Gallbladder Surgery

 

The most commonly performed surgery of the galbladder is the resection of the galbladder.

 

The most common reason for a cholecystectomy is because of symptomatic gallstones (these can be cholesterol or bile stones).

Contrary to the name gall (or bile), which we need to process our food intake, is not produced in the gallbladder but in the liver and delivered to the bowel system through a duct system called the biliary system.

The gallbladder is attached to this biliary system. Once the gallbladder contains stones, it gives symptoms (pain and nausea) and it can infect the gallbladder (and in a worse case the biliary tree), in the worse case due to stone migration one can have obstruction of the biliary tree which produces jaundice and severe morbidity including pancreatitis.

To prevent this once a patient has gallstones with symptoms or infection of the gallbladder the gallbladder needs to be removed.

 

Cholecystectomy is the medical term for surgically removing the galbladder.

A cholecystectomy can be done laparoscopically (minimal invasive, keyhole surgery) and considered low risk and routine. The gallbladder is resected by detaching it from the biliary tree with clips and then releasing it from the liver and taking it out of the abdomen. During the surgery the surgeon's primary task is to remove the gallbladder while not damaging the liver or the biliary tree where the gallbladder is attached to it (the common bile duct).

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Indication: Cholesterol stones or bilestones with symptoms or infection or in certain polyps or cancer of        the gallbladder

 

Classification Surgery: Minor-Medium

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Anesthesia: General (Full intubation and sedation)

 

Minimal invasive laparoscopic procedure: Yes

 

Expected hospital stay: daycare or short stay (2 days) hospitalisation

 

Complications and measures

All surgery under general or regional anesthesia carries systemic risks  such as deep venous thrombosis, lungembolus, cardiovascular complications: These risks are minimised through preoperative screening procedures and prophylactic (preventing) measures (anticoagulation agents, antibiotics on indication)

 

Specific complications due to this surgery:

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-Bile leakage (very low chance, less than 2%)

-Common bile duct lesion (very low chance), less than 2%

-Postoperative liver bleeding (very low chance, less then 2%)

-Wound infection (low chance, less than 5%)

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Open(Classical) cholecystectomy and conversion : The gallbladder can be removed laparoscopically or with open (classical) surgery through a larger cut under the right ribs.

Nowadays, in modern centers the surgery is performed primarily laparoscopically.

In certain cases however (extensive previous abdominal surgery or general condition of the patient) the surgeon may prefer to do the surgery open from the beginning or decide to change to open surgery during laparoscopic surgery for technical reasons (this changing from laparoscopy to open surgery is called conversion).

The international accepted rate of conversion for a cholecystectomy is around 5-10%.

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Postoperative Tract

Clinical: Postoperative patients may or may not have a temporary drain in the abdomen that is removed in the days after operation. Discharge may be same day (daycare surgery) or the next day (short stay surgery) longer hospital stay may be needed in difficult or complicated cases.

Outpatient: Outpatient postoperative controls in the following weeks may vary per surgeon and case

Usually patients can revert to a normal diet and lifestyle within weeks after the operation.

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