallbladders have been done for more than 100 years safely and with excellent results.
Who is a candidate for the procedure?
A person who is having gallbladder symptoms should discuss this procedure with his or her healthcare professional.
There are several reasons that the gallbladder can become inflamed. Sometimes gallstones form in the gallbladder. These stones can block the drainage of bile, a fluid that helps digest fat and excrete certain fatty materials into the stool. If the ducts for bile excretion become blocked by a gallstone, a person will usually feel pain in the upper right part of the abdomen.
About eighty percent of people who have gallstones have no symptoms. Some people will have a gallbladder that does not have stones but still does not drain well. This is called biliary dyskinesia. It may also treated by removing the gallbladder, but usually only if it also has symptomatic stone disease.
Certain other individuals such as children, or those of a specific race (Pima Indians, or other people with large gall stones, because they have a slightly higher risk for gall bladder cancer) may need the gall bladder removed even in the absence of symptoms..
How is the procedure performed?
Gallbladder removal is one of the most frequently performed operations in developed countries. It can be done either as open surgery or with a laparoscope
Open surgery without a laparoscope through a larger incision is the older and more traditional way to remove a gallbladder. An incision is made in the right upper part of the abdomen a few inches below the rib cage (or occasionally down the center of the abdomen).
The surgeon cuts all the way through the abdominal wall. This lets him or her look at the abdominal cavity for any other problems. The liver is lifted up toward the chest so that the underside can be seen. The gallbladder is then cut away from the liver and removed. The abdominal wall is stitched together and bandaged.
Laparoscopic gall bladder removal has become the most preferable approach. It can be performed safely in most hospitals with little risk to the individual and a shorter recovery time. Like open surgery, this approach requires general anesthesia, which puts the person to sleep.
The navel is opened with a 1-cm incision. The abdominal cavity is filled with carbon dioxide gas to move organs and intestines away from each other and make them easier to see. A video camera built like a tiny rod is inserted through the incision. Three smaller incisions are made in the abdomen. The same process is then used as in the open procedure, but through a smaller entry site.
The surgery is done using smaller instruments than for the open procedure. The air is removed from the abdominal cavity after the gall bladder is removed. The cuts are stitched and bandaged.
Open surgery may be needed if the gallbladder is severely inflamed or infected. This may make it too swollen to be grasped by the tiny instruments. If the person has internal scarring or has had extensive surgery, the abdomen may not inflate well when the gas is put in. This makes it difficult to see the gallbladder well.
Sometimes the anatomy of bile ducts or blood vessels makes them difficult to operate on through the laparoscope. These reasons may make it necessary for the surgeon to change from a laparoscopic approach to an open approach during the operation. This happens in about 5% of cases.
What happens right after the procedure?
After the operation, the individual is monitored in the surgical recovery room. After a laparoscopic procedure, about 50% of people are stable enough to go home directly from the recovery area. Some people will be kept overnight for observation. They may also need more time to recover from the effects of the anesthesia.
Most people will be given pain and anti-nausea medicines to take home. If the open approach is used, a person will usually need to spend a few days in the hospital. The difference between the two approaches is the amount of pain produced by the bigger incision.
Open surgery usually needs stronger painkillers, which are best administered in the hospital. Open surgery also creates a longer period of recovery before returning to normal activities to allow the abdominal muscles and intestines that are moved during surgery to heal from the larger incision.
What happens later at home?
Once at home, the individual can expect to feel fatigued to some degree for several days to a few weeks. This is true for either type of operation. Most people find it easier to eat small meals of bland food for the first few days. Eventually, they will be able to return to a normal diet. Often, people find that they can eat things that caused discomfort before the surgery. The body compensates well for not having a gallbladder.
What are the potential complications after the procedure?
The biggest potential problem from gallbladder surgery is injury to the bile ducts. The area where the cystic duct (the duct leaving the gall bladder with bile) comes together with the common bile duct (the duct that connects the liver with the bowel) is the place where the cutting is done.
There can be infection and scarring from gallbladder disease in this region. Inability to see this area easily is the main reason that surgeons switch to an open technique from a laparoscopic approach.
There are few complications after cholecystectomy. Infection at the incision site is rare. Some people will have looser bowel movements for a few weeks. This is because more bile reaches the large bowel than before the operation. It may have an irritating effect. This problem goes away once the body has adapted to the change.
Any new or worsening symptoms should be reported to the healthcare professional, especially worsening abdominal pain, fever, absence of bowel movements or continued vomiting..
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Author: Michael Peetz, MD
Date Written: 02/26/00
Medical Review: Gregory Rutecki, MD
Date Written: 9/7/2006
Reviewer: Reginald Finger, MD
Date Reviewed: 10/17/2006
Contributors
Potential conflict of interest information for reviewers available on request
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