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:
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.
These days, cholecystectomies are performed to treat a number of clinical conditions, including:
Biliary colic, aka symptomatic gallstones:
Acute cholecystitis, aka inflammation of the gallbladder:
Cholangitis, aka inflammation of the bile ducts:
Gallstone pancreatitis:
Gallbladder cancer:
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).
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A laparoscopic approach has the following proven benefits over the traditional open approach:
Both laparoscopic and open approach of gallbladder removal will:
Laparoscopic cholecystectomies are not recommended for patients who may be at risk of gallbladder cancer; for more information, kindly consult with your physician.
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:
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.
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;
Preoperative preparation:
To be completed for each patient who will have a cholecystectomy:
Following successful surgery, post-operative care for you will look like this:
What potential risks may the operation have?
A laparoscopic approach for gallbladder removal shares the following undesirable consequences with the open 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:
Are there alternative management options for gallbladder disease other than a cholecystectomy?
Cholecystectomies are recommended when:
Endoscopic retrograde cholangiopancreatography may be an alternative because (ERCP):
Conservative management is reserved for patients with:
Conservative management in its totality is administered with the following:
What are some special considerations to be made when considering a cholecystectomy?
Pregnancy:
Obesity:
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:
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.