Cholecystectomy

03/11/2021 by JED MED CORP0

 

Is the surgical removal of the gallbladder. The operation is done to remove the gallbladder due to gallstones causing pain or infection. 

The Gallbladder 

The gallbladder is a small pear-shaped organ under the liver. The liver makes about 3 to 5 cups of bile every day. Bile helps in digesting fats and is stored in the gallbladder. When fatty foods are eaten, the gallbladder squeezes bile out through the duct and into the small intestine. 

Gallstones are hardened digestive fluid that can form in your gallbladder. The medical term for gallstone formation is cholelithiasis. Gallstones can leave the gallbladder and block the flow of bile to the ducts and cause pain and swelling of the gallbladder. A gallstone in the common bile duct is called choledocholithiasis

Cholecystitis is inflammation of the gallbladder, which can happen suddenly (acute) or over a longer period of time (chronic). 

Gallstone Pancreatitis is caused by stones moving into and blocking the common bile duct, the pancreatic duct, or both. A cholecystectomy may be recommended.

Cholecystectomy is the surgical removal of the gallbladder. Gallstones that cause biliary colic (acute pain in the abdomen caused by spasm or blockage of the cystic or bile duct) are the most common reason for a cholecystectomy 

Common Symptoms 

  • Sharp pain in the upper right part of the abdomen that may go to the back, mid abdomen, or right shoulder 
  • Low fever 
  • Nausea and feeling bloated 
  • Jaundice (yellowing of the skin) if stones are blocking the common bile duct

Treatment Options 

Surgical Procedure

Laparoscopic cholecystectomy: The gallbladder is removed with instruments placed into small incisions in the abdomen. 

Open cholecystectomy: The gallbladder is removed through an incision on the right side under the rib cage. 

Common Tests 

  • Abdominal ultrasound is the most common study for gallbladder disease.1-2 You may be asked not to eat for 8 hours before the test. 
  • Hepatobiliary iminodiacetic acid scan (HIDA scan) 
  • Endoscopic retrograde cholangiopancreatography (ERCP) 
  • Magnetic resonance cholangiopancreatography (MRCP) 
  • Blood tests, including complete blood count
  • Liver function tests
  • Coagulation profile 

Laparoscopic Cholecystectomy 

This technique is the most common for simple cholecystectomy. The surgeon will make several small incisions in the abdomen. Ports (hollow tubes) are inserted into the openings. Surgical tools and a lighted camera are placed into the ports. The abdomen is inflated with carbon dioxide gas to make it easier to see the internal organs. The gallbladder is removed, and the port openings are closed with sutures, surgical clips, or glue. Your surgeon may start with a laparoscopic technique and need to change (convert) to an open laparotomy technique. The procedure takes about 1 to 2 hours. 

Open Cholecystectomy 

The surgeon makes an incision approximately 6 inches long in the upper right side of the abdomen and cuts through the fat and muscle to the gallbladder. The gallbladder is removed, and any ducts are clamped off. The site is stapled or sutured closed. A small drain may be placed going from the inside to the outside of the abdomen. The drain is usually removed in the hospital. The procedure takes about 1 to 2 hours 

Anesthesia 

Let your anesthesia provider know if you have allergies, neurologic disease (epilepsy, stroke), heart disease, stomach problems, lung disease (asthma, emphysema), endocrine disease (diabetes, thyroid conditions), or loose teeth; if you smoke, drink alcohol, use drugs, or take any herbs or vitamins; or if you have a history of nausea and vomiting with anesthesia. 

If you smoke, you should let your surgical team know, and you should plan to quit. Quitting before your surgery can decrease your rate of respiratory and wound complications and increase your chances of staying smoke-free for life. 

An intravenous line (IV) will be started
to give your fluids and medication. For general anesthesia, you will be asleep
and pain-free. 

Length of Stay 

If you have a laparoscopic cholecystectomy, you will usually go home the same day. You may stay overnight if you had an open removal of the gallbladder.

The Day of Your Operation 

  • Do not eat for 12 hours or drink anything but clear liquids for at least 4 hours before the operation. 
  • Shower and clean your abdomen and groin area with a mild antibacterial soap. 
  • Brush your teeth and rinse your mouth out with mouthwash. 
  • Do not shave the surgical site; your surgical team will clip the hair nearest the incision site. 

