Cholecystectomy - Laparoscopic Surgery for Gallbladder Removal

What Is Cholecystectomy?

The gallbladder is a small organ located under the liver that stores and concentrates the digestive juice known as bile produced by the liver. During the digestion process, this juice is released by the gallbladder into the small intestine to aid in the digestion of food. The gallbladder is not, however, essential to digestion and individuals with gallbladder disease for whom other treatment options have proven to be insufficient will be advised to undergo gallbladder removal surgery, medically called a cholecystectomy. 

When Is Cholecystectomy Advised?

Cholecystectomy is often advised to relieve the symptoms of gallstones. Stones in the gallbladder can block the tubes that transfer bile to the small intestines. This can result in severe pain in many cases depending upon the extent of the blockage. Additionally, inflammation of the cells and tissues and infection may ensue. The removal of the gallbladder stones is often accomplished with conservative approaches that involve the use of medications and changes in diet. This may offer relief to a certain extent. However, the symptoms may not be relieved in many cases ultimately requiring the removal of the gallbladder. Further, the condition usually recurs frequently. The repeated formation of stones, infections, inflammations or obstruction in the gallbladder may ultimately require the removal of this organ if the conservative measures are unable to treat the condition. 

How Is Cholecystectomy Performed?

Cholecystectomy may be performed using two methods: open cholecystectomy or laparoscopic cholecystectomy. An open cholecystectomy involves the removal of the gallbladder by placing a single large incision over the abdomen. The procedure is performed under general anesthesia and requires the individual to stay in hospital for an average of three to five days after the surgical procedure. Laparoscopic cholecystectomy is considered a minimal surgical technique which involves the placement of a few small incisions on the abdomen instead of a single large incision.

What Is Laparoscopic Cholecystectomy?

Laparoscopic cholecystectomy involves the use of an instrument known as laparoscope that has a light source and a camera attached to it. Other smaller instruments are used along with the laparoscope to perform the cholecystectomy. Laparoscopic cholecystectomy is the most commonly followed procedure to remove the gallbladder and is considered to be a minimal surgical technique. In contrast to open surgery, which involves the placement of a single large incision over the abdomen, the laparoscopic procedure involves the placement of two to three smaller incisions. This shortens the recovery time and also minimizes the amount of scar left behind after the procedure.

The laparoscope and the other small instruments used in the removal of the gallbladder are introduced into the body through the small multiple incisions placed on the abdomen. This procedure is performed under general anesthesia. The gall bladder is observed through the laparoscope and the instruments are used to incise and separate the gallbladder from its location. The laparoscope has a small light and a camera which transfers the images to a television and the operating surgeon can view a magnified image of the area being operated. Additional imaging procedures may be carried out to locate the additional blockages or presence of stones in the gall bladder tubes and clear them. Following the removal of the gallbladder the incisions are sutured or closed with surgical tapes. The operated individual is generally advised to stay in the hospital for a day to rule out the presence of any associated complications.

What Are The Post Surgery Instructions?

The individual undergoing laparoscopic cholecystectomy may need to stay in the hospital for about a day after the surgery, or may be sent home on the same day. They may be required to take medications to relieve any pain or other symptoms associated with the surgery. The recovery is usually faster and is generally not associated with any complications.

Resuming normal activities may vary with each individual and the doctors’ instructions must be followed, but most people can expect to resume their normal lives within two weeks. The individual who has undergone the laparoscopic cholecystectomy may be asked to visit the hospital at regular intervals to monitor the progress. Additional imaging studies may also be advised to evaluate the outcome of the surgical procedure. Medications may be advised as needed.

People with gallbladder disease are routinely advised to avoid fatty foods, while after the initial recovery period, there are no special dietary instructions for patients who have already had their gallbladder removed. Studies show, however, that many individuals who have undergone a cholecystectomy still experience complications such as diarrhea and abdominal discomfort. To avoid these unpleasant experiences, the ideal diet after gallbladder removal is one in which you avoid junk foods. People who have had their gallbladder removed do need fat in their diet, but should focus on healthy fats such as avocado. They will also benefit from eating smaller meals more often. 

What Are the pros and cons of laparoscopic cholecystectomy, and the risks involved?

A number of benefits are noted with the use of laparoscopic technique for the removal of the gallbladder. The open surgery technique involves the placement of a larger incision when compared to the laparoscopic procedure. Thereby with the laparoscopic cholecystectomy, the extent of incision is smaller, the healing is faster and minimal or no scar may be observed after the wound heals. The amount of pain associated with this technique is also less. The operated individual may return home within a day following the surgery. Everyday activities can be resumed from an earlier period when compared to individuals who have undergone the open method.

Laparoscopic cholecystectomy may not be feasible for all individuals. Obese individuals and individuals with a history of any other abdominal surgery that has resulted in the formation of dense scar tissues cannot be operated with laparoscopy. Increased bleeding and an inability to view the tissues clearly may affect the completion of the laparoscopy procedure and may create the need for an open technique. The presence of large stones or increased inflammation in the gallbladder may also be impossible to treat with laparoscopy.

What Are The Risks And Complications Of Laparoscopic Cholecystectomy?

Generally the laparoscopic cholecystectomy is associated with a lesser number of complications when compared to the open surgical technique.

As with any other operation involving the use of anesthesia, adverse reactions to the drugs administered or other associated complications may be noted in some cases of laparoscopic cholecystectomy. Some of the other complications of anesthesia can include breathing difficulties, pneumonia, the formation of blood clots in the legs or lungs, and heart problems. Accidental damage to the adjacent structures such as the small intestine may also occur in rare cases. Other complications such as bleeding may be noted either immediately following the procedure or during the recovery period. Secondary infections at the surgical site may also be noted in certain individuals. These complications may need additional hospital care.

If the gallbladder removal surgery went as planned without any complications, patients can still expect some amount of swelling, bruising, and pain in the immediate post-surgery period. During the immediate gallbladder removal recovery period, patients are advised to "take it easy", to take pain killers as prescribed, and to follow their surgeon's dietary recommendations. 

Should patients notice concerning symptoms while they are recovering from their surgery, or have questions about the post-surgery instructions, they are always advised to consult their surgeons rather than struggling with these issues by themselves. This can help prevent complications. 

Laparoscopic cholecystectomy patients are lucky in that they recover from their surgery much faster than those who underwent the more traditional surgery. Studies do show, however, that many individuals continue suffering from diarrhea and abdominal discomfort, the risk of which they can reduce by following a healthy, balanced, and low-fat cholecystectomy diet. The BRAT diet ("banana, rice, applesauce and tea/toast"), in particular, will help individuals prevent the diarrhea many people who have had their gallbladder removed suffer from.