Cholecystectomy is the surgical removal of the gall bladder. The gall bladder is a muscular sack that stores a substance produced in the liver called bile. Bile assists in digestion. When the gall bladder is blocked or inflamed it swells and can be very painful and sometimes it is necessary to remove the gall bladder. This surgery will involve either laparoscopic (small incision) surgery or open (large incision) surgery.
During laparoscopic surgery, the surgeon makes four small incisions in the abdomen, usually less than 2.5cm each in length. The abdomen is then gently inflated with carbon dioxide, lifting the abdominal wall to enable clear viewing and freer movement for the surgeon, and then an instrument called a laparoscope is inserted.
A laparoscope is a tube containing optical fibres attached to a video camera that enables the surgeon to see inside the abdomen and to remove the gall bladder with several thin instruments.
During an open cholecystectomy, the gall bladder is removed through a larger (around 10cm) incision just under the right side of the ribs. The surgeon can see the gall bladder directly. Open surgery generally requires a longer hospital stay and recovery time than the laparoscopic alternative but many surgeons prefer to be able to operate directly.
The type of surgery you have will depend on the nature and severity of your condition, what prior surgery you may have had, your general health, and the experiences of your surgeon with both procedures.
Cholecystectomy is highly effective at relieving troubling gall bladder symptoms. The risk of death is considered to be relatively low among major surgical procedures. However as with any surgical procedure, there are both general and specific risks. General risks apply to most surgery types, particularly where general anaesthesia is involved.
Risks which are specific to gall bladder removal include excessive bleeding, leakage of the bile into the abdomen causing severe inflammation, loss or blockage of gallstones, damage to the bile duct or blood vessels, gas embolus (when a gas bubble from the carbon dioxide accidentally makes its way into the bloodstream), very occasionally injury to other organs in the abdomen, and more commonly wound infection and problems with wound healing. In a minority of cases, a laparoscopic procedure will be completed via open surgery due to complications that arise.There are 2 types of Cholecystectomy treatments:
Q. Why is it performed ?
Generally, your doctor will recommend a cholecystectomy to treat : -
gallstones that are causing symptoms such as pain, nausea and vomiting (the most common reason for cholecystectomy)
infection or inflammation of the gall bladder, medically known as cholecystitis
gall bladder cancer (which is rare)
abnormal gall bladder function, medically known as biliary dyskinesia.
Laparoscopic Cholecystectomy
1. Liver 2. Gallbladder 3. Bile duct 4. Bile duct enters duodenum 5. Stomach
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 (point A) 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 (points B). 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 (point C) 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.
Complication
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 low complication rate is about the same for this procedure as for standard gallbladder surgery.
These complications may include : -
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.
Open Cholecystectomy
The surgery is performed under general anesthesia, which renders the patient unconscious. After the anesthesia is administered, the abdomen is cleaned with an antiseptic solution to reduce the risk for infection. The surgeon makes a 4- to 6-inch incision in the right upper portion of the abdomen. The liver is lifted out of the way and the gallbladder is carefully removed. The incision is closed and sutured.
The disadvantages of this procedure are longer hospitalization and recovery period, significant postoperative pain, and a large scar. However, the surgery is safe and carries a low risk for complications. Open cholecystectomy is used when laparoscopy is unsuitable for the patient.
benefits
The operation will remove the dangers of the present stones. It will also remove the gallbladder so that new stones cannot form. You do not need a gallbladder. The small bile ducts in the liver just become a little larger to act as a store for the bile.
Recently, laparoscopic surgery has become more common and laparoscopic cholecystectomy is now routine. But laparoscopic surgery is not possible in all cases. You should discuss the type of operation to be done with your surgeon. Laparoscopic cholecystectomy has a number of advantages over the open operation,
namely : -
A quicker recovery.
A shorter hospital stay.
Less pain.
A lower risk of infection.
Smaller wounds.
Less formation of adhesions.
The surgeon can examine the rest of the abdomen.
Q. Are there any benefits of laparoscopic cholecystectomy compared with open cholecystectomy ?
With laparoscopic cholecystectomy, you may return to work sooner, have less pain after surgery, and have a shorter hospital stay and a shorter recovery time. Surgery to remove the gallbladder with a laparoscope does not require that the muscles of your abdomen be cut, as they are in open surgery. The incision is much smaller, which makes recovery go quicker.
With laparoscopic cholecystectomy, you probably will only have to stay in the hospital overnight. With open cholecystectomy, you would have to stay in the hospital for about five days. Because the incisions are smaller with laparoscopic cholecystectomy, there isn't as much pain after this operation as after open cholecystectomy.
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