Cholecystectomy – Surgery to the Gall Bladder

Author: Jonathan Blood-smyth

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 preferred.

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 grounds.

Laparoscopic Cholecystectomy

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.

Open Cholecystectomy

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 up.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, musculo-skeletal conditions, neck pain, injury management and physiotherapists 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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