What is a cholecystectomy?

Indications and Procedures

Cholecystectomy is indicated when the patient exhibits nausea, vomiting, and abdominal pain and examination reveals gallstones. Gallstones, which consist mostly of crystallized cholesterol and bile, form in the gallbladder and may lodge in the bile duct. The stones
can be dissolved with medication or broken up with ultrasound and passed from the body. They can (and often do) form again, however, with renewed symptoms. Removal of the gallbladder is the method of choice to prevent the recurrence of symptoms. Surgery is performed under general anesthesia.

In open surgery, the abdomen is cleaned and a 7.5- to 15-centimeter (3- to 6-inch) incision made with a scalpel through the skin and abdominal tissues. The gallbladder is isolated from the liver. A duct and artery are tied off with surgical staples or sutures, and they are cut in order to free the gallbladder. The organ is removed, and the tissues are closed with sutures or staples.

In laparoscopic surgery, the surface is cleaned and the surgeon makes four small holes. A 1.3-centimeter (0.5-inch) cut is made at or near the navel and another just below the breastbone, as well as two small punctures to the right of the incisions. The laparoscope, with a video camera and light, is inserted into the navel incision. Long, thin dissecting instruments are passed through the three punctures, and the gallbladder is cut free as in open surgery. The organ is removed through the navel incision, which is then closed with sutures or staples. The punctures are closed with small adhesive bandages.

Uses and Complications

Open surgery for cholecystectomy requires a hospital stay of five to eight days and a recovery time of four to six weeks. Complications occur in 1.0 to 9.4 percent of the surgeries and range from postoperative bleeding and diarrhea to intestinal obstruction. Rare but major complications include severing the common bile duct that connects the liver and small intestine, or puncturing a major blood vessel. Overall, the mortality rate is low: 0.2 to 0.6 percent.

Laparoscopic surgery may require an overnight stay and a recovery period of five to seven days. The complication rate is lower than the rate in open surgery, but this may be a reflection of the fact that sicker patients with more complex diseases and, therefore, greater risk factors are generally referred for open surgery; not all patients are good candidates for the limited approach afforded by laparoscopy.

Bibliography

American College of Surgeons. "Cholecystectomy: Surgical Removal of the Gallbladder." FACS, n.d..

Carson-DeWitt, Rosalyn. "Cholecystectomy—Laparoscopic Surgery." Health Library, May 28, 2013.

Carson-DeWitt, Rosalyn. "Cholecystectomy—Open Surgery." Health Library, May 28, 2013.

Chellappa, M. Laparoscopic Cholecystectomy. Teaneck, N.J.: World Scientific, 1994.

Dunn, David C., and Christopher J. E. Watson. Laparoscopic Cholecystectomy: Problems and Solutions. Cambridge, Mass.: Blackwell Science, 1992.

Parker, James N., and Philip M. Parker, eds. The Official Patient’s Sourcebook on Gallstones. [N. p.]: ICON Group, 2007.

Porter, Robert S., et al., eds. The Merck Manual Home Health Handbook. Whitehouse Station, N.J.: Merck Research Laboratories, 2009.

Valverde, A., and H. Mosnier. "Laparascopic Cholecystectomy." Journal of Visceral Surgery148, no. 5 (October, 2011):353–360.