Gallbladder disease is one of the most common procedures performed in India. Before 1991, the open technique was the standard procedure for cholecystectomy. This usually involves doing an intraoperative cholangiogram if having CBD stones and the patient usually stays at home 2 to 6 days postoperatively. With the advent of laparoscopic cholecystectomy, the gold standard for cholecystectomy changed to the laparoscopic approach. This method shows a 30% improvement in the overall performance of elective cholecystectomy. Currently, 92% of all cholecystectomies are performed laparoscopically. But, there are several indications for open cholecystectomy and laparoscopic surgery.
Let us see this article provided by Dr Venu Gopal Pareek laparoscopic surgeon to know more about the Laparoscopic cholecystectomy and understand the indication and techniques of surgery.
What is cholecystectomy?
Cholecystectomy is the surgical removal of the gallbladder. The gallbladder is pear-shaped which is located in the upper right abdomen just below the liver. Your gallbladder collects and stores bile, a digestive fluid made by the liver. In most cases, you can go home for a cholecystectomy the same day.
The laparoscopic procedure most often performs cholecystectomy. But, In some complicated cases, a large incision can be used to remove the gallbladder. This is called an open cholecystectomy.
Understanding the indications of each surgery?
Cholecystectomy surgery is most often performed to treat gallstones and the complications they cause to the gallbladder. A doctor may recommend a cholecystectomy if you have the following indications:
- Gallstones in the gallbladder (cholelithiasis)
- Gallstones in the bile duct (choledocholithiasis)
- Gallbladder inflammation (cholecystitis)
- Large gallbladder polyps
- Pancreas inflammation (pancreatitis) due to gallstones
- Symptomatic cholelithiasis
- Biliary dyskinesia- hypofunction or hyperfunction
- Acalculous cholecystitis
- Gallbladder masses/polyps
- Mirizzi’s syndrome (Type I)
With the advent of laparoscopic cholecystectomy, the indications for open cholecystectomy have decreased. The most common cause (2% to 10%) of open cholecystectomy is switching from laparoscopy to open cholecystectomy. This change was made for several reasons that depend on the patient’s condition. Whenever questions about anatomy arise, surgeons can turn to open techniques. Extensive inflammation, adhesions, anatomical abnormalities, injury to the bile duct, retained gallstones, and uncontrolled bleeding indicate switching to an open procedure. The need for a joint bile duct examination can also be a reason for switching to an open procedure, as laparoscopic bile duct examination can be difficult. A planned open cholecystectomy can be performed for cirrhosis, gallbladder cancer, extensive surgery on the upper abdomen with adhesions and other accompanying diseases. A planned open cholecystectomy may also be required in the situation of a critically ill patient.
Techniques of cholecystectomy surgery:
Before the procedure:
Cholecystectomy is performed under general anaesthesia so that you won’t notice it during the procedure. Anaesthesia is given through a vein in your arm. Once the medication has started working, your medical team will insert a tube down your throat to make it easier for you to breathe. Your surgeon will then perform a cholecystectomy either laparoscopically or open; it depends on the surgery problem.
During the procedure
Depending on the patient’s situation, the surgeon will recommend one of two surgical approaches:
Minimally invasive cholecystectomy (laparoscopy)
During a laparoscopic cholecystectomy, the surgeon makes three or four small incisions in the abdomen area. A tube with a small video camera will be inserted through one of the incisions in your abdomen. Your surgeon watches a video monitor in the operating room while using surgical instruments inserted through the remaining incision in the abdomen to remove the gallbladder.
You can then get imaging tests, such as X-rays or ultrasound if your surgeon is concerned about possible gallstones or other problems with the bile ducts. Then your incisions will be stitched, and you will be taken to a recovery area. Laparoscopic cholecystectomy takes one to two hours.
Laparoscopic cholecystectomy is not for everyone. In some cases, your surgeon may initiate a laparoscopic approach and deem it necessary to make a larger incision because of scars from previous surgery or any other complications.
Traditional (open) cholecystectomy
General anaesthesia is used to relax muscles, prevent pain, and aid sleep. This is done once under the right side below the rib cage or in the middle of the abdomen . Your doctor can see the gallbladder and surrounding anatomy through an incision, and the gallbladder is cut from the surrounding tissue. The blood supply is interconnected and shared. Sometimes a cholangiogram (a particular type of x-ray) is done to look for stones in the common bile duct. If there are stones in the common bile duct, they will be removed at this time. The skin is closed with surgical forceps and sutures, and you will be taken to a recovery area. An open cholecystectomy takes one to two hours.
An open cholecystectomy may be needed instead of a laparoscopic cholecystectomy because:
- The main features of the previous operation.
- Bleeding disorders.
- Conditions that make vision through a laparoscope difficult.
After the procedure
You will be taken to a recovery area until the anaesthesia wears off. You will then be taken to the hospital room to continue your recovery. Recovery depends on your procedure:
- Laparoscopic cholecystectomy: People can often go home on the same day as their surgery, although it sometimes requires an overnight hospital stay. In general, once you can eat and drink painlessly and walk unaided, you can hope to return home. It takes about a week to recover fully.
- Open cholecystectomy: Expect two or three days in the hospital to recover. At home, it can take four to six weeks for everything to recover fully.
Cholecystectomy can relieve gallstone pain and discomfort. For example, Conservative treatment, such as dietary changes, usually will not prevent gallstones from coming back. In most cases, cholecystectomy prevents gallstones from returning.
Although you can experience mild to moderate pain after surgery, it shouldn’t be severe. Some pain relievers taken after surgery can cause constipation. Your doctor may prescribe a stool softener or laxative to relieve tension. You may also eat high-fibre foods that include fruits and vegetables.
The risk of complications after surgical removal of the open gallbladder is low. However, some symptoms may indicate an infection. Call your doctor if you have any symptoms.
About Dr Venugopal Pareek – Bariatric Surgeon
Dr Venugopal Pareek, Consultant Laparoscopic and Bariatric Surgeon in Sunshine Hospitals has done more than 9000 surgeries in 12 years of experience. He is one of the best laparoscopic and bariatric surgeons in Hyderabad, expertise in performing various surgical procedures like MIPH, appendicitis, thyroidectomy, cholecystectomy, gastric bypass surgery, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch. He has attended several conferences and published articles on bariatric surgery in various national and international journals. For more information, contact Dr Venu Gopal Pareek at 091777 77715.