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The gallbladder is a pear-shaped organ that sits beneath the
liver in the right-upper abdomen. It is attached to the bile
ducts that come from the liver. These ducts carry liver bile to
the intestine where the bile helps digest food. The gallbladder
is not necessary to maintain good health.
Gallstones
Gallstones usually form in the gallbladder because of
excessive cholesterol in bile. They are a very common medical
problem. When they cause pain or other problems, treatment is
usually needed. The removal of the gallbladder is one of the most
common types of surgery done in this country. In the past, open
abdominal surgery was the standard treatment. This procedure
required a three- to seven-day stay in the hospital and a three-
to seven-inch incision and scar on the abdomen.
Laparoscopy
Most females have heard of laparoscopy, also known as
"bellybutton" or "Band-Aid" surgery.
Gynecologists have long used this technique to tie the Fallopian
tubes and to inspect the female reproductive organs. Now the use
of laparoscopy has been expanded to include removing a diseased
gallbladder. With new video technology, thelaparoscope has become
a miniature television camera. Exquisite magnification is now
possible, showing the intestinal organs in great detail.
Laparoscopic Cholecystectomy
 A cholecystectomy is the surgical removal of the gallbladder.
Using advanced laparoscopic technology, it is now possible to
remove the gallbladder through a tiny incision at the navel. The
technique is performed as follows. The patient receives general
anesthesia. Then a small incision is made at the navel and a thin
tube carrying the video camera is inserted. The surgeon inflates
the abdomen with carbon dioxide, a harmless gas, for easier
viewing and to provide room for the surgery to be performed.
Next, two needle-like instruments are inserted at points. These
instruments serve as tiny hands within the abdomen. They can pick
up the gallbladder, move intestines around, and generally assist
the surgeon. Finally, several different instruments are inserted
to clip the gallbladder artery and bile duct, and to safely
dissect and remove the gallbladder and stones. When the
gallbladder is freed, it is then teased out of the tiny navel
incision. The entire procedure normally takes 30 to 60 minutes.
The three puncture wounds require no stitches and may leave very
slight blemishes. The navel incision is barely visible.
What Are the Benefits?
The main benefit of this procedure is the ease of recovery for
the patient. There is no incision pain as occurs with standard
abdominal surgery. The patient is up and about the same day. In
fact, up to 90% of patients go home the same day. The remainder
are usually discharged the next day. And within several days,
normal activities can be resumed. So the recovery time is much
quicker. Also there is no scar on the abdomen and the overall
expense is usually low.
What Are the Complications?
While the procedure seems very easy for the patient, it is
still abdominal surgery. And, even though infrequent, it still
carries the same risks as general surgery. Current medical
reports indicate that the complication rate is about the same for
this procedure as for standard gallbladder surgery: very
small.
- The surgeon will advise you that in about 5 to 10% of cases,
the gallbladder cannot be safely removed by laparoscopy. Standard
open abdominal surgery is then immediately performed
- Nausea and vomiting may occur after the surgery
- Injury to the bile ducts, blood vessels, or intestine can
occur, requiring corrective surgery
- Quite uncommonly, a diagnostic error or oversight may
occur.
Are there Other Treatment Options?
Depending on the size, number, and chemical makeup of
gallstones, there is another way to treat the condition. If the
stones are small, they may be dissolved with long-term drug
therapy lasting 12 to 18 months.. A problem with this option is
that recurrence of gallstones is frequent, so the problem may not
be permanently solved. When symptoms are bad, it is usually
unwise to wait because a major complication may occur.
Who Can't Have the Procedure?
Surgeons have been amazed at how quickly laparoscopic
gallbladder removal has developed. They are finding that cases
previously felt to be unsuitable can now be done safely with this
technique. Still, there are instances in which the surgeon will
not recommend the procedure. The following list is a general one
and each case must be individually evaluated:
-- Pregnancy
-- Obstruction of the intestine
-- Previous surgery in the upper abdomen causing adhesions which
may require conversion to the standard surgery requiring a skin
incision.
In each instance, the surgeon will weigh the benefit for the
patient against the risks, always considering other medical
problems and always making the recommendation that is in the
patient's best interest.
In Summary
Gallbladder removal by laparoscopic surgery is an exciting
development because it offers so much to the patient. The surgeon
carefully evaluates each case and discusses it with the patient.
While problems can occur with the procedure, they are unusual. In
most instances, patients experience excellent results and resume
their normal activities very quickly.
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