Laparoscopic Cholecystectomy Removing the gallbladder is called cholecystectomy. It is the preferred treatment for the majority of people who have gallstones that cause symptoms. Gallbladder surgery using a laparoscope (laparoscopic cholecystectomy) has become the gold standard in the early nineties, almost immediately after its inception.
A laparoscope is a pencil-thin tube with its own lighting system and miniature video camera. A surgeon inserts the laparoscope into your abdomen through a hollow tube (cannula) which is placed just below the belly button. The video camera then produces a magnified view on a television monitor of the inside of your abdomen. This allows the surgeon to see the surgery in detail. To remove your gallbladder, the surgeon uses long, thin instruments, one in each hand. They are inserted through two separate small abdominal incisions. A fourth incision for an assistant to retract the gallbladder can be avoided in most cases. Not using retraction reduces the risk that small stones move through the cystic duct towards the common bile duct. As indicated in the diagrams, the use of tree canulas instead of four keeps the stones away from the cystic duct before it can be divided.
Laparoscopic gallbladder surgery is the best method of treating gallstones that cause symptoms. Surgery eliminates gallstones located in the gallbladder. It does not remove stones in the common bile duct. Gallstones can form in the common bile duct years after the gallbladder is removed, though this is uncommon.
Benefits
Recovery is much faster and less painful after laparoscopic surgery than after traditional open surgery. The hospital stay after laparoscopic surgery is shorter than after open surgery. People generally go home the next day, compared with 3 to 5 days or longer for open surgery. You will spend less time away from work and other activities after laparoscopic surgery (about a week to 10 days).
Open surgery may occasionally still be required. Especially when walls of the distended gallbladder are so thick and hard from inflammation that the gallbladder can be felt before surgery as a tender lump in the upper right part of your abdomen. Recovery from open surgery typically entails up to a week's stay in the hospital, followed by 4 to 6 weeks at home.
Risks
The overall risk of complications is low.
- The most serious complication is injury to the common bile duct. However, this is infrequent, occurring in only 0.14% to 0.5% of people in large studies.
- Another possible serious complication is injury to the small intestine by one of the instruments used during surgery. If the injury is small, it may be closed with stitches using the laparoscopic instruments. If the injury is more severe, which is rare, the surgery may have to be converted to an open procedure (involving a larger incision) to make repairs and reduce the possibility of infection in the abdomen.
- The risk of death is far less than 1%.
Other uncommon complications may include:
- Injury to the cystic duct, which carries bile from the gallbladder to the common bile duct.
- Bile leaking into the abdominal cavity.
- Injury to abdominal blood vessels, such as the major blood vessel carrying blood from the heart to the liver (hepatic artery). This is rare.
- A gallstone being pushed into the common bile duct.
- The liver being cut.
More surgery may be needed to repair some of these complications.
After gallbladder surgery, some people experience persistent abdominal symptoms, such as pain, bloating, gas, and diarrhea (postcholecystectomy syndrome).
What To Expect After Surgery
You may have gallbladder surgery as an outpatient, or you may stay 1 or 2 days in the hospital.
Expected complaints after surgery may include:
- Pain in the right shoulder and upper right abdomen lasting 24 to 72 hours (from gas used to inflate the abdomen during surgery). It may last as long as a week.
- Widespread muscle aches from anesthesia.
- Diarrhea.
- Minor inflammation or drainage at the surgical wound sites.
- Loss of appetite and some nausea.
Most people can return to their normal activities after a week and most discomfort is gone within 2 to 3 weeks. No special diets or other precautions are necessary after surgery.
As many as 20 percent of people who have surgery to remove their gallbladder develop temporary loose stools or diarrhea. This may last some time but often improves — even without treatment.
The cause of diarrhea after gallbladder removal isn't clear. But many experts believe it results from an increase in bile, especially the bile acids, entering the colon between meals. The small intestine absorbs most of the bile as it passes through. But some excess bile may still reach the colon. The bile acids interfere with the colon's ability to absorb water and as a result act as a laxative.
No scientific evidence indicates that changing your diet will help.
Treatment of diarrhea after gallbladder removal may include:
Antidiarrheal medication, such as loperamide (Imodium), to decrease the frequency of bowel movements.
Cholestyramine (Questran, Prevalite) or aluminum hydroxide (Amphojel). These medications attach to bile acids so that they pass out of the body without being absorbed.
Increasing fiber in your diet may help. Fiber absorbs water and gives stool more bulk. Caffeine, alcohol, spicy foods, dairy products, fatty foods and some over-the-counter and prescription medications may worsen diarrhea – regardless of the cause. Before you make any changes to your diet or in the medications you take, talk to your doctor. Chronic diarrhea can have many causes, which your doctor may want to investigate.
A common myth is that people without a gallbladder gain weight. This has more to do with the fact that most patients who undergo the procedure are middle aged. At this stage in life almost everybody has difficulty maintaining the weight they had when they were younger.
