Gallbladder Removal

Laparoscopic Cholecystectomy

Overview

The gallbladder lies in the right upper abdomen under the liver edge. Gallstones can form in the gallbladder and may occlude or lodge in the neck of the gallbladder. If this occurs, acute inflammation of the gallbladder (cholecystitis) develops. Many times, the gallstone may pass through the bile duct and into the small bowel. Each episode of cholecystitis results in more inflammation of the gallbladder with subsequent fibrosis and scarring of the gallbladder wall. Also, if the gallstone becomes lodged in the bile duct, it can obstruct the bile duct or the pancreatic duct and cause inflammation of the bile ducts or pancreas.

Procedure

The treatment for gallstones is surgical removal of the gallbladder. This can be accomplished laparoscopically through one to four small incisions (>1 inch each) as opposed to the “open” procedure which may require an 8-10 inch incision. A laparoscope and long thin instruments are used to perform the operation. The laparoscope functions as a camera to visualize and magnify the abdominal contents to monitors outside of the body. The gallbladder is dissected from the liver, and the artery and duct to the gallbladder are clipped and divided. Often an X-ray of the bile ducts is taken during surgery to ensure that gallstones have not occluded the bile ducts.

Advantages of the Procedure

The advantages of removing the gallbladder laparoscopically include; less pain, a faster recovery, a smaller incision, less wound complications, and a lower chance of future hernias.

Recovery

A liquid diet is started after surgery and patients are advanced to a low fat diet as tolerated. Pain medication is given by mouth and the majority of patients return home the day after surgery. Some patients may go home the same day as the operation. Walking is encouraged after surgery, and activity is dependent on how the patient feels. Most patients return to work in less than one week depending on the physical requirements of their occupation. Patients return approximately two weeks after surgery for routine follow-up with their surgeon.

Publications

Rosen M, Brody F, Ponsky J.Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg. 2002 Sep;184(3):254-8.

Hazey JW, Brody FJ, Rosenblatt SM, Brodsky J, Malm J, Ponsky JL.Laparoscopic management and clinical outcome of emphysematous cholecystitis. Surg Endosc. 2001 Oct;15(10):1217-20.

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