Cholecystectomy – Surgery to the Gall Bladder
Patients recover very quickly from this abdominal
operation and it is rare to suffer serious side-effects.
Cholecystectomy produces a number of minor post-operative complications
so it is important to understand these as well as the rare potential
for more critical complications.
The Gall Bladder and its Removal
The gall bladder is situated beneath the liver and holds bile in a
small sac, bile which the liver secretes. Bile is releases in the gut
to assist in the digestion of food fats whenever we have a meal. Gall
stones can develop within the gallbladder and can be of various types
and sizes. It is common for people in the middle of life or older to
have gallstones which are not symptomatic and do not require surgery.
Stones may in some cases cause inflammation and pain in the gall
bladder and some stones escape from the gall bladder where they move
into the main connecting tube between the gut and the liver, the main
bile duct. This can cause blockage of the duct and lead to a yellowing
of the skin (jaundice). A surgical removal of the gall bladder, known
as a cholecystectomy, may be needed in these cases.
Is it Harmful to Have the Gall Bladder Removed?
The gall bladder's function is only to store bile so its removal allows
patients to live an entirely normal life in its absence. Long-term
complications should not occur after cholecystectomy.
How is a Cholecystectomy Performed?
Keyhole or laparoscopic surgery is by far the most commonly used
surgical method for this operation although about 5 percent of
operations involve the open technique with an incision several inches
long. There may be several reasons why a surgeon decides that it is
safer to employ the open technique and these include if there is a
large degree of gall bladder inflammation, making laparoscopic removal
unwise. If there is a lot of scarring between the gall bladder and the
surrounding organs (adhesions) then open operation may be again
Although surgeons mostly intend to perform the gall bladder removal
laparoscopically, patients need to understand that during the operation
the decision may be made to convert to an open operation on clinical
Laparoscopic cholecystectomy involves four small incisions through
which special surgical instruments are passed into the body. The
surgeon is able to see inside using an instrument called a laparoscope.
This is a form of telescope with a powerful light to which a miniature
video camera is attached. This projects a clear image onto a TV screen
allowing the surgeon to see the inside the abdomen and to find and
operate on the gall bladder.
Carbon dioxide gas is pumped into the abdomen to increase the viewable
space for the surgeon. The laparoscope is introduced into the abdomen
through an incision below the tummy button (umbilicus) and three small
incisions are made on the right hand side under the ribcage for the
other instruments to be used. The gallstones and the gallbladder are
removed through the incision below the umbilicus.
Laparoscopic operation may not always be possible and so an open
operation is opted for, with the surgeon making an incision on the
right side about ten to fifteen centimetres long under the rib cage. To
enter the abdominal cavity the muscles and skin are divided, enabling
the surgeon to identify the gallbladder beneath the liver and then
remove it. To reduce the chance of a fluid collection in the abdomen a
drain can be inserted.
What about the Anaesthetic?
The anaesthetic is usually started by giving an injection into the hand
or arm. The operation usually takes about one hour and the surgeon will
often inject some long-lasting anaesthetic into the incision sites to
try and make the patient as comfortable as possible afterwards.
In addition some surgeons insert a long-acting painkiller in the form
of a suppository into the back passage when the patient is asleep.
Patients are advised clearly about having no food for about 6 hours
before the operation and nothing to drink for about 2 to 3 hours
beforehand. After the operation patients can get up as soon as they
feel able with a nurse making sure they can manage when they first get
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles
back pain, musculo-skeletal conditions, neck pain, injury management
in Gloucester. Jonathan is a superintendant physiotherapist
at an NHS hospital in the South-West of the UK.
Article Source: http://www.articlesbase.com/health-articles/
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