Gallbladder removal - laparoscopic

Definition

Laparoscopic gallbladder removal is surgery to remove the gallbladder using a medical device called a laparoscope.

Alternative Names

Cholecystectomy - laparoscopic

Description

Using a laparoscope is the most common way to remove the gallbladder. A laparoscope is a thin, lighted tube that lets the doctor see inside your belly.

Gallbladder removal surgery is done while you are under general anesthesia (asleep and pain-free).

• The surgeon will make three to four small cuts in your belly.
• The laparoscope will be inserted through one of the cuts.
• Other medical instruments will be inserted through the other cuts.
• Gas will be pumped into your belly to expand it. This gives the surgeon more space to work.

First, the surgeon cuts the bile duct and blood vessels that lead to the gallbladder. Then the surgeon removes the gallbladder, using the laparoscope.

An x-ray called a cholangiogram may be done during your surgery. This involves squirting dye into your common bile duct and taking an x-ray. This duct will be left inside you after your gallbladder has been removed. The dye helps find other stones that may be outside your gallbladder. It also helps identify the branches of the bile duct. If any stones are found, the surgeon may remove these other stones with a special instrument.

Sometimes the surgeon cannot safely take out the gallbladder using a laparoscope. In this case, the surgeon will instead do an open cholecystectomy.

See also: Gallbladder removal - open

Why the Procedure Is Performed

Your doctor may recommend gallbladder removal surgery if you have pain or other symptoms from gallstones or your gallbladder is not working normally (biliary dyskinesia).

You may have some or all of these symptoms:

• Indigestion
• Pain after eating, usually in the upper right or upper middle area of your belly (epigastric pain)
• Nausea and vomiting

Most people have fewer problems and a shorter hospital stay when their gallbladder is removed using a laparoscope compared to people who have open surgery. You will also have smaller surgical cuts.

Risks

The risks for any anesthesia include:

• Reactions to drugs you are given
• Breathing problems
• Pneumonia
• Heart problems
• Blood clots in the legs or lungs

The risks for gallbladder surgery include:

• Bleeding
• Damage to the blood vessels that go to the liver
• Infection in your belly
• Injury to the common bile duct
• Injury to the small intestine
• Pancreatitis (inflammation in the pancreas)

Before the Procedure

Your doctor may ask you to have these tests done before your surgery:

• Blood tests (complete blood count, electrolytes, and kidney tests)
• Chest x-ray or electrocardiogram (EKG), for some people
• Several x-rays of the gallbladder

Always tell your doctor or nurse:

• If you are or might be pregnant
• What drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription

During the week before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.
• Your doctor or nurse will tell you when to arrive at the hospital.

On the day of your surgery:

• Do not eat or drink anything after midnight the night before your surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Shower the night before or the morning of your surgery.

Prepare your home for after the surgery.

After the Procedure

If you do not have any signs of problems, you will be able to go home when you are able to drink liquids easily. Most people go home on the same day or the day after this surgery.

If there were problems during your surgery, or if you have bleeding, a lot of pain, or a fever, you may need to stay in the hospital longer.

Outlook (Prognosis)

Most patients do very well and recover quickly.

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References

Chari RS, Shah SA. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. St. Louis, M0: WB Saunders; 2008: chap 54.

Gurusamy KS. Surgical treatment of gallstones. Gastroenterol Clin North Am. 2010; 39:229-244.

Keus F, Gooszen HG, van Laarhoven CJ. Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane Hepato-Biliary Group reviews. Cochrane Database Syst Rev. 2010:(1):CD008318.