What to Bring 

  • Insurance card and identification  
  • List of medicines 
  • Loose-fitting, comfortable clothes 
  • Slip-on shoes that don’t require that you bend over 
  • Leave jewelry and valuables at home 

Home Medication 

Bring a list of all of the medications and vitamins that you are taking, including blood thinners, aspirin, or NSAIDS, and inform your surgical team. Some medications can affect your recovery and response to anesthesia and may have to be adjusted before and after surgery. 

After surgery

Pain 

The amount of pain is different for each person. The new medicine you will need after your operation is for pain control, and your doctor will advise how much you should take. You can use throat lozenges if you have sore throat from the tube placed in your throat during your anesthesia. 

Preventing Pneumonia and Blood Clots 

Movement and deep breathing after your operation can help prevent postoperative complications such as blood clots, fluid in your lungs, and pneumonia. Every hour, take 5 to 10 deep breaths and hold each breath for 3 to 5 seconds. 

When you have an operation, you are at risk of getting blood clots because of not moving during anesthesia. The longer and more complicated your surgery, the greater the risk. This risk is decreased by getting up and walking 5 to 6 times per day, wearing special support stockings or compression boots on your legs, and, for high-risk patients, taking a medication that thins your blood. 

Your Recovery 

If general anesthesia is given or if you are taking narcotic pain medication, it may cause you to feel different for 2 or 3 days, have difficulty with memory, or feel more fatigued. You should not drive, drink alcohol, or make any big decisions for at least 2 days. 

Wound Care 

  • Always wash your hands before and after touching near your incision site.
  • Do not soak in a bathtub until your stitches, Steri-Strips®, or staples are removed.
    You may take a shower after the second postoperative day unless you are told not to. 
  • Follow your surgeon’s instructions on when to change your bandages. 
  • A small amount of drainage from the incision is normal. If the dressing is soaked with blood, call your surgeon. 
  • If you have Steri-Strips in place, they will fall off in 7 to 10 days. 
  • If you have a glue-like covering over the incision, just let the glue to flake off on its own. 
  • Avoid wearing tight or rough clothing. It may rub your incisions and make it harder for them to heal. 
  • Your scars will heal in about 4 to 6 weeks and will become softer and continue to fade over the next year. 

Bowel Movements 

  • Anesthesia, decreased activity, and pain medication (narcotics) can contribute to constipation. Avoid straining with bowel movements by increasing the fiber in your diet with high-fiber foods or over-the-counter medicines (like Metamucil® and FiberCon®).
    Be sure you are drinking 8 to 10 glasses of fluid each day. Your surgeon may prescribe a stool softener if necessary. 

Nutrition 

  • When you wake up from the anesthesia, you will be able to drink small amounts of liquid. If you do not feel sick, you can begin eating regular foods. 
  • Continue to drink about 8 to 10 glasses of water per day. 
  • Eat a high-fiber diet so you don’t strain while having a bowel movement. 

Activity 

  • Slowly increase your activity. Be sure to get up and walk every hour or so to prevent blood clot formation. 
  • Patients usually take 1 to 3 weeks to return comfortably to normal activity.16 
  • You may go home the same day after a laparoscopic repair. If you have other health conditions or complications such as nausea, vomiting, bleeding, or difficulty passing urine, you may stay longer. 
  • Persons sexually active before the operation reported being able to return to sexual activity in 14 days (average). 

WORK

You may usually return to work 1 week after laparoscopic or open repair, as long as you don’t do any heavy lifting. Discuss the timing with your surgeon. 

Do not lift items heavier than 10 pounds or participate in strenuous activity for at least 4 to 6 weeks. 

When to Contact Your Surgeon 

Contact your surgeon if you have: 

  • Pain that will not go away 
  • Pain that gets worse 
  • A fever of more than 101°F or 38.3°C 
  • Continuous vomiting 
  • Swelling, redness, bleeding, or bad-smelling drainage from your wound site 
  • Strong or continuous abdominal pain or swelling of your abdomen 
  • No bowel movement 2 to 3 days after the operation 

 

*We provide procedure education for prospective patients and those who educate them. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with your situation. The American College of Surgeons (ACS) makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard.



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