Saturday, April 11, 2009

Surgery to the Gallbladder (Cholecystectomy)

By Jonathan Blood Smyth

Patients recover very quickly from this abdominal operation and it is rare to suffer serious side-effects. Cholecystectomy produces a number of minor post-operative complications so it is important to understand these as well as the rare potential for more critical complications.

What is a Cholecystectomy?

The gall bladder is a small sac lying underneath the liver which stores bile produced in the liver. Whatever we eat, bile is released into the gut to help the body digest fats in the food. Small stones of various sorts can develop within the gall bladder which are known as gall stones. Many people, particularly from middle age onwards, develop gallstones which produce no symptoms whatsoever and do not need to be removed.

Stones may in some cases cause inflammation and pain in the gall bladder and some stones escape from the gall bladder where they move into the main connecting tube between the gut and the liver, the main bile duct. This can cause blockage of the duct and lead to a yellowing of the skin (jaundice). A surgical removal of the gall bladder, known as a cholecystectomy, may be needed in these cases.

Is it Harmful to Have the Gall Bladder Removed?

The gall bladder's function is only to store bile so its removal allows patients to live an entirely normal life in its absence. Long-term complications should not occur after cholecystectomy.

How Cholecystectomy is Done

Keyhole or laparoscopic surgery is by far the most commonly used surgical method for this operation although about 5 percent of operations involve the open technique with an incision several inches long. There may be several reasons why a surgeon decides that it is safer to employ the open technique and these include if there is a large degree of gall bladder inflammation, making laparoscopic removal unwise. If there is a lot of scarring between the gall bladder and the surrounding organs (adhesions) then open operation may be again preferred.

Although surgeons mostly intend to perform the gall bladder removal laparoscopically, patients need to understand that during the operation the decision may be made to convert to an open operation on clinical grounds.

Cholecystectomy via the Laparoscope

The surgeon will make four small cuts so that he or she can insert the instruments they will use into the abdominal cavity. The main instrument is a laparoscope, a flexible device which has a small video camera and a bright light attached, allowing a clear view of the inside of the abdomen. This allows surgeons to view the abdominal contents on a television screen, find the gallbladder and guide the operation procedure.

To increase the space around the organs carbon dioxide gas is introduced. The telescope in inserted under the umbilicus (tummy button) and three small incisions under the rib cage on the right then allow the instruments to be inserted for the operation. The gall bladder and the gallstones are then removed, usually through the umbilical incision.

Open Cholecystectomy

Removal of the gallbladder via open operation sometimes cannot be performed, meaning that an open operation will have to be done. The incision is about four to six inches long below the right cage to allow the surgeon to locate the gall bladder. Then the organ can be removed and a drain inserted to drain off any excess fluid from the abdomen.

The Anaesthetic

An injection inserted into the arm or hand is the typical way of starting off the anaesthetic. After a typical hour long operation the surgeon often places some long-term anaesthetic at the sites of the incision to ensure the maximum comfort for the patient when they wake up.

To give some long acting pain relieving cover after the operation the surgeon may use a suppository in the rectum towards the end of the operation. For 6-8 hours before the operation patients are instructed not to eat anything, and not to drink for 2-3 hours prior to the event. Mobilisation of the patient can occur whenever they feel well enough to get up and about and with help initially. - 14130

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