Cholecystectomy (; plural: cholecystectomies) is the surgical removal of the gallbladder. In 2011, cholecystectomy was the 8th most common operating room procedure performed in hospitals in the United States. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. The operation is performed either laparoscopically, using a video camera, or via an open surgical technique. There are advantages and disadvantages to each operation. The surgery is typically very successful in relieving symptoms that people have, but up to 10% of people may continue to experience similar symptoms, which has been termed postcholecystectomy syndrome. Additionally, there can be serious complications of cholecystectomy, such as bile duct injury, retained or dropped gall stones, abscess formation and narrowing (stenosis) of the bile duct.
Video Cholecystectomy
Medical use
The gallbladder is removed in order to treat inflammation of the gallbladder (cholecystitis), biliary dyskinesia or gallbladder cancer. Cholecystitis may be acute or chronic, and may or may not involve the presence of gallstones. The most common indication to remove the gallbladder laparoscopically is symptomatic gallstones (cholelithiasis) that cause right upper abdominal pain intermittently, which is termed biliary colic. In cases of suspected gallbladder cancer (carcinoma) the open technique for cholecystectomy is usually performed.
Removal of the gallbladder is also used to prevent the relapse of pancreatitis that is caused by gallstones that block the common bile duct.
Maps Cholecystectomy
Contraindications
There are no specific contraindications for this procedure, but anyone who cannot tolerate general surgery should not receive it. Typically this means people who cannot tolerate general anesthesia, who have end-stage liver disease with portal hypertension, or whose blood does not clot properly. This subset of people should not have a cholecystectomy.
Procedure
Laparoscopic cholecystectomy
By 2013, laparoscopic cholecystectomy had replaced open cholecystectomy as the first-choice of treatment for gallstones and acute cholecystitis, a condition where the gallbladder is inflamed, unless there are contraindications to the laparoscopic approach. The preference to perform laparoscopic cholecystectomy versus open is because the laparoscopic approach has decreased mortality, decreased morbidity, and decreased cardiac and respiratory complications.
Laparoscopic cholecystectomy requires several (usually 4) small incisions in the abdomen to allow the insertion of operating ports, small cylindrical tubes approximately 5 to 10 mm in diameter, through which surgical instruments and a video camera are placed into the abdominal cavity. The surgeon inflates the abdominal cavity with carbon dioxide to create a working space prior to starting. The camera illuminates the surgical field and sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. The surgeon watches the monitor and performs the operation by manipulating the surgical instruments through the operating ports. The gallbladder fundus is identified, grasped, and retracted superiorly. With a second grasper, the gallbladder infundibulum is retracted laterally to expose and open Calot's Triangle (cystic artery, cystic duct, and common hepatic duct). The triangle is gently dissected to clear the peritoneal covering and obtain a view of the underlying structures. The cystic duct and the cystic artery are identified, clipped with tiny titanium clips and cut. Then the gallbladder is dissected away from the liver bed and removed through one of the ports.
A technique called Laparoendoscopic Single Site Surgery or "LESS" or Single Incision Laparoscopic Surgery or "SILS" has been developed. This is an operation in which a single cut is made through the navel, instead of the 3-4 four small different cuts used in standard laparoscopy. There appears to be a cosmetic benefit over conventional four-hole laparoscopic cholecystectomy, and no advantage in postoperative pain and hospital stay compared with standard laparascopic procedures. There is no scientific consensus regarding risk for bile duct injury with SILS versus traditional laparoscopic cholecystectomy.
Open cholecystectomy
Sometimes people need open surgery instead of laparascopy. In open cholecystectomy, a surgical incision of around 8 to 12 cm is made below the edge of the right rib cage and the gallbladder is removed through this large opening, typically using electrocautery. The liver is retracted superiorly, and a top-down approach is taken (from the fundus towards the neck) to remove the gallbladder from the liver. This is done if the person has severe cholecystitis, emphysematous gallbladder, fistulization of gallbladder and gallstone ileus, cholangitis, cirrhosis or portal hypertension, and blood dyscrasias.
Sometimes problems arise during the laparoscopic procedure -- for example, the person has unusual anatomy and the surgeon cannot see well enough through the camera, or it looks like the person has cancer -- and the laparascopy is stopped and the person is opened up with a larger incision instead.
Open cholecystectomy is associated with greater post-operative pain, longer hospital length of stay, increased use of antibiotics, and a longer proportion of time out of work than a laparoscopic cholecystectomy.
Biopsy
After removal, the gallbladder should be sent for pathological examination to confirm the diagnosis and look for an incidental cancer. Incidental cancer of the gallbladder is found in approximately 1% of cholecystectomies. If cancer is present, a reoperation to remove part of the liver and lymph nodes will be required in most cases.
Procedural risks and complications
All surgery carries risk of serious complications or even death. The mortality rate for laparoscopic or open cholecystectomy is less than 0.3%.
The most serious complication of cholecystectomy is damage to the bile ducts. In laparoscopic cholecystectomy, this occurs in between 0.3% and 0.6% of cases. Approximately 25-30% of biliary injuries are typically noticed intraoperatively during laparoscopic cholecystectomy and the rest during the early post-operative period. Damage to the duct that causes leakage typically manifests as either fever, jaundice, and abdominal pain several days following cholecystectomy or manifests in laboratory studies as rising total bilirubin and alkaline phosphatase.
Leakage from the stump of the cystic duct is a complication that is more common with the laparoscopic approach than the open approach but is still rare, occurring in less than 1% of procedures; it is treated by drainage followed by insertion of a bile duct stent.
Long-term prognosis
A portion of the population who have undergone a cholecystectomy, up to 40%, develop a condition called postcholecystectomy syndrome, or PCS. Symptoms are typically similar to the pain and discomfort prior to cholecystectomy and most commonly include gastrointestinal distress (dyspepsia) and persistent pain in the upper right abdomen.
Some people following cholecystectomy may develop chronic diarrhea. The cause is unclear, but is presumed to involve the disturbance to the bile system. The disturbance is thought to be due to increased speed of enterohepatic recycling of bile salts, causing the terminal ileum to be unable to absorb them all. This overwhelmed portion of the intestine leads to diarrhea. Most cases clear up within weeks or a few months, though in rare cases the condition may last for many years. It can be controlled with medication such as cholestyramine.
Epidemiology
About 600,000 people receive a cholecystectomy in the United States each year.
In a study of Medicaid-covered and uninsured U.S. hospital stays in 2012, cholecystectomy was the most common operating room procedure.
History
German Surgeon Wilhelm Fabry in 1618 removed the first gallstone from a living person. The first elective cholecystectomy was performed in 1882 by Carl Langenbuch. Introduced in 1987 by Phillipe Mouret in France, the laparoscopic cholecystectomy, which is a less invasive surgery than an open cholecystectomy, has become the standard operation for the treatment of symptomatic gallstones.
See also
- List of surgeries by type
References
Source of article : Wikipedia
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