Cholecystectomy

What is Cholecystectomy?

A cholecystectomy is majorly performed to treat gallstones and the complications they cause. Gallstones refer to the hardened deposits of digestive fluid that can develop in the gallbladder. The size of a gallstone can be a grain of sand to as large as a ball.

However, a surgeon may recommend a cholecystectomy if you have:

• Gallstones in the bile duct, called choledocholithiasis
• Gallbladder inflammation, called cholecystitis.
• Big polyps in the gallbladder, which can be malignant.
• Inflamed pancreas, called pancreatitis, from gallstones.
• Cancer of the gallbladder

What are the Types of Gallstone Removal Surgery?

About 80% of individuals with gallstone symptoms like pain in the abdomen lasting several hours, nausea, vomiting, and fever will require surgery. Surgeons may remove your entire gallbladder (cholecystectomy), or just the stones from bile ducts. There are typically two types of gallstone removal surgery, which include:

• Laparoscopic cholecystectomy: This technique of gallstone surgery is also known as 'keyhole' surgery. In this procedure, the surgeon makes some tiny incisions (cuts) through the skin, allowing access to various medical instruments. He/she then uses a long, thin tube known as a laparoscope and puts it through one of the incisions. The tube has a tiny video camera, and light attached to it. The camera transmits images of the area back to a monitor, which the surgeon uses to perform the procedure. The surgeon then removes the entire gallbladder or stone through one of the incisions.
• Open cholecystectomy (laparotomy): In open cholecystectomy, a single, large incision is created to access the gallbladder. The large incision helps the surgeon view the gallbladder and the nearby tissues. The surgeon then removes the gallbladder or the stones, inspects the surrounding areas, and seals the incision with sutures. Open surgery is generally suitable for individuals with severe gallbladder conditions or with scars from previous abdominal surgeries.

What Happens During a Cholecystectomy?

Here are certain steps mentioning what happens during a cholecystectomy:

1. Preparation: Before the procedure, the patient undergoes a preoperative assessment, which may include blood tests, ultrasound or CT scan, and an electrocardiogram (ECG) to evaluate heart function. The patient is also advised by the surgeon to fast for several hours before the procedure.
2. Anesthesia: On the day of the surgery, the patient is placed under general anesthesia to ensure he/she is unconscious and doesn't experience any pain.
3. Incision: The surgeon then decides on the technique of the procedure. There are two main approaches to cholecystectomy: open cholecystectomy and laparoscopic cholecystectomy. In laparoscopic cholecystectomy, many tiny incisions (typically 4 to 5) are created in the abdomen. Whereas, in an open surgical procedure, a larger incision is made to directly access and remove the gallbladder.
4. Procedure: During a laparoscopic surgery, your surgeon will:
   • Create a small incision (about 2 or 3 centimeters long) and several other keyhole incisions in the upper right abdomen.
   • A narrow tube called a cannula is inserted into one of the incisions. Carbon dioxide gas is then injected through this tube to inflate the abdomen. This creates space and helps to separate the abdominal walls from the organs.
   • After this, the surgeon will insert the laparoscope into the larger incision. Utilizing the images from the laparoscope as a guide, the surgeon will insert surgical instruments through the other small incisions to carefully remove the gallbladder.
   • Once the gallbladder is removed, the surgeon will release the carbon dioxide gas from the abdomen. The tiny incisions are then closed with stitches or surgical glue.

   During an open cholecystectomy, your surgeon will:

   • Make a single big incision in the upper right abdomen. This incision allows him/her direct access to the gallbladder.
   • After the incision is made, the surgeon will carefully separate the surrounding tissues and muscles to uncover the gallbladder.
   • Post this, the surgeon will separate the gallbladder from the liver, bile ducts, and nearby blood vessels.
   • Once the gallbladder has been removed, the surgeon will utilize sutures or surgical staples to close the incision and then apply a sterile dressing.

After performing the procedure, the patient is taken to a recovery area where he/she is monitored closely. Pain medication is generally prescribed by the doctor to manage any discomfort. Most patients can go home the same day or after a short hospital stay, depending on the type of surgery and their overall health.

What are the Advantages of Cholecystectomy?

Here are some advantages of cholecystectomy:

• Relief from symptoms like abdominal pain, nausea, vomiting, and indigestion.
• Prevention of complications like inflammation of the gallbladder, blockage of the bile ducts, pancreatitis, or infection.
• Improved Quality of Life
• Reduction in Risk of Recurrence
• Resolution of Digestive problems
• Less Risk of Gallbladder Cancer
• Possibility of Laparoscopic Surgery

How to Prepare for Cholecystectomy?

To prepare for a cholecystectomy, your healthcare provider may ask you to follow these steps:

• Eat nothing the night before the procedure. However, you may drink a sip of water with your prescriptions, but avoid drinking or eating anything for at least 4 to 5 hours before your surgery.
• Let your doctor know all the medicines and supplements you consume. He/she may ask you to quit certain medicines and supplements because they may increase your risk of bleeding. Hence, stop taking medications and supplements as advised by your healthcare provider
• Most individuals go home on the same day of their procedure. However, if the patient has undergone an open surgery, he/she may need to stay for one or more nights in the hospital. Therefore, plan if you need to stay in the hospital by bringing your essential personal items. These may include your toothbrush, towels, comfortable clothing, etc.
• Ask a friend or family member to drive you home after surgery.
• If you smoke, quit or at least reduce smoking before surgery. Smoking can impact healing and increase the risk of complications during and after surgery.

What are the Recovery Tips to Follow After Cholecystectomy?

Here are some important steps to follow after cholecystectomy:

• Take plenty of rest after surgery. Ensure you take at least 8 to 10 hours of sleep a day and naps during the day if required.
• Keep yourself hydrated. Drink healthy liquids and eat a balanced and nutritious diet.
• Take all your medications as advised by your healthcare provider. Also, abstain from medicines that were given a red signal by your doctor.
• Keep your surgical site clean and dry.