Cholecystectomy - Surgical Removal of the Gallbladder

What Is Cholecystectomy?

This is a surgery for the removal of a poorly functioning gallbladder. The gallbladder is a small organ located under the liver on the right side of the abdomen. It collects and stores bile - “a digestive juice” secreted by the liver. It is connected to other parts of the digestive system through a series of ducts called the bile ducts. When we start eating, the gallbladder receives signals to squeeze the stored bile into the small intestine through the bile ducts, which is essential for digesting fats.

In patients with gallbladder dysfunction, the bile flow becomes static, resulting in gallstones. These stones get stuck in the ducts causing inflammation and pain. The gallbladder issues are treated by removing the gallbladder, a procedure known as cholecystectomy. The gallbladder is not an essential part of the human body; once removed, the bile will flow from the liver into the small intestine without getting stored in the gallbladder.

Who Will Need Cholecystectomy?

The most common condition affecting the gallbladder is gallstones. The few risk factors which enhance the formation of gallstones are obesity, estrogen, multiparity, and advancing age, often called the 4 F’s- female, fat, fertile, and forty. Gallstones, along with a few other conditions, require surgery (cholecystectomy); they are:

• Biliary Dyskinesia - It is a condition that reduces the contraction ability of the gallbladder muscles leading to poor emptying of the bile stored in the gallbladder. Symptoms include pain, nausea, vomiting, and fatty food intolerance.

• Symptomatic Cholelithiasis - Cholelithiasis, also known as gallstones, is often asymptomatic. However, in a few patients, they cause remitting pain, fever, yellowing of the eyes (jaundice), dark urine, and light-colored stools. This condition is known as symptomatic cholelithiasis.

• Cholecystitis - Inflammation of the gallbladder due to gallstones is known as cholecystitis. It causes fever and pain and often needs surgery.

• Acalculous Cholecystitis - It is a life-threatening disorder that has a high risk of perforation and necrosis (death) of the gallbladder due to hypokinetic (slow) movement of gallbladder muscles.

• Gallstone Pancreatitis - Inflammation of the pancreas due to the obstruction of the pancreatic duct by gallstones is known as gallstone pancreatitis.

• Gallbladder Masses or Polyps - Gallbladder polyps are growths that protrude from the lining inside the gallbladder. They are often benign, but the clinician recommends cholecystectomy to prevent them from getting malignant.

• Gallbladder Cancer - It is rare and usually occurs due to metastasis of cancer from a different location.

What Are the Symptoms of Gallbladder Dysfunction?

Symptoms start to appear when the gallstones obstruct the flow of bile; they are:

• Upper right abdominal pain.

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• Jaundice.

• Nausea and vomiting.

• Fever.

• Light-brown urine and light-brown stool.

• Pain after eating a fatty meal.

What Tests Are Done Before Cholecystectomy?

Apart from the symptoms, the clinician will need a few tests before the procedure; they are:

• Abdominal Ultrasound - Helps to determine the size of the gallbladder, grade of inflammation present, and detects gallstones.

• Endosonography - It guides the drainage of the gallbladder before resection.

• Endoscopic Retrograde Cholangiopancreatography (ERCP) - It combines the use of an X-ray and endoscope to diagnose stones in the gallbladder.

• Computed Tomography (CT Scan) - It helps to evaluate the gallbladder and peritoneal adhesion (gallbladder wall thickening).

• Magnetic Resonance Imaging (MRI) - Helps to detect gallstones and rule out liver abnormalities.

• Blood Work - They can help to reveal an infection if present and any abnormal bilirubin levels which indicate gallbladder dysfunction.

• Urine Analysis - It is done to evaluate enzyme levels and to estimate the need for a catheter post-surgery.

It is always advisable to let the clinician know if the patient is under medication for any chronic conditions like diabetes, hypertension, etc.

How Is Cholecystectomy Done?

Surgical removal of the gallbladder is known as cholecystectomy; it can be done in three ways; they are:

• Open Cholecystectomy - A planned open cholecystectomy is performed in cases of cirrhosis (fibrous thickening) and gallbladder cancer. Nowadays, it is done while converting from a planned laparoscopic cholecystectomy to open cholecystectomy due to poor visualization and unclear anatomy.

Once the patient is adequately anesthetized, the surgeon makes an upper midline incision and adequately exposes the gallbladder. Care is taken not to injure the liver. The gallbladder is grasped with clamps and removed using electrocautery or a scalpel. The abdomen is then closed using the standard suturing technique.

• Laparoscopic Cholecystectomy- Instead of one large incision, the surgeon makes three small incisions in the abdomen. Carbon dioxide is pumped into the abdomen to inflate the surgical area making it easy to see. Then a laparoscope (a thin tube with a camera attached) is inserted through one of the incisions using special tools. The surgeon detaches the gallbladder from the rest of the body.

Laparoscopic cholecystectomy is referred to as the gold standard in gallbladder removal surgeries. It is, however, contraindicated in patients with severe gallbladder problems and a previous history of surgery in the abdomen.

• Robotic Cholecystectomy - This is a more recent method where the surgeon performs the surgery sitting in a console and using a robotic platform like Xi or Si.

What Are the Risks of Cholecystectomy?

All surgeries, both elective and emergency, come with a certain level of risk. A few are specific to cholecystectomy; they are:

• Bleeding.

• Bile leaking into the body.

• Hernia.

• Injury to the liver and intestine.

• Peritonitis (inflammation of the abdomen).

• Urinary tract infection (UTI).

What Is the Recovery Time for Cholecystectomy?

For open surgery, the patient will have to stay in the hospital for two to six days. However, for laparoscopic cholecystectomy, the patient can go home on the same day. The patient is usually advised to take a week off from regular activities and not take up heavy lifting.

How Do I Take Care of Myself After a Gallbladder Surgery?

A few steps can be taken at home to promote faster healing; they are:

• Drinking plenty of water.

• Avoiding high-fat content foods.

• Increasing fiber intake.

• Walking helps to prevent blood clots post-operative.

• Proper dressing for the incisions.

When to Seek Medical Attention Post-surgery?

Contact the hospital immediately if any of the below-mentioned symptoms appear:

• Fever and chills.

• Cramps in the abdomen.

• Bleeding and swelling at the site of the incision.

• No bowel movement for three days.

• Vomiting and yellow skin.

Conclusion:

Cholecystectomy is a well-tolerated surgery with a high success rate. With the recent developments in technology, the surgery has become minimally invasive with very less scarring. It is important to know that, unlike kidney stones, gallstones do not dissolve on their own, and if they are symptomatic, it is always advisable to contact the healthcare provider for further guidance.