What is a cholecystectomy. How is the procedure performed. What are the risks and benefits of gallbladder removal. Who needs this surgery. How to prepare for a cholecystectomy. What happens during and after the procedure. What is the recovery process like.

Understanding Cholecystectomy: What You Need to Know

A cholecystectomy is a surgical procedure to remove the gallbladder, a small organ located under the liver on the upper right side of the abdomen. This pear-shaped organ stores bile, a digestive fluid produced by the liver. While the gallbladder plays a role in digestion, it’s not essential for survival, and its removal is a common solution for various gallbladder-related issues.

Types of Cholecystectomy

There are two primary methods for performing a cholecystectomy:

1. Open (Traditional) Method: This involves making a single incision, approximately 4 to 6 inches long, in the upper right-hand side of the abdomen. The surgeon then locates and removes the gallbladder through this opening.
2. Laparoscopic Method: This minimally invasive technique uses 3 to 4 small incisions. A laparoscope, a long, thin tube equipped with a tiny video camera and surgical tools, is inserted through these incisions. The surgeon performs the procedure while viewing a monitor, removing the gallbladder through one of the small openings.

Which method is best for a patient? The laparoscopic approach is generally preferred due to its less invasive nature, resulting in reduced bleeding and shorter recovery times. However, in some cases where the gallbladder is severely diseased or complications arise, the surgeon may need to switch to the open method for safe removal.

Indications for Gallbladder Removal: When Is It Necessary?

Understanding when a cholecystectomy is recommended can help patients make informed decisions about their health. Here are some common reasons why a healthcare provider might suggest this procedure:

• Gallstones: Solid lumps of material that form in the gallbladder
• Cholecystitis: Inflammation or infection of the gallbladder
• Gallbladder cancer: Though rare, this can be a reason for removal

What are the symptoms that might indicate gallbladder problems? Patients often experience pain that:

• Occurs on the right side or middle of the upper abdomen
• May be constant or worsen after heavy meals
• Can sometimes feel more like fullness than pain
• Might be felt in the back and at the tip of the right shoulder blade

Additional symptoms may include nausea, vomiting, fever, and chills. It’s crucial to note that these symptoms can resemble other health issues, so a proper medical evaluation is essential for accurate diagnosis.

Risks and Complications: What Patients Should Be Aware Of

While cholecystectomy is generally considered a safe procedure, it’s important for patients to understand potential risks and complications. What are the possible adverse outcomes of gallbladder removal?

• Bleeding: This can occur during or after the surgery
• Infection: As with any surgical procedure, there’s a risk of infection at the incision site
• Bile duct injury: The tube carrying bile from the gallbladder to the small intestine may be damaged
• Liver injury: Though rare, the liver can be inadvertently injured during the procedure
• Scarring and numbness: Patients may experience these sensations at the incision site
• Hernia: A bulging of organ or tissue at the incision site can occur

During laparoscopic procedures, there’s also a risk of injury to intestines or blood vessels due to the insertion of surgical tools into the abdomen. It’s crucial for patients to discuss any concerns and their individual risk factors with their healthcare provider before the procedure.

Preparing for Cholecystectomy: Steps to Ensure a Successful Procedure

Proper preparation is key to a successful cholecystectomy. What steps should patients take before their surgery?

1. Consultation: Your healthcare provider will explain the procedure in detail. Don’t hesitate to ask questions and voice any concerns.
2. Consent: You’ll be asked to sign a consent form. Read it carefully and ensure you understand all aspects of the procedure.
3. Medical history review: Your provider will ask about your past health and may perform a physical exam to ensure you’re in good health for the surgery.
4. Diagnostic tests: Blood tests and other diagnostic procedures may be necessary.
5. Fasting: You must not eat or drink for 8 hours before the procedure, often meaning no food or drink after midnight.
6. Medication review: Inform your provider about all medications you’re taking, including over-the-counter drugs, vitamins, and supplements. You may need to stop taking certain medications, especially blood thinners, before the surgery.
7. Transportation arrangements: If it’s an outpatient procedure, arrange for someone to drive you home afterward, as you won’t be able to drive due to the anesthesia.

How should patients with specific health conditions prepare? If you’re pregnant or think you might be, have allergies to medications or latex, or have a history of bleeding disorders, it’s crucial to inform your healthcare provider. They may need to take special precautions or adjust the procedure accordingly.

The Cholecystectomy Procedure: What Happens During Surgery?

Understanding the steps of a cholecystectomy can help alleviate anxiety and prepare patients for what to expect. How does the surgical process unfold?

