Laparoscopic Cholecystectomy

• Symptoms of gallstones can sometimes be similar to symptoms of peptic ulcers or gastritis, such as bloating, gas, or abdominal pain and heartburn that comes and goes. When in doubt, see a doctor for accurate diagnosis.
• Gallstones may be either asymptomatic or symptomatic. If gallstones are detected in the gallbladder, but there are no abnormal symptoms, then surgical intervention is not required; however, there is always a chance of complications, although there is no way of knowing what or when they could occur.
• In a laparoscopic cholecystectomy, the surgeon makes just 3-4 small incisions in the patient’s abdomen, thus minimizing recovery time and allowing patients to return home and to their daily life as normal within 2-3 days of undergoing surgery.

The gallbladder is an organ in the abdominal area that stores bile produced by the liver and concentrates that bile by the absorption of water so it is ready to help in the digestion of fatty foods.

Imbalances or abnormalities in the gallbladder can lead to a variety of diseases, one of most common of which is gallstones. While the exact cause of gallstones in Asian populations is yet unknown, in western populations it is generally found to be the result of excess cholesterol buildup in the bile. While some people with gallstones may go their whole lives without any symptoms, untreated gallstones residing in the gallbladder that begin to cause gallbladder malfunction or abnormalities can cause a variety of more serious complications such as cholecystitis or even gangrenous cholecystitis, which is necrosis of the gallbladder. All of these possible outcomes make treatment more complicated.

• Bloating, gas, abdominal pain or heartburn, with symptoms that come and go, similar to symptoms of peptic ulcer or gastritis
• Severe pain in the upper right abdomen, which is the result of inflammation of the gallbladder (cholecystitis) caused by blockage of the cystic duct, blocking bile stored in the gallbladder from flowing as it should into the common bile duct and small intestine
• Jaundice (yellowing of the skin and eyes), caused by blockage of the bile duct by gallstones and pancreatitis 
• Some patients may not experience any symptoms

• Being age 40 or older (however gallstones are sometimes found in patients younger than 40)
• Obesity or being overweight
• Eating too much fatty food or foods high in cholesterol
• Taking medications that contain estrogen
• Taking certain types of weight-loss drugs
• Rapid weight loss
• Certain blood disorders involving faster red blood cell breakdown, such as thalassemia

First, the doctor will review your medical history, along with a physical examination and blood test. If the results show that you are at risk of gallstones, additional examinations may be performed using an ultrasound of the upper abdomen, for which you need to refrain from eating for at least 6 hours prior to the examination. The test provides more than 80% accuracy and fast results.

• Non-surgical Treatments involve taking medications to dissolve gallstones. This method is only used to treat gallstones caused by excess cholesterol and, as such, is not usually suitable for the treatment of gallstones in Asians. Additionally, these drugs must be taken continuously over a long period of time and may not dissolve all the stones. Gallstones may also recur after the medication is discontinued.  In addition, gallstones can be treated by a special machine called a lithotripter. However, while this works well for ureteral stones, it is largely ineffective for the treatment of gallstones. Therefore, machine and medication treatments to dissolve gallstones are not particularly popular.
• Surgical Treatments are the most efficient and effective methods. There are currently two main surgical approaches:  
  • Laparoscopic Cholecystectomy: The surgeon makes 3-4 small incisions just 1-3 centimeters in length in the patient’s abdomen. The surgical tools and tiny video camera with which the surgery is performed are inserted through these incisions.
  • Traditional (open) Cholecystectomy: This is mainly used in cases where laparoscopic surgery is not possible, such as cholecystitis, when the patient has already undergone abdominal surgery for other diseases, or if there are other abnormalities in the area surrounding the gallbladder. During an open cholecystectomy, the surgeon makes either a crosswise incision in the patient’s abdomen under the right rib cage, or a vertical cut in the middle of the belly. The size and length of the incision will depend on the patient’s body shape and the pathology of the gallbladder.

Laparoscopic Cholecystectomy is a type of Minimally Invasive Surgery (MIS), which is highly popular because the surgical incisions are extremely small, reducing blood loss and minimizing recovery time. This means patients are able to return home and resume their daily lives within just 2-3 days of undergoing surgery.

The rate of success for laparoscopic cholecystectomy is 95%. However, the presence of cholecystitis, a large amount of fibrosis around the gallbladder, or other abnormalities can affect the success of laparoscopic surgery. Because the surgeon may not be aware of some of these issues in advance, during the surgery the methods may need to be changed and traditional open surgery may be used instead at the discretion of the surgeon supervising the surgery.

At present, removing gallstones from the gallbladder without removing the gallbladder itself is not generally recommended, as gallstones can return after just a short time. The only time this method would be used is if the patient has severe cholecystitis and the body is so weak that it cannot tolerate the general anesthesia used in major surgery. There are also a number of misunderstandings surrounding the use of lasers in surgery. Lasers, in this case, are used as a surgical tool to help destroy abnormal tissue or stop bleeding, but are not a surgical method of gallbladder surgery.

• Once the patient has recovered from the general anesthesia used during surgery, they may drink water or eat small amounts of liquid foods
• Patients can take oral pain relief medications
•  After very complicated surgeries, the doctor may recommend that the patient refrain from food and water for an additional 24-48 hours
• Intramuscular or intravenous painkiller injections may be given to patients experiencing a lot of pain in the wound area 
• Patients should closely follow their doctor’s advice and make sure to attend all scheduled follow-up appointments

After the gallbladder has been removed, there is generally no impact on body functions or daily life. However, in rare cases, complications from the surgery may occur including:

• Bile leakage
• Bleeding in the abdomen
• Bile duct obstruction, causing jaundice
• Wound infection in the naval area

Gallstones can be either asymptomatic or symptomatic. If gallstones are detected in the gallbladder but the patient does not experience any abnormal symptoms, surgical intervention is not required. Patients should be aware, however, that there is always a chance of complications, although there is no way of knowing what complications might occur, or when. If complications do arise, the symptoms can be severe. As such, the doctor will likely recommend surgery if the patient is still fairly young and in good health or if a patient has diabetes. Surgery will also be recommended if the gallstones are fairly large in size, as this too can significantly increase the chance of developing complications. Whether or not surgery is performed, however, is, of course, dependent upon the patient’s own personal decision.

Annual health check-ups  are very important for early detection of the disease. The same is true if you are experiencing severe abdominal pain or any other symptoms. If you are unsure, you should always see a doctor for proper diagnosis and effective treatment.