Laparoscopic Cholecystectomy - Gallbladder Removal

Laparoscopic cholecystectomy is one of the most common abdominal procedures performed by general surgeons.

It is very important that you do not eat or drink anything after midnight the night prior to surgery. This includes coffee, water, mints, gum, candies. You may ingest only a small sip of water with your morning medications.

Dr. Fusco's office staff will advise you when to arrive at the hospital or surgery center. Since the procedures scheduled prior to yours may be longer or shorter than anticipated, we ask that you remain available prior to your arrival time so that you can by contacted and informed of any changes in your surgery time.

When patients bathe the night prior to surgery they should thoroughly cleanse the umbilicus (belly button).

Incisions
An incision approximately 1/2 inch long is made just above the umbilicus . This is used to insert the laparoscope (camera). Three additional 1/4 inch incisions are used to insert the instruments used to remove the gallbladder. If open surgery is required, the incision roughly connects the three upper abdominal incisions.

Some patients may be candidates for SILS cholecystectomy, a procedure where the gallbladder can be removed from a single incision burried in the belly button.

Conduct of the operation
Using the inserted instruments the cystic duct and the cystic artery are clipped. The clips used are made of a material that is inert to the body. The clips remain in place forever, they are not detected by metal detectors and they do not prevent patients from undergoing MRI scans. The gallbladder is then separated from its attachments to the liver. Once free from all attachments, the gallbladder is extracted from the umbilical incision. The incisions are closed with absorbable sutures. Steri strips (butterfly stitches) are placed. These remain on the wounds until they peel off on their own, usually in two weeks. The wounds are covered with Band-Aids. These Band-Aids can be removed the day after surgery. Patients are allowed to bathe normally the day following surgery.

Recovery
The surgery is done as an outpatient surgery or sometimes as an overnight stay. Patients can resume light daily activity immediately. The average patient will require 1-2 weeks recovery before resuming more vigorous activity. There is no forced limitation of activity, instead patients are asked to advance their activity as tolerated. This applies to the resumption of work, sports, and sexual activity.

Patients will want to eat light foods the night after surgery. Then they can eat food as tolerated.

Patients are seen in the office 5 to 9 days after surgery for a postoperative check, but patients are encouraged to contact the office sooner if they have any questions or problems. Dr. Fusco requests you contact the office for any of the following:

• Nausea or vomiting that persists for greater then 24 hours after surgery - nausea shortly after surgery is commonly due to general anesthesia and usually resolves within this time period.
  
• Temperature greater than 101.5 degrees - Temperature elevations less than this are very common after surgery and usually have little significance.
  
• Any yellow discoloration of the eyes or skin.
  
• Pain that is not relieved by the oral pain medication prescribed.
• Inability to pass urine. Some difficulty is common the first night after surgery but usually resolves in 12 to 24 hours. For patients that are unable to pass urine and feel pelvic discomfort, they should contact the office for instructions.
• Any questions or concerns.
• Patients experiencing any difficulty breathing, chest pain, change in level of consciousness, or loss of vision or strength should promptly call 911 for transport to the nearest emergency department.
  

Results
Cholecystectomy relieves classic gallbladder symptoms in greater than 90 percent of cases. Atypical symptoms are less likely to be relieved.

Risks of surgery (with approximate incidence)

• Bleeding (needing transfusion) - 2%
  
• Infection - 2%
  
• Conversion to open surgery - 2%
  
• Bile leak - 2%
  
• Retained stone in the common bile duct - variable depending on preoperative tests
  
• Injury to the common duct 0.2 %
  
• Injury to other structures in the abdomen including small intestines, liver, and blood vessels - <1%
• Hernia development at incision sites - < 1%