Index
It is a less invasive procedure than open surgery, which is used to remove the gallbladder.
Benefits
Laparoscopic cholecystectomy provides safe and effective treatment for most patients with symptomatic gallstones and has become the treatment of choice for many patients.
Surgery to remove the gallbladder with a laparoscope does not require cutting the muscles of your abdomen since they are in open surgery.
The incision is much smaller, which makes a recovery faster.
With laparoscopic cholecystectomy, postoperative pain is reduced, the need for analgesics is reduced, the hospital stay is shortened from 1 week to less than 24 hours, and the patient is returned to complete the activity in 1 week.
Although the direct costs of the operating room and recovery room are higher for laparoscopic cholecystectomy, the shortened duration of the hospital stay leads to a net saving.
A faster return to regular activity can lead to indirect cost savings.
Contraindications
Absolute contraindications for laparoscopic cholecystectomy include the inability to tolerate general anesthesia and uncontrolled coagulopathy.
Patients with severe obstructive pulmonary disease or congestive heart failure may not tolerate carbon dioxide pneumoperitoneum and may be better served with open cholecystectomy if necessary.
Gallbladder cancer should be considered a contraindication for laparoscopic cholecystectomy.
If gallbladder cancer is diagnosed intraoperatively, the operation should become an open procedure.
Preoperative care
Because the gallbladder surgery is performed under general anesthesia, the stomach must be empty.
This precaution is taken to avoid vomiting during and after surgery.
Medicines to thin the blood, including aspirin, should be stopped several days before the operation to avoid excessive bleeding during the procedure.
The discontinuation of any medication should be discussed with the doctor when the surgery is scheduled.
Preoperative tests are usually ordered and completed a few days before surgery.
Depending on the patient’s health, blood tests, a chest x-ray, an ECG ( electrocardiogram ), and a urinalysis.
The anesthesiologist (the doctor who administers the anesthesia) talks to the patient before the surgery and performs a brief physical evaluation.
He should know all medications the patient uses regularly and any history of allergies and adverse reactions before anesthesia.
This is to evaluate possible conditions or problems that may influence the choice and dose of anesthesia and determine what special precautions should be taken.
Process
Laparoscopic cholecystectomy is performed through several small incisions.
The laparoscope is a small, thin tube placed in the abdomen through a small cut just below the navel.
Then, the surgeon can see the gallbladder on a television monitor and perform the surgery with tools inserted into three other minor cuts made in the upper right part of the abdomen.
The gallbladder is removed through one of the incisions.
Post Operative Care
The following is a list of instructions on the care that should be taken after laparoscopic cholecystectomy has been performed:
- Physical activity: it is advisable to take short walks between 2 and 3 times a day; this will help reduce the risk of blood clots after surgery.
- Driving: Driving is not advised until you have been seen at your first postoperative visit.
- Lifting: do not lift heavy objects during the first four weeks. You should also avoid pushing, pulling, or abdominal pressure during these first four weeks.
- Cough: practice ten deep breaths every hour (for at least 12 hours a day) during the first week after surgery to reduce the risk of lung problems or pneumonia.
- Medication: Pain medications can cause nausea on an empty stomach, so it is recommended to take them with meals.
- Incisions: You can shower the day after surgery and allow clean, soapy water to run over the incision, but do not expose the incisions to soaking in water (bathtubs, swimming pools, etc.), or place any ointment or cream over incisions during the first six weeks after surgery.
- Diet: You can return to regular food after surgery. You may want to avoid fatty or heavy foods as some of these foods may cause diarrhea or nausea temporarily during the first few days.
Recovery
- The time it takes to recover from surgery to remove the gallbladder depends on whether you underwent a laparoscopic procedure or an open cholecystectomy.
- Most people who undergo laparoscopic surgery can leave the hospital on the same day of the operation.
- Generally, it will take about a week to return to normal activities. The activity depends on how the patient feels.
- Often, the return to work depends on its nature since patients who perform manual labor or lift heavy objects may require two to four weeks of recovery.
- After open surgery, you will usually have to stay in the hospital for three to five days, and your recovery time will be longer.
- It may even take six to eight weeks to return to normal activities.
Complications
Complications of laparoscopic cholecystectomy are infrequent, and the vast majority of laparoscopic gallbladder patients recover and quickly return to normal activities.
However, all surgery carries the risk of serious complications or even death. The mortality rate for laparoscopic or open cholecystectomy is less than 0.3%.
The most severe complication of cholecystectomy is damage to the bile ducts. This occurs between 0.3% and 0.6% of cases in laparoscopic cholecystectomy.
If the gallbladder accidentally or deliberately opens during the procedure, stones from the gallbladder and into the abdomen that can lead to subsequent scars may fall.
Approximately 25% and 30% of biliary cases are usually seen intraoperatively during laparoscopic cholecystectomy and the rest during the early postoperative period.
Duct damage usually manifests with fever, jaundice, and abdominal pain several days after cholecystectomy or is evidenced in laboratory studies with increased total bilirubin and alkaline phosphatase.
After the intervention, some of the complications include bleeding, infection, loss of bile in the abdomen, pneumonia, blood clots, or heart problems.
The development of yellow fever, skin or eyes, worsening abdominal pain, distension, nausea, persistent vomiting, or drainage of the incision indicates a complication may have occurred.
