HOW WILL IT BE TAKEN OUT?
Laparoscopic cholecystectomy is one of the most common operations performed in the United States. It is performed using four small (largest, 1cm) incisions and instruments placed through these incisions to safely and efficiently remove the gallbladder. The abdomen is filled with carbon dioxide to create space for the surgeon to work. The gallbladder is manipulated so that the surgeon is able to clearly visualize the ducts, being careful to divide the cystic duct and avoiding the common bile duct. The gallbladder is then separated from the undersurface of the liver with electrocautery, then removed from the abdomen through the incision near the umbilicus (belly button) as it is typically the largest of the four.
Intra-Operative Cholangiogram is a procedure that may be performed during the gallbladder removal in which a small catheter is placed through the cystic duct and into the common bile duct. Contrast dye is pushed through the catheter while an X-Ray image is being taken. This allows for full visualization of the bile duct system. This is typically done to examine for stones that may have inadvertently fallen into the common bile duct during manipulation of gallbladder removal. It is also an excellent tool for the surgeon to confirm that the duct he/she is about to cut is actually the cystic duct and not the common bile duct.
Open cholecystectomy is surgical removal of the gallbladder through a single, larger incision in the right upper abdomen. This operation is done less frequently and is only usually done because laparoscopic removal is not possible or safe. The muscles on the abdominal wall are cut allowing access into the abdominal cavity. The gallbladder is clearly visualized hanging off the undersurface of the liver. The gallbladder is first taken off the liver with electrocautery down to the artery that supplies blood to the gallbladder. This is clipped or tied and divided. Lastly the cystic duct is clipped or tied and divided and the gallbladder is removed. Frequently a drain is left in the space and comes out of the abdominal wall beneath the incision. The abdomen wall muscles are closed with suture and the skin is closed with sutures or staples as by preference of the surgeon.
WHAT ARE THE RISKS OF THIS PROCEDURE?
Every surgical procedure has risks, regardless of how large or small the surgery.
Infection - The risk of infection increases when the gallbladder is taken out for the purpose of infection, such as cholecystitis. A dose of antibiotics is frequently given prior to surgery of all cholecystectomies to prevent infection.
Bleeding – Anytime skin is cut, there is a risk of bleeding. Bleeding can occur at the level of the skin resulting in bruising or can occur at the location of the gallbladder and the liver resulting in a hematoma inside the abdomen which typically presents two or three days after surgery with abdominal pain. These rarely require re-operation and the hematoma is typically reabsorbed by the body.
Injury to the Common Bile Duct – This is the most feared complication of cholecystectomy, and thankfully rare, occurring in 1 to 2 of 1,000 cholecystectomies. The common bile duct is essential as it is the passageway by which bile empties from the liver. If this duct is injured, a much larger operation is necessary to reconstruct the duct.
Injury to other Intra-abdominal Organs – This is also quite rare, but any organ is a possibility. If any injuries occur and are noticed during the initial operation, they are typically repaired at that time. If it becomes apparent after the operation, a second operation may be necessary. The incidence of injury is typically higher for those patients who have had previous abdominal operations.
WHAT SHOULD I EXPECT BEFORE AND AFTER SURGERY?
Prior to surgery, your primary care physician will refer you to a surgeon for removal. The surgeon will get basic information concerning your health, perform a physical examination, and order any remaining laboratory tests which have not already been performed by your PCP. You will be counseled on all the risks of the operation at this visit and scheduled for surgery. You will also be instructed on which medications must be stopped several days before surgery, such as aspirin, Plavix, or Coumadin (warfarin).