Cholesystectomy : Open gallbladder surgery for gallstones
CHOLECYSTECTOMY : A cholecystectomy is the surgical removal of the gallbladder. The two basic types of this procedure are open cholecystectomy and the laparoscopic approach.
The laparoscopic cholecystectomy involves the insertion of a long narrow cylindrical tube with a camera on the end, through an approximately 1 cm incision in the abdomen, which allows visualization of the internal organs and projection of this image onto a video monitor. Three smaller incisions allow for insertion of other instruments to perform the surgical procedure. A laser may be used for the incision and cautery (burning unwanted tissue to stop bleeding), in which case the procedure may be called laser laparoscopic cholecystectomy.
In a conventional or open cholecystectomy, the gallbladder is removed through a surgical incision high in the right abdomen, just beneath the ribs. A drain may be inserted to prevent accumulation of fluid at the surgical site.
Why It Is Done
A cholecystectomy is performed to treat cholelithiasis and cholecystitis. In cholelithiasis, gallstones of varying shapes and sizes form from the solid components of bile. The presence of stones, often referred to as gallbladder disease, may produce symptoms of excruciating right upper abdominal pain radiating to the right shoulder. The gallbladder may become the site of acute infection and inflammation, resulting in symptoms of upper right abdominal pain, nausea and vomiting. This condition is referred to as cholecystitis. The surgical removal of the gallbladder can provide relief of these symptoms.
Symptoms
Several conditions may lead to surgery to remove the gallbladder. Conditions that may require open rather than laparoscopic surgery include:
Severe inflammation of the bile duct or gallbladder.
Inflammation of the abdominal lining (peritonitis).
High pressure in blood vessels in the liver (portal hypertension). This is caused by cirrhosis of the liver.
Being in the third trimester of pregnancy.
A major bleeding disorder or use of medicines to prevent blood clotting (blood thinners or anticoagulants).
Scar tissue from many previous abdominal surgeries.
Abnormal anatomy in the abdomen.
How long is the procedure?
You will need general anesthesia, and the surgery lasts 1 to 2 hours. The surgeon will make the incision either under the border of the right rib cage or in the middle of the upper part of the abdomen (between the belly button and the end of the breastbone).
How Well It Works?
After surgery to remove the gallbladder, bile flows from the liver (where it is produced) through the common bile duct and into the small intestine. Because the gallbladder is gone, bile no longer is stored between meals. In most people, this has little or no effect on digestion.
What to Expect After Surgery?
Most people can return to their normal activities within 4 to 6 weeks. Open surgery involves more pain afterward and a longer recovery period than laparoscopic surgery.
This surgery leaves a moderately large scar [4in. to 8in. long].
No special diets or other precautions are needed after surgery.