Definition and Overview
Cholecystectomy is a gallbladder removal procedure performed primarily to treat gallstones. This can be carried out using either traditional open technique or minimally invasive method.
The gallbladder is a pouch- or pear-shaped organ that collects and stores bile, a digestive fluid produced by the liver.
Who Should Undergo and Expected Results
Cholecystectomy is often performed when gallstones formed in the gallbladder.
Gallstones are a fairly common problem and are believed to develop due to the imbalance of the compounds found in the bile primarily the cholesterol level. Some suggest that eating food that’s high in cholesterol could be the reason but some studies suggest that there is no specific diet that can prevent or reduce the risk of gallstones.
Gallstones may also occur due to high amounts of bilirubin in the bile. The excessive level may be caused by damage to the liver, which breaks down the red blood cells. It could be the liver is already experiencing scarring (cirrhosis) or there’s a tumour growing in the organ. It’s also possible that the bile ducts are infected.
The stones appear in different colours, which may indicate the possible reason for their formation. If they’re pigmented, they may have developed due to high bilirubin. If they’re yellow, they are caused by high cholesterol. A patient can also have mixed gallstones.
Gallstones have several risk factors such as age, ethnicity, obesity, and gender. They are more common among women as estrogen contains cholesterol.
A patient can develop and accumulate gallstones without his knowledge. Symptoms usually appear when the stones begin to block the biliary ducts or there’s already an infection. Some of these symptoms include abdominal pain, fever, indigestion, itchy skin, appetite loss and jaundice (yellowing of the skin and the whites of the eyes).
A person can undergo gallbladder removal surgery with hardly any problem with digestion. However, some may experience bloating, bowel movement problems, and reduced ability to absorb fat-soluble vitamins.
How Does the Procedure Work?
As mentioned earlier, cholecystectomy can be performed either through open or traditional method or laparoscopic (keyhole) technique. To help the surgeon decide, different exams including blood tests that can determine the overall function and health of the liver and other vital organs will be conducted. An imaging examination can also be helpful in knowing the exact position of the gallstones, the condition of the bile duct and the gallbladder, and the most ideal surgical procedure for the patient. Usually, open surgery is recommended if the patient needs a liver transplant, there is a substantial scarring in the area, or if the patient has already been operated in the liver, bile duct, or the gallbladder before.
A consultation is also necessary to prep the patient, who will be advised to quit smoking a few weeks before the surgery and stop the intake of medications that may increase bleeding or prevent clotting. The surgeon will also talk about the risks and complications of the procedure, possible outcomes, follow-up care, and nutrition after the gallbladder has been removed.
In the case of open surgery, a large incision (about 6 inches) is made in the belly area to fully expose the liver and the gallbladder. The gallbladder is then detached using tools, such as electrocautery, before sutures are used to close the incision.
If the surgery is to be performed using laparoscopic methods, four small incisions are made in the abdominal area. Air is used to expand the abdominal cavity while a laparoscope, a probe with a camera and a light, is inserted into one of these incisions. The camera delivers real-time images of the organs to a monitor to guide the surgeon during the operation. Using microsurgical instruments, the gallbladder is removed, and the incisions are sutured.
In both procedures, the patient is provided with general anaesthesia. Usually, anticoagulants and antibiotics are given to the patient before surgery to minimise certain risks such as infection and bleeding.
The operation may take around an hour to complete. Patients who have undergone open surgery are typically advised to stay in the hospital for up to five days so their condition can be closely monitored. Meanwhile, keyhole surgery patients are allowed to go home after spending the night in the hospital.
Possible Risks and Complications
A surgical gallbladder removal may cause bleeding, infection and pain. These risks are more likely to occur in open surgery than in a laparoscopic procedure.
Other possible complications are bile leakage, injury to the other organs including the intestine, inflammation of the pancreas, and development of blood clots. There is also a small chance that sepsis will develop. This a life-threatening condition characterized by systemic inflammation that can lead to organ failure or damage.
Glasgow RE, Mulvihill SJ. Treatment of gallstone disease: In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 66.
Gurusamy KS. Surgical treatment of gallstones. Gastroenterol Clin North Am. 2010;39:229-244.
Jackson PG, Evans SRT. Biliary system. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 55.