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Site FeedbackLaparoscopic Cholecystectomy
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The Gallbladder, Bile Ducts and Gallstones
The gallbladder is a pear shaped organ located on the undersurface of the liver. Its function is to store bile and empty it into the intestine, usually after a meal. The gallbladder only serves as a backup supplier and storage reservoir for bile. After the gallbladder is removed, bile made by the liver will be sufficient to assist in digesting dietary fat without it. The gallbladder is connected to the intestine through a series of tubes (bile ducts). The "cystic duct" is the one that connects the gallbladder to the main bile duct and it subsequently empties into the intestine. Gallstones are stones formed within the gall bladder and usually build-up over a long period of time. They vary in size from as small as a sand granule (biliary sludge) or reach several centimeters in size.
[back to top]You May Have These Symptoms
The most common symptoms of gallbladder disease are caused by the intermittent or continuous blockage of the bile ducts by a gallstone. A stone blocking the passage of bile in the cystic duct causes right upper abdominal pain, that may radiate to the back and usually presents several hours after eating. It may also cause nausea, vomiting, heartburn and back pain. If the blockage persists, the gallbladder can become infected which would cause other symptoms such as fever. If the main bile duct is blocked by a stone, bile will back up into the liver causing jaundice (yellowing of the skin) or pancreatitis (inflamed pancreas).
What are the Indications for Cholecystectomy?
- The presence of gallstones or biliary sludge that cause symptoms
- Chronic or acute inflammation of the gallbladder
- Infection
- The presence of polyps or a mass in the gallbladder
What is Laparoscopic Cholecystectomy?
Laparoscopic cholecystectomy is the removal of the gallbladder using small incisions in the abdomen. A telescope (laparoscope) is used to visualize the gallbladder so it can be dissected and removed through a small abdominal incision.
How is Laparoscopic Cholecystectomy Done?
Laparoscopic cholecystectomy is a surgical technique used to remove the gallbladder without making a large incision. You will be given general anesthesia. After you are asleep, the anesthesiologist may insert a tube into your stomach to empty it. Surgery will be done with you lying on your back. Several small incisions are made into the abdomen. Carbon dioxide gas is pumped into the abdominal cavity to allow room to work and to allow the surgeons to see. This gas is harmless and will be eliminated by your body's circulation. The laparoscope is inserted through one of the small incisions in the abdomen. Instruments are inserted through the other abdominal incisions. The bile duct and artery at the base of the gallbladder are identified and closed off using small metal clips. Dye may be injected into the bile ducts and an X-ray taken (cholangiogram) during surgery, to see if there are any other stones within the ducts. The gallbladder is then progressively freed from the underside of the liver. Large stones and bile in the gallbladder are removed to allow the gallbladder to deflate. The gallbladder, now the size of a deflated balloon, is guided to the incision in your navel and removed. Small gauze sponges or adhesive bandages will be used as dressings for the small abdominal incisions.
What are the Contraindications for Laparoscopic Cholecystectomy?
There are very few situations where the laparoscopic approach to gallbladder removal would not be possible. If you are unable to tolerate general anesthesia, have a certain type of liver disease (portal hypertension) or have an untreated blood clotting disorder, laparoscopic cholecystectomy may not be advisable. Multiple prior abdominal operations make the procedure more difficult because of the development of adhesions (fibrous bands of tissue that adhere to the internal organs) but do not automatically prevent the attempt at laparoscopic removal of the gallbladder. Your doctor can best advise you of your suitability for this surgery.
What are the Risks of Having Laparoscopic Cholecystectomy?
Laparoscopic cholecystectomy is a very safe and common procedure. It is estimated that there are around 700,000 laparoscopic cholecystectomies performed in the US every year. Nevertheless, as with any other surgical procedure, complications may occur. Intraoperative bleeding that cannot be quickly controlled may require conversion from a laparoscopic to an open cholecystectomy. Infection, injury to surrounding organs, and injury to the bile ducts are other possible risks but are also risks of the open procedure for gallbladder removal. You should discuss these risks in more detail with your surgeon and your anesthesiologist.
