Cholecystectomy
Cholecystectomy is a surgical procedure involving the removal of the gallbladder, typically indicated for patients suffering from symptoms such as nausea, vomiting, and abdominal pain caused by gallstones. Gallstones, primarily composed of crystallized cholesterol and bile, can block the bile duct, leading to significant discomfort and potential complications. While gallstones can sometimes be treated with medication or ultrasound, recurrent symptoms often necessitate surgical intervention to prevent further issues.
The procedure can be performed using two main techniques: open surgery and laparoscopic surgery. Open surgery involves making a larger incision in the abdomen, while laparoscopic surgery utilizes smaller incisions and specialized instruments, including a camera, for a less invasive approach. Recovery times vary, with open surgery generally requiring a hospital stay of two to three days and a recovery period of four to six weeks, whereas laparoscopic surgery often allows for a shorter hospital stay and quicker recovery.
Despite its effectiveness, cholecystectomy carries potential risks, with complication rates ranging from 1.0 to 9.4 percent. These may include postoperative bleeding and intestinal obstruction, with rare but severe complications such as damage to major bile ducts or blood vessels. However, the overall mortality rate associated with this procedure remains low, ranging from 0.2 to 0.6 percent. Understanding the indications, techniques, and potential risks of cholecystectomy can help patients make informed decisions regarding their treatment options.
Subject Terms
Cholecystectomy
Anatomy or system affected: Abdomen, gallbladder, gastrointestinal system
Definition: The surgical removal of a diseased gallbladder
Indications and Procedures
Cholecystectomy is indicated when the patient exhibits nausea, vomiting, and abdominal pain, and examination reveals gallstones. Gallstones, which consist mostly of crystallized cholesterol and bile, form in the gallbladder and may lodge in the bile duct. The stones can be dissolved with medication or broken up with ultrasound and passed from the body. They can (and often do) form again, however, with renewed symptoms. Removal of the gallbladder is the method of choice to prevent the recurrence of symptoms. Surgery is performed under general anesthesia.
In open surgery, the abdomen is cleaned, and a 7.5- to 15-centimeter (3- to 6-inch) incision made with a scalpel through the skin and abdominal tissues. The gallbladder is isolated from the liver. A duct and artery are tied off with surgical staples or sutures, and they are cut to free the gallbladder. The organ is removed, and the tissues are closed with sutures or staples.
In laparoscopic surgery, the surface is cleaned, and the surgeon makes four small holes. A 1.3-centimeter (0.5-inch) cut is made at or near the navel and another just below the breastbone, as well as two small punctures to the right of the incisions. The laparoscope, with a video camera and light, is inserted into the navel incision. Long, thin dissecting instruments are passed through the three punctures, and the gallbladder is cut free as in open surgery. The organ is removed through the navel incision, which is then closed with sutures or staples. The punctures are closed with small adhesive bandages.
Uses and Complications
Open surgery for cholecystectomy requires a hospital stay of two to three days and a recovery time of four to six weeks. Laparoscopic cholecystectomy requires Complications occur in 1.0 to 9.4 percent of the surgeries and range from postoperative bleeding and diarrhea to intestinal obstruction. Rare but major complications include severing the common bile duct that connects the liver and small intestine, or puncturing a major blood vessel. Overall, the mortality rate is low: 0.2 to 0.6 percent.
Laparoscopic surgery may require an overnight stay and a recovery period of five to seven days. The complication rate is lower than the rate in open surgery, but this may be a reflection of the fact that sicker patients with more complex diseases and, therefore, greater risk factors are generally referred for open surgery; not all patients are good candidates for the limited approach afforded by laparoscopy.
Bibliography
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Dunn, David C., and Christopher J. E. Watson. Laparoscopic Cholecystectomy: Problems and Solutions. Blackwell Science, 1992.
Ibrarullah, Mohammad, and Sadiq S. Sikora. Safe Laparoscopic Cholecystectomy: An Illustrated Atlas. CRC Press, 2022
"Laparoscopic Cholecystectomy (Gallbladder Removal)." Cleveland Clinic, 19 Jan. 2021, my.clevelandclinic.org/health/treatments/7017-laparoscopic-cholecystectomy-gallbladder-removal. Accessed 20 July 2023.
Parker, James N., and Philip M. Parker, eds. The Official Patient’s Sourcebook on Gallstones. ICON Group, 2007.
Porter, Robert S., et al., eds. The Merck Manual Home Health Handbook. Merck Research Laboratories, 2009.
Valverde, A., and H. Mosnier. "Laparascopic Cholecystectomy." Journal of Visceral Surgery, vol. 148, no. 5, Oct. 2011, pp. 353–360.