1. Anesthesia: The procedure is typically performed under general anesthesia, meaning you’ll be in a deep sleep throughout the surgery.
2. Preparation: You’ll be asked to remove any jewelry or objects that might interfere with the surgery. You’ll change into a hospital gown.
3. IV Line: An intravenous (IV) line will be placed in your arm or hand for administering medications and fluids.
4. Incision: Depending on whether it’s an open or laparoscopic procedure, the surgeon will make the necessary incision(s).
5. Gallbladder removal: The surgeon carefully detaches the gallbladder from surrounding tissues and removes it through the incision.
6. Closure: Once the gallbladder is removed, the incision(s) will be closed with sutures or surgical staples.

What’s the typical duration of a cholecystectomy? The procedure usually takes about 1 to 2 hours, but this can vary depending on the complexity of the case and whether it’s an open or laparoscopic surgery.

Post-Surgery Recovery: What to Expect After Gallbladder Removal

Recovery after a cholecystectomy varies depending on the type of surgery and individual factors. What can patients expect in the immediate aftermath and the days following the procedure?

Immediate Post-Op Period

• Observation: You’ll be taken to a recovery room where your vital signs will be monitored as you wake up from anesthesia.
• Pain management: You may experience some pain or discomfort, which can be managed with medication.
• Nausea: Some patients experience nausea as a side effect of anesthesia, which can be treated with medication if necessary.

Hospital Stay

How long will patients need to stay in the hospital? For laparoscopic procedures, many patients can go home the same day or after one night. Open surgeries typically require a hospital stay of 2 to 4 days.

At-Home Recovery

What should patients expect during their at-home recovery period?

• Rest: It’s important to get plenty of rest, but also to move around to prevent blood clots.
• Pain management: Your doctor will provide instructions for managing pain at home, which may include over-the-counter or prescription medications.
• Wound care: You’ll receive instructions on how to care for your incision site(s) to prevent infection.
• Diet: You may need to start with clear liquids and gradually return to solid foods.
• Activity restrictions: You’ll need to avoid strenuous activities for a period of time, typically 1 to 2 weeks for laparoscopic surgery and 4 to 6 weeks for open surgery.

When can patients return to normal activities? Most people can return to normal activities within 1 to 2 weeks after laparoscopic surgery, or 4 to 6 weeks after open surgery. However, it’s essential to follow your doctor’s specific instructions and attend follow-up appointments to ensure proper healing.

Living Without a Gallbladder: Adjusting to Life Post-Cholecystectomy

Many patients wonder about the long-term implications of living without a gallbladder. How does gallbladder removal affect daily life and digestive function?

Digestive Changes

While the gallbladder plays a role in digestion, its removal doesn’t typically cause significant long-term issues. However, some patients may experience changes:

• Diarrhea: Some people may have looser stools for a few weeks after surgery.
• Fat digestion: Without the gallbladder to store and concentrate bile, some patients may have difficulty digesting fatty foods.
• Bile flow: Bile now flows directly from the liver to the small intestine, which can sometimes cause digestive discomfort.

Dietary Adjustments

What dietary changes might be necessary after gallbladder removal? While many people don’t need to make significant changes, some find it helpful to:

• Eat smaller, more frequent meals
• Reduce fat intake, especially in the weeks following surgery
• Increase fiber intake to help normalize bowel movements
• Avoid foods that seem to trigger digestive discomfort

It’s important to note that these dietary adjustments are often temporary, and most people can return to their normal diet over time.

Long-Term Health Considerations

Are there any long-term health implications of not having a gallbladder? For most people, living without a gallbladder does not cause significant health issues. However, it’s important to maintain a healthy lifestyle and attend regular check-ups with your healthcare provider.

In rare cases, some patients may experience ongoing digestive issues or a condition called postcholecystectomy syndrome. If you experience persistent symptoms after recovery, it’s crucial to consult with your doctor for proper evaluation and management.

Alternatives to Cholecystectomy: Exploring Other Treatment Options

While cholecystectomy is often the recommended treatment for gallbladder issues, there are situations where alternative approaches may be considered. What are some alternatives to gallbladder removal?

Non-Surgical Treatments

• Medication: For some patients with small gallstones, medications to dissolve the stones may be an option. However, this treatment can take months or years to be effective and stones may recur once treatment is stopped.
• Lithotripsy: This procedure uses shock waves to break up gallstones. It’s typically only used for patients who can’t undergo surgery and is not widely available.
• Lifestyle changes: In some cases, dietary modifications and weight loss may help manage mild gallbladder issues.

When Are Alternatives Considered?

Alternative treatments may be explored in situations such as:

• Patients who are not good candidates for surgery due to other health conditions
• Cases where gallstones are small and not causing significant symptoms
• Situations where the risks of surgery outweigh the potential benefits

It’s important to note that these alternatives are not suitable for all patients and may not provide a permanent solution to gallbladder problems. What factors determine the best treatment approach? The decision between cholecystectomy and alternative treatments depends on various factors, including:

• The severity and frequency of symptoms
• The size and number of gallstones
• The overall health of the patient
• The risk of complications from untreated gallbladder disease

Patients should have a thorough discussion with their healthcare provider to determine the most appropriate treatment plan for their individual situation.

