JACHO Notice

Cholecystectomy

A cholecystectomy is the surgical removal of the gallbladder.  The gallbladder is a pear-shaped organ, located in the abdomen, which stores bile--a substance that aids in the absorption of fat.  When gallstones are present or the gallbladder becomes infected or inflamed due to gallbladder disease, a cholecystectomy is the only curative treatment.  During this procedure, the bile ducts, which transport bile from the gallbladder to the small intestine, are not removed.  Once the gallbladder is removed, the liver takes over the transportation of bile using these bile ducts.  In most cases, there are no symptoms following this procedure.  Sometimes, however, there are residual symptoms, but these occasions  are rare.

There are two types of cholecystectomy: laparoscopic or conventional/"open".

Laparoscopic Cholecystectomy

In this type of cholecystectomy, four incisions are made in the abdomen, each approximately 1/2" in length.  One incision is made around the navel and the other three are areas around the abdomen (see figure).  In this procedure, the physician uses a laparoscope, a thin, rigid viewing tube, which is used to navigate through the organs and assist the physician in removing the gallbladder.  The laparoscope is inserted into the incision by the navel.  Images taken by the scope are reflected on two TV monitors in the operating room.  The other three incision are used to insert other instruments, which grasp, clamp and cut free the gallbladder from its attachments.  The gallbladder is cut away using either a laser or electrocautery device; both of which used localized heat to minimize bleeding.  Once the gallbladder has been cut free it is drained of bile, collapsed and removed through the navel incision.  Patients are usually home by the next day and back to normal activities within a week.

Complications resulting from this type of procedure are very rare.  Nevertheless, they do exist.  The complications are: bleeding, infection, bile duct damage, intestinal damage and blood vessel damage.

1 out of every 20 cases results in complications where the gallbladder is severely diseased.  In this case, the surgeon will have to perform a conventional cholecystectomy instead.  The surgeon will not be able to tell how damaged the gallbladder truly is until he/she sees it with the laparoscope.  Thus, patients undergoing a laparoscopic procedure should be prepared for a conventional cholecystectomy as well.

Conventional Cholecystectomy

Also known as "open" cholecystectomy.  This procedure is usually done when complications arise during a laparoscopic procedure or if the patient has had previous gallbladder surgery or bleeds a lot.  In this procedure, the surgeon makes one incision 4-8" in length.  The incision is either made vertically or at a slant under the right ribs.  The appendix may also be removed during this procedure to prevent the possibility of having an appendectomy later in life.  This procedure is much more involved.  The size of the incision requires that stomach muscles be cut; therefore, the hospital stay and recovery period is much greater for the conventional procedure--typically 5 days in the hospital and 4-8 weeks of recovery at home, depending on the severity of the surgery.

In either case, whether your physician recommends a laparoscopic or conventional procedure, you should take comfort in the fact that this procedure is very simple and complications are rare.  Under the care of a good physician and surgeon, this type of surgery should go very smoothly.