What you need to know about:

Laparoscopic Cholecystectomy (Gallbladder Removal)

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Overview of

Laparoscopic Cholecystectomy (Gallbladder Removal)

in Thailand

What is Cholecystectomy?

A Cholecystectomy is a surgical procedure done to remove the gallbladder to treat symptomatic gallstones or other gall bladder conditions which need surgical intervention. An estimated 700,000 cholecystectomy surgeries are performed yearly in the United States, making it one of the most common surgical operations.

Cholecystectomies are usually performed in one of two ways: 

  • Laparoscopic cholecystectomy
  • Open cholecystectomy

Open cholecystectomies: a surgical technique of removing the gallbladder through a large incision made in the abdomen, requiring the surgeon to reach beneath tissue and organs.

Laparoscopic cholecystectomies:  a less invasive surgical procedure which uses trocars - medical devices that minimally penetrate the skin and allow the insertion of dextrous tools - with attached cameras for guidance in the removal of the gallbladder.

Goals of

Laparoscopic Cholecystectomy (Gallbladder Removal)

These days, cholecystectomies are performed to treat a number of clinical conditions, including:

Biliary colic, aka symptomatic gallstones

  • When gallstones become symptomatic, people will experience an intense, dull aching pain located in the right upper quadrant of the abdomen, epigastrium or less often, in the substernal area.
  • The pain usually radiates to the right upper back and may be associated with nausea, vomiting, and diaphoresis. 
  • Although colic itself means intermittent, the pain of biliary colic is constant.

Acute cholecystitis, aka inflammation of the gallbladder

  • Though the common cause for this condition is the presence of stones in the gallbladder, acalculus (no stone) causes may also incite inflammation. 
  • People commonly complain of right upper abdominal pain and present with high body temperatures (fever), and/or yellowish discoloration in the eye or the skin (jaundice).
  • Blood work and imaging techniques like abdominal sonographies are needed to make the diagnosis.

Cholangitis, aka inflammation of the bile ducts:

  • Can present with complete or partial obstruction of the biliary tract.
  • The presence of stones (cholidocholithiasis) in the biliary tract usually precedes it.
  • Fever, abdominal pain, and jaundice are the usual complaints for people to seek medical care.

Gallstone pancreatitis:

  • Inflammation of the pancreas as a result of either obstruction of the pancreatic duct by an impacted gallstone or temporary obstruction of the duct while the stone travels through the ampulla of vater to the duodenum.
  • Clinical manifestations include the sudden onset of abdominal pain associated with nausea and vomiting.
  • Elevation of pancreas specific serum enzymes coupled with imaging findings and clinical conditions will help to make the diagnosis.

Gallbladder cancer:

  • A very rare malignancy found in the elderly.
  • Patients are usually given a poor prognosis due to the condition usually being found in its advanced stages. 
  • The presence of stones in the gallbladder is most indicative of risk for its occurrence.
  • Subjective experiences and objective findings of this disease are indistinguishable from other gallbladder conditions like cholecystitis and cholelithiasis.

The procedure is also performed in treatment of other conditions like porcelain gallbladder (calcified gallbladder wall), and gallbladder polyps (outgrowths from the gallbladder inner lining).

Price of

Laparoscopic Cholecystectomy (Gallbladder Removal)

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Pros and cons of

Laparoscopic Cholecystectomy (Gallbladder Removal)


A laparoscopic approach has the following proven benefits over the traditional open approach:

  • Lower rate of complications
  • Shorter hospital stay, you may even be allowed to go home on the same day
  • Comfortable post-operative period
  • Several smaller incisions instead of 1 big incision, less pain
  • Quicker recovery and you will be able to resume your regular activities faster

Both laparoscopic and open approach of gallbladder removal will:

  • Relieve pain
  • Treat the infection
  • Usually stop gall stone complications from arising again


Laparoscopic cholecystectomies are not recommended for patients who may be at risk of gallbladder cancer; for more information, kindly consult with your physician.

How it works:

Laparoscopic Cholecystectomy (Gallbladder Removal)

Laparoscopic cholecystectomies are performed under the guidance of trocars with attached cameras, which enter the body through small incisions and help provide a visualization of the gallbladder on a screen. Surgeons are then able to safely and accurately access the gallbladder.

Techniques (types) of laparoscopic cholecystectomy:

  1. Standard laparoscopic cholecystectomy: uses 4 ports through which 4 trocars of different sizes are inserted.
  2. Single-port cholecystectomy: A laparoscopic approach in which the surgeon uses a single port, usually the umbilicus, through which the entire operation is performed.
  3. NOTES cholecystectomy: NOTES stands for Natural orifice trans-luminal endoscopic surgery. It is the removal of the gallbladder using naturally available openings, including trans-vaginal, trans-gastric, and trans-colonic ones.

Gallbladder biopsies and laparoscopic cholecystectomies:

Pathological results continue to be the gold standard for the conclusive diagnosis of gallbladder cancer. Therefore a cholecystectomy is needed to obtain a total biopsy.

Despite the fact that laparoscopic cholecystectomies are a common procedure for benign lesions like cholecystitis, they aren’t universally recommended for patients who may be at risk of gallbladder cancer. This is because such surgery includes the risk of peritoneal dissemination and port-site recurrence (PSR) due to intraoperative gallbladder perforation of the thinned gallbladder wall. 

Physicians have yet to fully understand why this occurs, therefore resulting in the associated risk sometimes being too great to take.

Preparation before

Laparoscopic Cholecystectomy (Gallbladder Removal)

Pre - treatment

As with all surgeries, there are certain investigations and safety precautions you must first take to ensure the highest success rates. 

