1. Laparoscopic Cholecystectomy
What is Laparoscopic Cholecystectomy?
Laparoscopic Cholecystectomy is a gall bladder surgery that removes the gall bladder and the gall stones through several small incisions in the abdomen. The surgeon inflates the abdomen with air or carbon dioxide in order to see clearly.The surgeon inserts a lighted scope attached to a video camera (laparoscope) into one incision near the belly button.
The surgeon then uses a video monitor as a guide while inserting surgical instruments into the other incisions to remove your gall bladder.
What are the advantages of performing the procedure laparoscopically?
Through Laparascopicalremoval of gall bladder and gall bladder stones, the advantages are:
Rather than a five to seven inch incision, the operation requires only four small openings in the abdomen
Patients usually have minimal post-operative pain
Patients usually experience faster recovery than open gallbladder surgery patients
Most patients go home within one day and enjoy a quicker return to normal activities
What preparations are required for the surgery?
The following includes typical events that may occur prior to laparoscopic surgery; however, since each patient and surgeon is unique, what will actually occur may be different:
Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on the age and medical condition of the patient
The surgeon may request that the patient has a completely empty colon and cleansed intestines prior to surgery. The patient may be asked to drink clear liquids, only, for one or several days prior to surgery.
After midnight the night before the operation, the patient should not eat or drink anything except medications to be taken with a sip of water as permitted by the surgeon
Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
The patient should quit smoking and arrange for any help to reach back home
How is Laparoscopic Cholecystectomy performed?
The surgery is done under general anaesthesia so the patient is asleep throughout the surgery.
Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen in the area of the belly-button
A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient’s internal organs on a television screen
Other cannulas are inserted which allow the surgeon to delicately separate the gallbladder from its attachments and then remove it through one of the openings
Many surgeons perform an X-ray, called a cholangiogram, to identify stones, which may be located in the bile channels, or to insure that structures have been identified
If the surgeon finds one or more stones in the common bile duct, he may remove them with a special scope, may choose to have them removed later through a second minimally invasive procedure, or may convert to an open operation in order to remove all the stones during the operation
After the surgeon removes the gallbladder, the small incisions are closed with a stitch or two or with surgical tape
What should the patient expect after the surgery?
Gallbladder removal is a major abdominal operation and a certain amount of postoperative pain occurs. Nausea and vomiting are not uncommon.Most patients who have a laparoscopic gallbladder removal go home from the hospital the day after surgery. Some may even go home the same day the operation is performed.
Once liquids or a diet is tolerated, patients leave the hospital the same day or day following the laparoscopic gallbladder surgery
Activity is dependent on how the patient feels. Walking is encouraged. Patients can remove the dressings and shower the day after the operation
Patients will probably be able to return to normal activities within a week’s time, including driving, walking up stairs, light lifting and working
The surgeon should be contacted in case of onset of fever, yellow skin or eyes, worsening abdominal pain, distention, persistent nausea or vomiting, or drainage from the incision
Most patients can return to work within seven days following the laparoscopic procedure depending on the nature of your job. Patients with administrative or desk jobs usually return in a few days while those involved in manual labor or heavy lifting may require a bit more time. Patients undergoing the open procedure usually resume normal activities in four to six weeks
A follow up appointment is made with the surgeon within 2 weeks following the operation
What are the risks and complications involved?
While there are risks associated with any kind of operation, the vast majority of laparoscopic gallbladder patient’s experiences few or no complications and quickly return to normal activities. Complications of laparoscopic cholecystectomy are infrequent, but include bleeding, infection, pneumonia, blood clots, or heart problems. Unintended injury to adjacent structures such as the common bile duct or small bowel may occur and may require another surgical procedure to repair it. Bile leakage into the abdomen from the tubular channels leading from the liver to the intestine may rarely occur.
The patient should call the surgeon in case of:
Persistent fever over 101 degrees F (39 C)
Increasing abdominal swelling
Pain that is not relieved by medications
Persistent nausea or vomiting
Persistent cough or shortness of breath
Purulent drainage (pus) from any incision
Redness surrounding any of the incisions that is worsening or getting bigger
Inability to eat or drink liquids
Who is an eligible candidate for Laparoscopic Cholecystectomy?
Although there are many advantages to laparoscopy, the procedure may not be appropriate for some patients who have had previous upper abdominal surgery or who have some pre-existing medical conditions. A thorough medical evaluation by the personal physician, in consultation with a surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal is an appropriate procedure for the patient.