Patient Information
Surgeries: Laparoscopic: Cholecystectomy (Lap Chole)
Laparoscopic cholecystectomy involves the removal of the gallbladder through a laparoscopic approach. The gallbladder normally stores bile produced in the liver until it is needed for digestion. Unfortunately, the gallbladder often forms gallstones. These seem to be related to body weight, diet, gallbladder motility and inherited body chemistry. Many patients have stones which do not cause symptoms and require no surgery. If however these stones attempt to pass out of the gallbladder and block the gallbladder outlet, severe upper abdominal pain can develop. This is known as colic. It usually lasts for short periods of time and often occurs after fatty meals which stimulate the gallbladder to contract.
Occasionally, these stones may become lodged within the neck of the gallbladder and results in prolonged episodes of pain associated with infection. This is known as acute cholecystitis and generally requires admission to hospital and cholecystectomy. Another complication of gallstones may be obstructive jaundice. In this situation the gallstones pass out of the gallbladder and into the bile duct where they occlude the bile duct exit. This may result in progressive jaundice and infection known as cholangitis. This needs to be treated immediately as discussed in the further sections. Once a person has had one attack of gallstones, they are likely to develop more. It is thus wise to remove the gallbladder between attacks, since surgery is simpler when there is no acute infection or obstruction.
In the operating room under general anesthesia, a small needle is inserted into the umbilicus to allow inflation of the abdomen with gas. A telescope is inserted through a small 10 mm. hole or "port" inserted in the umbilicus to allow visualization. A second hole (port) is placed just under the breast bone in the midline of the abdomen. Two small ports are placed in the right side of the abdomen to allow for retraction. The gallbladder is then freed of any scar tissue which may be present from previous episodes of acute cholecystitis. The cystic duct (the duct that joins the gallbladder to the bile duct) is identified. The small artery known as the cystic artery supplying blood to the gallbladder is also identified.
A small incision is made either in the gallbladder itself or in the cystic duct to allow insertion of a small tube or catheter. Dye is injected through this catheter to allow visualization of the bile ducts and insure that no stones are present within the bile duct on an x-ray screen. If there are no stones present in the bile duct, the cystic duct is divided after sealing it with metallic clips. The cystic artery is clipped and divided and the gallbladder is removed from the bed of the liver with a cautery device or laser. The gallbladder is then removed through one of the small incision (usually the umbilicus) and the ports are closed. The patient is able to eat immediately after waking from surgery and is usually discharged home that day or the next. Most patients return to normal activities within one to two weeks of their procedure.
If a stone is found in the common bile duct, most may also be removed during the laparoscopy. These stones can be flushed through the bile duct and into the bowel where they will pass without further problems. If they are not flushed easily, access to the bile duct can be gained through the cystic duct by dilating it up to a size big enough to allow passage of a small scope known as a choledocho scope. The choledocho scope allows doctors to see within the bile duct and the stones can be grasped with small baskets and removed. Rarely, if the stones are impacted a small drain is left in place, and the stones are removed later at another procedure called ERCP.