Preoperative evaluation:

The following tests will aid in the diagnosis of gallbladder disease, and some of the tests must be performed to assess your readiness for the procedure;

  • Complete blood count
  • Liver function tests
  • Pancreatic enzymes ( lipase and amylase)
  • Coagulation profile 
  • Abdominal ultrasound
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Electrocardiogram (ECG) and Chest x-ray (for patients over 45 years of age or those who have medical indication)

Preoperative preparation:

To be completed for each patient who will have a cholecystectomy:

  • Informed written consent: The patient must sign written consent after the procedure is described along with its potential complications.
  • Prophylactic antibiotics: Administering antibiotics ranging from 30 minutes to 2 hours prior to skin incision is recommended. Cefazolin is the preferred antibiotic of choice.
  • Thromboprophylaxis: Compression stocking or anticoagulant like low molecular weight heparin is indicated to prevent deep venous thrombosis (DVT).
  • Bladder emptying: The short duration of laparoscopic procedures reduces the need for urinary catheters. You will instead simply be asked to empty your bladder before the surgery.

Recovery after

Laparoscopic Cholecystectomy (Gallbladder Removal)

Post - treatment

Following successful surgery, post-operative care for you will look like this:

  • Diet: You can take clear oral liquids once you are awake from anesthesia and you can slowly begin to return to your normal diet depending on your bodily reactions.
  • Hospital stay: If you have adequate homecare support, you can leave the hospital within 6 hours after surgery.
  • Activity: No activity restriction is imposed on you after laparoscopic surgery unless the skin incision was large. However, it's advisable to limit heavy lifting for a few weeks after the procedure.
  • Pain: It’s normal to have abdominal pain for up to 3 days after the operation. Painkillers are commonly prescribed to manage your pain.
  • Nausea: Some people may experience the urge to vomit after the operation. Antiemetics may be prescribed to help with this.

Risks & side effects

What potential risks may the operation have?

A laparoscopic approach for gallbladder removal shares the following undesirable consequences with the open cholecystectomies:

  • Misdiagnoses 
  • Retention of common bile duct (CBD) stones
  • Post-cholecystectomy syndrome, which manifests as persistent or recurrent abdominal pain and heartburn after cholecystectomies.

The difficulties listed below can also arise exclusively after laparoscopic cholecystectomies as a result of patient selection, surgical expertise, and some technical aspects of the treatment:

  • Bile leaks: Major biliary leakage occurs 2-10 days after the procedure.  Patients who are affected frequently experience a fever, discomfort in the abdomen, and/or bile containing abdominal collection.
  • Bile duct injuries: Most injuries are not initially apparent following the procedure. Signs and symptoms of bile duct damage that present tend to be  nonspecific and include generalized abdominal discomfort, prolonged nausea and vomiting, and low-grade fever.
  • Bowel injury: Bowel injury can become evident within 96 hours after the surgery and the patient may complain of abdominal fullness, pain and diarrhea.
  • Bleeding: Bleeding may occur at port insertion sites, the liver or along arteries throughout the body. Uncontrollable bleeding leading to brain hemorrhaging may occur, albeit with less than a 1% chance.
  • Conversion to open technique: Converting from laparoscopic approaches to the open technique has been reported to have a 5 to 15% chance of occurring. This shouldn't be seen as a failure on the side of the surgeon. Significant inflammation or adhesions that make it difficult to identify the anatomy are the most common reasons for conversion, especially in patients who have undergone prior surgeries.


Laparoscopic Cholecystectomy (Gallbladder Removal)

Are there alternative management options for gallbladder disease other than a cholecystectomy?

Cholecystectomies are recommended when: 

  • Decompression and drainage of the distended, inflamed, hydropic, or purulent gallbladder using a catheter with ultrasound guidance is required.
  • The patient is not fit for surgery.

Endoscopic retrograde cholangiopancreatography may be an alternative because (ERCP):

  • It presents both diagnostic and therapeutic advantages.
  • It’s the preferred technique for removal of stones in the common bile duct with complications like cholangitis and gallstone pancreatitis.
  • Stone extraction and sphincterotomy can be done using it.

Conservative management is reserved for patients with:

  • Acute cholecystitis is found, but the patient is an unsuitable candidate for surgical intervention.
  • Acute cholangitis 
  • Chronic cholecystitis is found while waiting for surgery.

Conservative management in its totality is administered with the following: 

  1. Intravenous fluids
  2. Gut rest (NPO)
  3. Intravenous antibiotics
  4. Analgesics
  5. Bed rest

What are some special considerations to be made when considering a cholecystectomy?


  • There is a clear link between pregnancy and gallstones.
  • Laparoscopic cholecystectomy can be done safely during any trimester of pregnancy.
  • It’s advisable to have pre-operative obstetric evaluation and peri-operative fetal monitoring.


  • Trocar placement presents as an issue as the abdominal wall is thick.
  • Longer trocars are needed to traverse the wall.

What is porcelain gallbladder?

A term used to denote gallbladder wall calcification, occurring as a result of longstanding inflammation. Patients are usually asymptomatic. An increased risk of gallbladder cancer has been found in patients with porcelain gallbladder, though the magnitude of risk is very low.

What are contraindications of laparoscopic cholecystectomy?

Absolute contraindications for the procedure are:

  • Uncontrolled coagulopathy (tendency to bleed)
  • Inability to tolerate general anesthesia

What is a mini-laparoscopic cholecystectomy?

It’s a form of laparoscopic approach which attempts to lessen the invasiveness of the procedure by decreasing the number and the size of the operating ports, as well as the size of the instruments.

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