Cholecystectomy

What is a cholecystectomy?

A cholecystectomy is the surgical removal of the gallbladder, an organ located just under the liver on the upper right quadrant of the abdomen. The gallbladder stores and concentrates bile, a substance produced by the liver and used to break down fat for digestion.

Types of cholecystectomies:

The gallbladder may be removed in one of two ways:

· open method: In this method, a two- to three-inch incision is made in the upper right-hand side of the abdomen. The surgeon locates the gallbladder and removes it through the incision.

· laparoscopic method: This procedure uses several small incisions and three or more laparoscopes - small thin tubes with video cameras attached - to visualize the inside of the abdomen during the operation. The surgeon performs the surgery while looking at a TV monitor. The gallbladder is removed through one of the incisions.

A laparoscopic cholecystectomy is considered less invasive and generally requires a shorter recovery time than an open cholecystectomy. Occasionally, the gallbladder may appear severely diseased upon laparoscopic examination or other complications may be apparent, and the surgeon may have to perform an open surgical procedure to remove the gallbladder safely.

Reasons for the Procedure

A cholecystectomy may be performed if the gallbladder contains gallstones (cholelithiasis), is inflamed or infected (cholecystitis), or is cancerous.

Gallbladder inflammation or infection may cause pain which may be described as follows:

· is generally located on the right side of the upper abdomen

· may be constant or may become more severe after a heavy meal

· at times, may feel more like fullness than pain

· may be experienced in the back and in the tip of the right shoulder blade

Other symptoms of gallbladder inflammation or infection include, but are not limited to, nausea, vomiting, fever, and chills.

The symptoms of gallbladder problems may resemble other medical conditions or problems. In addition, each individual may experience symptoms differently. Always consult your physician for a diagnosis.

There may be other reasons for your physician to recommend a cholecystectomy

Risks of the Procedure

As with any surgical procedure, complications may occur. Some possible complications of cholecystectomy may include, but are not limited to, the following:

· bleeding

· infection

· injury to the bile duct - the tube that carries bile from the gallbladder to the small intestine

During laparoscopic cholecystectomy, insertion of the instruments into the abdomen may injure the intestines or blood vessels.

If you are pregnant or suspect that you may be pregnant, you should notify your physician.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure

· Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

· You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.

· In addition to a complete medical history, your physician may perform a physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood or other diagnostic tests.

· You will be asked to fast for eight hours before the procedure, generally after midnight.

· If you are pregnant or suspect that you may be pregnant, you should notify your physician.

· Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

· Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

· Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

· If your procedure is to be done on an outpatient basis, you will need to have someone drive you home afterwards because of the sedation given prior to and during the procedure.

· The area around the surgical site may be shaved.

· Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

A cholecystectomy may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

A cholecystectomy is generally performed while you are asleep under general anesthesia.

Generally, a cholecystectomy follows this process:

1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.

2. You will be asked to remove clothing and be given a gown to wear.

3. An intravenous (IV) line will be inserted in your arm or hand.

4. You will be positioned on the operating table on your back.

5. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

6. The skin over the surgical site will be cleansed with an antiseptic solution.

open method cholecystectomy:

7. An incision (open method) will be made. The incision may slant under the ribs on the right side of the abdomen, or it may be an up-and-down incision in the upper part of the abdomen.

8. The gallbladder is removed.

9. In some cases, one or more drains may be inserted through the incision to allow drainage of fluids or pus.

laparoscopic method cholecystectomy:

10. Three to four small incisions will be made in the abdomen. Carbon dioxide gas will be introduced into the abdomen to inflate the abdominal cavity so that the gallbladder and surrounding organs can be more easily visualized.

11. The laparoscope will be inserted through one of the incisions and instruments will be inserted through the other incisions to remove the gallbladder.

12. When the procedure is completed, the laparoscope will be removed.

procedure completion, both methods:

13. The gallbladder will be sent to the lab for examination.

14. The skin incision(s) will be closed with stitches or surgical staples.

15. A sterile bandage/dressing or adhesive strips will be applied.

After the Procedure

In the hospital:

After the procedure, you will be taken to the recovery room for observation. Your recovery process will vary depending upon the type of procedure performed and the type of anesthesia that is given. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. As a laparoscopic cholecystectomy procedure may be performed on an outpatient basis, you may be discharged home from the recovery room.

You may receive pain medication as needed, either by a nurse or by administering it yourself through a device connected to your intravenous line.

You may have a thin plastic tube inserted through your nose into your stomach to remove air that you swallow. The tube will be removed when your bowels resume normal function. You will not be able to eat or drink until the tube is removed.

You may have one or more drains in the incision if an open procedure was done. The drains will be removed in a day or so. You might be discharged with the drain still in your abdomen covered with a dressing. Follow your physician’s instructions for taking care of it.

You will be encouraged to get out of bed within a few hours after a laparoscopic procedure or by the next day after an open procedure.

Depending on your situation, you may be given liquids to drink a few hours after surgery. Your diet may be gradually advanced to more solid foods as tolerated.

Arrangements will be made for a follow-up visit with your physician, usually two to three weeks after the procedure.

At home:

Once you are home, it is important to keep the incision clean and dry. Your physician will give you specific bathing instructions. If stitches or surgical staples are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.

The incision and the abdominal muscles may ache, especially after long periods of standing. Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Walking and limited movement are generally encouraged, but strenuous activity should be avoided. Your physician will instruct you about when you can return to work and resume normal activities.

Notify your physician to report any of the following:

· fever and/or chills

· redness, swelling, or bleeding or other drainage from the incision site(s)

· increased pain around the incision site(s)

· abdominal pain, cramping, or swelling

· pain behind the breastbone

· Following a cholecystectomy, your physician may give you additional or alternate instructions, depending on your particular situation.

The Biliary System: Anatomy and Functions

Anatomy of the biliary system:

The biliary system consists of the organs and ducts (bile ducts, gallbladder, and associated structures) that are involved in the production and transportation of bile. The transportation of bile follows this sequence:

1. When the liver cells secrete bile, it is collected by a system of ducts that flow from the liver through the right and left hepatic ducts.

2. These ducts ultimately drain into the common hepatic duct.

3. The common hepatic duct then joins with the cystic duct from the gallbladder to form the common bile duct, which runs from the liver to the duodenum (the first section of the small intestine).

4. However, not all bile runs directly into the duodenum. About 50 percent of the bile produced by the liver is first stored in the gallbladder, a pear-shaped organ located directly below the liver.

5. Then, when food is eaten, the gallbladder contracts and releases stored bile into the duodenum to help break down the fats.

Functions of the biliary system:

The biliary system's main function includes the following:

· to drain waste products from the liver into the duodenum

· to help in digestion with the controlled release of bile

Bile is the greenish-yellow fluid (consisting of waste products, cholesterol, and bile salts) that is secreted by the liver cells to perform two primary functions, including the following:

· to carry away waste

· to break down fats during digestion

Bile salt is the actual component which helps break down and absorb fats. Bile, which is excreted from the body in the form of feces, is what gives feces its dark brown color.