Laparoscopic Gall Bladder Surgery

Laparoscopic gall bladder surgery has made this operation much less invasive and expensive than in the past. This explains diagnostic tests as well as the procedure.

Laparoscopic gallbladder surgery, also referred to as laparoscopic cholecystectomy, is the removal of the gallbladder using several very small incisions instead of the more traditional method of one larger, more invasive incision.

The gallbladder is a small organ located high on the right side of the abdomen, under the liver. It is attached to the common bile duct by the cystic duct which leads to the liver and small intestine. The gallbladder aids digestion by storing a small amount of the bile produced by the liver and adding it to the contents of the small intestine as needed to aid in the digestion of fatty foods.

Gallbladder disease may occur when the chemical balance of bile in the gallbladder is disrupted, causing the bile to become solid. The gallbladder may be found to contain small crystals or larger stones, which may cause the bile to move more sluggishly or be completely trapped inside the gallbladder. Symptoms may be mild or severe and can include pain in the upper abdomen, nausea, vomiting, or bloating, but you may have no noticeable symptoms. The symptoms can also be confusing or attributed to other ailments.

If you report the above symptoms to your doctor, she may first recommend an upper g.i. series or barium swallow, painless tests during which your upper digestive tract will be x-rayed to indicate any abnormalities, such as ulcer or hernias. If the answer is not found there, she may further order that you have a gallbladder ultrasound, which is also painless. This test is highly effective in revealing the presence of gallstones.

If gallstones are not indicated from the test and your symptoms are still not explained, further tests may include a gallbladder emptying. The gallbladder emptying test is an outpatient test involving an injection into your arm of a substance which will cause your gallbladder to fill with bile quickly. While this is happening, you will lay very still while a radiologist watches by x-ray the speed in which your gallbladder fills. Then you will be injected with another fluid that will cause your gallbladder to spasm violently and empty its contents rapidly. This causes intense, though brief nausea, which should last approximately 5 minutes and end suddenly. By observing the speed your gallbladder empties itself, your doctor will be able to tell whether or not it may be diseased.

Another test to indicate gallbladder disease is done under mild sedation, also outpatient. During this test, your doctor will put an instrument down your throat, withdraw a small amount of the bile from the gallbladder and examine it. This test is highly effective in determining if your gallbladder has crystals that are too small to be picked up by the ultrasound. Most people experience no pain during this procedure and little or no recovery period is required.

Once your doctor has determined that your gallbladder is diseased, she will explain your options. The gallbladder is not considered an essential organ. Generally, the body will adapt to its absence quickly with little or no effect. The potential complications from an untreated diseased gallbladder, however, can be very painful and may even be life-threatening. Pain may increase and can become debilitating. If the duct becomes completely blocked or the gallbladder stops emptying, it may become infected or even develop gangrene, which is deadly if not treated. The pancreas, which is an organ essential for life, may become involved or damaged. Your doctor may recommend removal of the gallbladder by one of two methods.

The traditional method of gallbladder removal involves a sizable incision in the upper right abdomen which may take several weeks recovery and cause considerable discomfort and several days of hospitalization. Laparoscopic gallbladder surgery is increasingly the method of choice for gallbladder removal.

If you and your surgeon opt for laparoscopic gallbladder surgery, you will be asked to not eat or drink anything after midnight on the night before surgery. Generally you will go to the hospital shortly before your scheduled surgery, where you will talk with a nurse and an anesthesiologist and have an intravenous line started which will be used to administer anesthesia. You may also be given a drug to prevent nausea, a common after affect of anesthesia. Your doctor may order that you have special pressure stockings put on your legs to help prevent blood clots from forming. These will be removed after surgery. Your abdominal area may be shaved.

Laparoscopic gallbladder removal is done under general anesthesia and involves making several, usually four, very small incisions, one at the navel and the others scattered around the upper right abdomen. The surgeon will use these incisions to insert a light and camera which will transmit a picture to a video monitor which the surgeon will use to guide his instruments. Your abdomen will be expanded by pumping carbon dioxide inside, allowing the surgeon a clearer view and room to move around. The bile duct and blood vessel will be clamped and cut and the gallbladder will be moved to the opening at the navel, where it's contents will be emptied outside your body, causing it to collapse until it is flat and flexible enough to pull out through the incision. The procedure generally takes around an hour, but this may vary.

The carbon dioxide will then be taken out of your abdomen and the incisions closed, either with small bandages or perhaps one or two stitches may be used. You may or may not have a small drainage tube inserted in one of the incisions for a few hours to drain off remaining fluid your surgeon may have used during the surgery. Your surgeon may also send your diseased gallbladder to a laboratory for further testing, including a biopsy.

Occasionally your surgeon may make the decision during surgery that laparoscopic gallbladder removal may not be suitable for you and switch to the traditional method. This may happen if some other condition interferes with your doctor's ability to see using the laparoscope, for instance you may have accumulated scar tissue from previous surgeries. If your surgeon determines that she must go ahead with an open incision, your surgery may take longer and your recovery time may be much longer.

As with any surgery, there are certain risks, which may include excessive bleeding or blood clots, difficulty with anesthesia, or infection. As a preventive measure, your surgeon may administer antibiotics through your i.v. After surgery, most patients will spend several hours recovering at the hospital and then be released either the same day or the next day, barring complications. Once the anesthesia has worn off, you may be asked to walk around to help prevent blood clots. You may be given a liquid diet for a few hours after surgery, but in most cases, you may return to a regular diet the next day and your regular routine within a few days.

Most patients will experience some pain and a prescription pain reliever may be given. A common complaint is gas pain, which can be caused by residual carbon dioxide moving up through the body into the right shoulder. Intestinal gas pain and constipation are also common after surgery and may be aggravated by anesthesia, pain relievers or drinking through a straw.

Generally, one or two follow-up visits with your surgeon will be required. Scarring from laparoscopic gallbladder surgery will be very minimal.

You may experience intermittent diarrhea beginning a few weeks after surgery. This may occur while the body adjusts to losing the gallbladder. If it continues, your doctor may prescribe Cholestyramine, which is a powder you mix with water. This powder will help bind the stool and relieve this form of diarrhea.

Gallbladder disease is a fairly common condition. It may possibly be prevented by eating a diet high in fiber and low in fat, drinking lots of water and avoiding caffeine.

If you suspect you may have gallbladder disease, consult your doctor. This information is not meant to substitute for medical advice but is based on research, interviews with patients who have undergone laparoscopic gallbladder surgery, and doctors.

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