Cholecystectomy: Indications and Risks

Gall bladder is a pear shaped organ located in the right upper abdomen under the liver. This organ is responsible for storing and concentrating the bile, produced by the liver, before secreting it into the small intestine to help with digestion. Sometimes stones are formed inside the gall bladder called gallstones; most individuals with gall stones are asymptomatic but those with symptoms experience:

• Sharp pain in the upper right abdomen that may radiate to the right shoulder
• Low grade fever
• Nausea and vomiting
• Jaundice: if the stone obstructs the bile duct.

Cholecystectomy is a surgery done to remove the gall bladder to treat the pain caused due to gall stones or infection. The surgery can be of two major types:

• Laparoscopic surgery
• Laparotomy or open surgery.

Procedure

The surgery is done under the effect of general anaesthesia; hence you will be unconscious during the procedure and won’t feel any pain. After administering the anaesthesia your surgeon will make an incision according to the type of surgery.

Laparoscopic Cholecystectomy: your surgeon will make small incisions in your abdomen to insert ports into your abdominal cavity. Carbon dioxide will be pumped in to inflate your abdomen for better visualisation. Instruments and camera are introduced through the port for the removal of the gall bladder. After the removal of the gall bladder the incisions are closed with the help of sutures or surgical glue.

Open Cholecystectomy: the surgeon will make an incision in your right upper abdomen, about 6 inches long, to gain access to the gall bladder. The gall bladder is removed and the any ducts are clamped. The incision is closed with the help of sutures of surgical staples. A drain may be placed connecting the inside of the surgical site to the outside. This drain will be removed before you get discharged from the hospital.

Indications for Cholecystectomy

Cholecystectomy is recommended for patients with:

• Symptomatic gall stones in the gall bladder (cholelithiasis)
• Gall stone in the bile duct (choledocholithiasis)
• Gall stones causing pancreatitis
• Inflammation of the gall bladder (cholecystitis)

Preparation

Before the operation your doctor will take a detailed history of your complain and do a thorough physical examination. The doctor might also order few blood tests, urinalysis and an ultrasound of the abdomen. Your doctor would also like to know about all the medicines that you’ve been taking and may make a few changes to them. Inform your doctor if you have been taking opioid medications or have been consuming alcohol or are a chronic smoker, changes will have to be made to the dosage of your anaesthetic medication accordingly. Inform your doctor about any allergies to anaesthetic medicine that you might have. On the day of the operation you will be asked to stop eating four hours before the surgery and to stop drinking two hours before the surgery.

Risks of Cholecystectomy

Complications seen after a Cholecystectomy are:

• Retained stone in the bile duct: you will have to undergo the surgery again to have it removed
• Infection of wound site
• Fever
• Pneumonia due to aspiration of contents of the stomach into the lungs
• Formation of blood clots: the risk of blood clots increases with as the length of the surgery increases. The clot may get lodged into the lungs leading to pulmonary embolism
• Injury to bile duct
• Renal failure

Recovery

Laparoscopic surgeries have a faster recovery time compared to open cholecystectomy. You may be allowed to go home as soon as the effects of anaesthesia wear off after a laparoscopic cholecystectomy.  You may be discharged after an overnight stay following an open cholecystectomy. After the surgery you are advised to drink 8 to 10 glasses of water every day. Your doctor will suggest a diet rich in fibres to reduce the strain on your abdomen during defecation. Slowly increase your activities after the surgery. Most individuals take about three weeks for complete recovery. Do not lift heavy objects for atleast four weeks after the surgery .Ensure that you walk once every hour to reduce the risk of formation of blood clots. Contact your surgeon if you experience any of the following:

• Fever
• Redness at the site of surgery accompanied by foul smelling discharge
• Pain in the abdomen that doesn’t go away or gets worse
• Absence of bowel movement two to three days after the surgery
• Continuous vomiting.

Resources:

• American College of Surgeons
• Society of American Gastrointestinal and Endoscopic Surgeons