What Happens if Surgery Cannot be Performed by Laparoscopic Technique?
Sometimes it is not possible for the surgeon to use the laparoscopic technique because it may be difficult to see or handle the organs safely. The surgeon decides to perform an open procedure either before or during the surgery. The surgeon may decide to convert the laparoscopic surgery to an open procedure in certain situations and for patient safety. Though very infrequent, when conversion to an open technique occurs, it should not be considered a failure of the procedure. If cholecystectomy cannot be performed laparoscopically, it will need to be done in an open surgical procedure. This would require hospitalization for 3-5 days and 2-6 weeks for full recovery.
What can I Expect to Happen Before Having Laparoscopic Surgery?
- A thorough medical evaluation will be made by your physician. Several diagnostic tests may be needed You may have blood tests, an electrocardiogram (EKG) or chest x-ray to check your heart and lungs.
- An ultrasound of the abdomen may be ordered to check for presence of gallstones in the bile ducts.
- Occasionally, ERCP (endoscopic retrograde cholangiopancreatography) may be ordered to further evaluate the cause of jaundice. This is an endoscopic and an x-ray procedure which examines the ducts of the pancreas and bile ducts after the injection of a contrast dye. ERCP is not routinely ordered but is a possibility if your surgeon needs further information about the presence of gallstones in the bile ducts.
- Taking no food or fluids after midnight the night before surgery. This decreases the risk of vomiting after you receive anesthesia.
- If taking medications daily, discuss the need to take them with your doctor prior to the morning of surgery (with a sip of water). If taking blood thinner, aspirin or arthritis medications, discuss the proper time to stop these medications before the surgery date (day).
- Speak to the anesthesiologist before surgery to discuss anesthesia during surgery and pain management postoperatively.
- Arrange for someone to drive you to the hospital the day of surgery and take you home when you are discharged from the hospital.
What can I Expect the Day of Surgery?
- Arrive at the hospital on the day and time you are instructed.
- Sign a written consent authorizing your physician to perform the surgery.
- Receive a small needle/catheter in your vein to provide medication before, during and after your surgery.
- Receive preoperative medications as necessary.
- Undergo general anesthesia (asleep) prior to your surgery.
- Understand the procedure may take 1-3 hours.
- Going to the recovery room after surgery and having your blood pressure, pulse and respirations closely monitored until you are fully awake.
- Being discharged the day of surgery or being admitted overnight to the hospital and discharged the next day.
What can I Expect After Surgery?
- Engage in light activity at home.
- Experience mild postoperative pain and having pain medication available as needed.
- Within a few hours after your surgery, taking liquids and progressively advancing to a light meal.
- You may have some gas pains or other discomfort while your digestive system returns to normal. Eat whatever foods were easiest for you to digest prior to your surgery until your body adjusts.
- Resume normal activities such as showering, stair climbing, working, lifting, driving and having sexual intercourse after discussing these with your physician.
- Call and schedule a follow-up appointment within one to two weeks after surgery.
- Schedule any additional follow-up appointments as needed.
- Stitches will usually not need to be removed since the incisions are small and if any sutures are used, they are absorbable.
When Should I Call My Physician?
Make certain that you call your physician if you have any of the following symptoms:
- Shortness of breath or persistent cough
- Persistent fever over 101 degrees Fahrenheit
- Significant drainage from incisions
- Persistent chills
- Increased abdominal swelling or pain
- Prolonged soreness or no relief from prescribed pain medications
- Bleeding
- Persistent nausea or vomiting
If you have any questions about the need for laparoscopic cholecystectomy, alternatives, procedure cost, insurance or billing, physician training and experience, or have questions about surgery, you are encouraged to ask office staff or your physician.
Written by:
Horatio Asbun, M.D.
Director of Minimally Invasive Surgery Programs
John Muir Health
Jacklyn J. Schuchardt, RN, MSN, CNOR
Clinical Nurse Specialist, Surgery
John Muir Medical Center, Walnut Creek Campus
Walnut Creek, California
Diane M.Graham, RN, MSN, CNOR
Perioperative Clinical Nurse Specialist, John Muir Medical Center, Concord Campus, Concord, CA