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1. Overview

Cholecystectomy is a surgical procedure that involves removing the gallbladder (pear-shaped organ located under the liver on the right side, above the abdomen).

Gallbladder collects and stores bile – digestive fluid produced by the liver. Cholecystectomy may be necessary if a person has pain due to gallstones, obstructing the flow of bile.

Cholecystectomy is an easy surgery, with small risks of complications. In most cases patients can return home the same day after cholecystectomy.


1. Overview
2. What is cholecystectomy?
3. Anatomy and physiology
4. Symptoms and diagnosis
5. Surgery
6. Complications

2. What is cholecystectomy?

Cholecystectomy involves most often some incisions through which the doctor will insert an instrument with a tiny camera at one end that will see inside the abdomen, and through the other four small incisions will introduce special surgical tool with which will remove gallbladder.

This is laparoscopic cholecystectomy. In some cases, it may be necessary a larger incision in the right upper abdomen to remove the gallbladder. This is called open cholecystectomy.

3. Anatomy and physiology

Bile flow through the cystic duct from the gallbladder and reach into the hepatic duct where it forms the common bile duct. Common bile duct is then emptied into the lower intestine. The main purpose of the gallbladder is to store and concentrate the bile.

This will release bile through the common bile duct into the small intestine when the person consumes fatty foods. Bile helps digest fatty foods. However, any person can live without the gallbladder without any discomfort.

4. Symptoms and diagnosis

Among those prone to gallbladder seizures are:
- Women, especially those aged over 40 years;
- Women who gave birth – risk of developing gallstones increases with each pregnancy;
- Overweight men and women;
- Those who consume large quantities of dairy products, animal fats and fried foods;
- Those who already have cases of gallbladder diseases in their medical family history.

Symptoms of gallstones may include
- Nausea;
- Bloating;
- Vomiting or fever;
- Intolerance to fatty food consumption;
- Other signs of infection.

Events occur, usually after eating fatty or fried foods. Symptoms may recur frequently and can be unpleasant.

Diagnosis of gallstones is decided after some special tests were made:
- Blood tests – with which the doctor can detect the jaundice or any increases of the enzymes that occur as a result of bile flow obstruction;
- Abdominal ultrasound – abdominal scanning is useful in order to identify gallstones. By using this technology, the doctor can see the presence, size and position of gallstones, common bile duct dimension and gallbladder wall thickness.

5. Surgery

- Classic gallbladder removal can be achieved by open cholecystectomy, which involves an incision that is made in the right upper abdomen. Then the gallbladder will be removed, detaching it from its surrounding structures.

This type of surgery is done in difficult or dangerous cases in which laparoscopic cholecystectomy is not possible, situations involving technical difficulties due to abdominal dense adhesions from previous surgery, when the gallbladder is inflamed or when gallbladder anatomy not is clearly visible through a laparoscope.

Recovery time and hospitalization lasts 4-5 days. In some cases, gallstones obstructing common bile duct can be removed by common bile duct exploration after open surgery.

- Laparoscopic cholecystectomy is the most common surgery used to relieve gallbladder problems. The laparoscope is a long tube that contains a light source at one end with a video camera connected to a screen. Through this system, the surgeon can view the abdomen during surgery.

Before surgery, doctors recommend intravenous antibiotics to reduce the infection rate. After anesthesia, on the site of the future incision it will be applied an antiseptic and will make several small incisions (3-4) in the abdominal wall. Then, it will introduce a needle into the abdomen for abdomen distension with carbon dioxide gas that will create space for placing instruments.

Laparoscopy and laparoscopic instruments will be inserted through the long abdominal incisions. The entire surgery is then performed while the surgeon watches a magnified image of the internal organs through a screen. The gallbladder is detached from surrounding structures. The cystic duct that attaches the gallbladder to the common bile duct is dissected and caught with several metal clips.

In some cases, a small catheter might be inserted through the cystic duct to inject dye in order to visualize on the x-ray radiography if there still are any stones that could clog the common bile duct. If gallstones are present in the bile ducts, they can be removed by using laparoscopic exploration of the common bile duct, by using endoscopic retrograde cholangiopancreatography or by opening the abdomen.

After cystic duct is divided, the gallbladder is dissected and small arteries that supply blood to the gallbladder (cystic artery) will be attached with metal clips. Gallbladder is then detached from the liver and will try to avoid spill the bile into the abdominal cavity.

6. Complications

Incidence of complications after cholecystectomy is relatively low and includes:
- Complications of general anesthesia;
- Post-surgery bleeding;
- Damage to the bile duct or the right hepatic artery;
- Bile leak;
- Wound infection;
- Damage to other abdominal organs;
- Pulmonary embolism;
- Deep vein thrombosis (DVT);
- Respiratory or urinary infections.



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