Gallbladder Removal (Cholecystectomy)

Cholecystectomy is the operation for removal of the gall bladder. Traditionally
the surgery was carried out through an incision in the right side of the upper
abdomen. More recently the surgery is done through a laparoscope employing
3 or 4 small incisions.

SILSTM: Surgery with the potential of no visible scars.
From multiple incisions to one. Offering patients the newest advancement
in surgery, the SILSTM procedure replaces the three to four incisions required
by standard laparoscopic and robotic assisted surgeries with just one incision
in the belly button. The benefits to patients include the potential elimination
of visible scars and the pain associated with multiple points of entry.

The gallbladder is a small pear shaped organ located beneath the liver in the
right side of the upper abdomen. The cystic duct carries bile from the gallbladder
and joins the common hepatic duct to form the common bile duct. The common
bile duct then empties into the beginning of the small intestine. The main purpose
of the gallbladder is to concentrate and store bile. It releases bile by ejecting it
through the common bile duct into the small intestine when fatty foods are eaten.
The bile aids in the digestion of fatty foods. However, one can live without the
gallbladder without suffering symptoms. Stones may form in the gall bladder,
which block the flow of bile resulting in pain in the right upper abdomen. Gallstones
can lodge in the terminal part of the common bile duct that opens into the small
intestine. Here the stones can also block the flow of pancreatic juice from the
pancreatic duct that joins the common bile duct. This may result in a severe
inflammation of the pancreas called pancreatitis. The exact cause of gall bladder
disease is unknown. Some studies suggest that gallstones may be related to how
the body handles cholesterol and bile acids that are synthesized in the liver and
stored in the gall bladder. While some people may have no symptoms even in the
presence of gallstones, others may have gallbladder problems even in the absence
of stones.

Diagnosis
Those individuals most likely to have gallbladder attacks are:
• Women, especially in their 40s.
• Women who have been pregnant . The risk of gallstones may increases with
each pregnancy.
• Overweight men and women.
• People who eat large quantities of dairy products, animal fats and fried foods.
• Family history of gallbladder disease.
• Gallbladder disease with stones may be associated with bloating, nausea
or vomiting and in severe cases fever and other signs of infection. There may
be intolerance to fatty foods. The symptoms of gallstones may occur after
eating fried or oily foods, or a heavy meal. The symptoms may recur frequently
and may be disabiling.

Indications
Commonly patients with gallbladder problems have nausea, vomiting, or
various types of pain due to their gallbladder not functioning properly. In the
majority of patients the problem is the presence of stones within the gallbladder
(cholelithiasis) although in some patients the problem is that the gallbladder
doesn’t contract, (or squeeze) normally. This is termed biliary dyskinesia, and is
another indication for gallbladder removal.

Pre-operative Evaluation
• Blood tests may be taken to detect jaundice or elevation of enzymes that
occur as a result of blockage to the flow of bile.
• Ultrasound of the abdomen. This test employs sound waves to scan the
abdomen for gallstones. The echoes from the sound waves are recorded
and imaged on a screen. The presence, size and position of the gallstones
can be determined as well as gallbladder wall thickness and the size of the
common bile duct.
• HIDA scan. This scan employs a radioactive isotope to evaluate the function
of the gallbladder.

Procedure
In the vast majority of patients, the gallbladder can be removed laparoscopically
using small incisions, a television camera, and long thin instruments. In some
patients a longer, traditional incision is required.

Risks
As with all surgery, laparoscopic and open gallbladder surgeries carry risks
of complication. In addition to the risks associated with anesthesia there are
recognized surgical risks which include bleeding, infection, and injury to organs,
blood vessels, nerves or other structures, including bile ducts.

In the event of a complication, additional surgery and/or a longer stay in the
hospital may be necessary and recommended by your physician.

While death is a risk and can result from gallbladder surgery, it is an extremely
rare event.

Patients should further consult their surgeon if they have questions or would
like additional information.

Length Of Stay
The patient usually has minimal pain that is well controlled with medication.
Frequently, patients are discharged home on the same day as their laparoscopic
cholecystectomy was performed with a prescription for pain medication.
Occasionally a patient may remain overnight. If a traditional open gallbladder
removal is done, the patient may stay three to five days after open surgery.

Recovery
Patients eat a normal light diet on the day of surgery and may be able to return
to light work in 3-4 days. It is preferable to avoid exertion and heavy work for a
several weeks though one can take regular walks. No driving on prescription
pain medication. After open surgery no driving for two weeks and no lifting over
five pounds for six weeks.