Technological Advancements in Cholecystectomy: The Future of Gallbladder Surgery

The field of gallbladder surgery continues to evolve with technological advancements. What are some of the latest innovations in cholecystectomy procedures?

Robotic-Assisted Surgery

Robotic-assisted cholecystectomy is an advanced form of laparoscopic surgery. How does it work?

• The surgeon controls robotic arms from a console
• The robotic system provides enhanced 3D visualization
• It allows for greater precision and control during the procedure

What are the potential benefits of robotic-assisted cholecystectomy? While research is ongoing, some studies suggest it may offer advantages such as:

• Reduced post-operative pain
• Shorter hospital stays
• Quicker return to normal activities

Single-Incision Laparoscopic Surgery (SILS)

SILS is a technique that aims to further minimize the invasiveness of gallbladder removal. How does it differ from traditional laparoscopic surgery?

• It uses a single incision, typically through the navel
• This approach may result in less scarring and potentially faster recovery

While promising, it’s important to note that SILS is not suitable for all patients and may require specialized training for surgeons.

Imaging Technologies

Advancements in imaging technologies are also improving cholecystectomy procedures. What are some of these innovations?

• Fluorescence imaging: This technique can help surgeons better visualize the biliary anatomy during surgery, potentially reducing the risk of bile duct injury.
• 3D laparoscopy: This provides surgeons with enhanced depth perception during the procedure.

How do these technological advancements impact patient outcomes? While more research is needed, these innovations have the potential to improve surgical precision, reduce complications, and enhance overall patient experiences.

As technology continues to advance, it’s likely that cholecystectomy procedures will become even more refined and patient-friendly. However, it’s important to remember that the choice of surgical technique should always be based on individual patient factors and the surgeon’s expertise.

Cholecystectomy | Johns Hopkins Medicine

What is a cholecystectomy?

A cholecystectomy is surgery to remove your gallbladder.

The gallbladder is a small organ under your liver. It is on the upper right side of your belly or abdomen. The gallbladder stores a digestive juice called bile which is made in the liver.

There are 2 types of surgery to remove the gallbladder:

• Open (traditional) method. In this method, 1 cut (incision) about 4 to 6 inches long is made in the upper right-hand side of your belly. The surgeon finds the gallbladder and takes it out through the incision.

• Laparoscopic method. This method uses 3 to 4 very small incisions. It uses a long, thin tube called a laparoscope. The tube has a tiny video camera and surgical tools. The tube, camera and tools are put in through the incisions. The surgeon does the surgery while looking at a TV monitor. The gallbladder is removed through 1 of the incisions.

A laparoscopic cholecystectomy is less invasive. That means it uses very small incisions in your belly. There is less bleeding. The recovery time is usually shorter than an open surgery.

In some cases the laparoscope may show that your gallbladder is very diseased. Or it may show other problems. Then the surgeon may have to use an open surgery method to remove your gallbladder safely.

Why might I need a cholecystectomy?

A cholecystectomy may be done if your gallbladder:

• Has lumps of solid material (gallstones)

• Is red or swollen (inflamed), or infected (cholecystitis)

• Is cancerous

Gallbladder problems may cause pain which:

• Is usually on the right side or middle of your upper belly

• May be constant or may get worse after a heavy meal

• May sometimes feel more like fullness than pain

• May be felt in your back and in the tip of your right shoulder blade

Other symptoms may include nausea, vomiting, fever, and chills.

The symptoms of gallbladder problems may look like other health problems. Always see your healthcare provider to be sure.

Your healthcare provider may have other reasons to recommend a cholecystectomy.

What are the risks of a cholecystectomy?

Some possible complications of a cholecystectomy may include:

• Bleeding

• Infection

• Injury to the tube (the bile duct) that carries bile from the gallbladder to the small intestine

• Liver injury

• Scars and a numb feeling at the incision site

• A bulging of organ or tissue (a hernia) at the incision site

During a laparoscopic procedure, surgical tools are put into your belly. This may hurt your intestines or blood vessels.

You may have other risks that are unique to you. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for a cholecystectomy?

• Your healthcare provider will explain the procedure to you. Ask him or her any questions you have.

• You may be asked to sign a consent form that gives permission for the procedure. Read the form carefully and ask questions if anything is not clear.

• Your provider will ask questions about your past health. He or she may also give you a physical exam. This is to make sure you are in good health before the procedure. You may also need blood tests and other diagnostic tests.

• You must not eat or drink for 8 hours before the procedure. This often means no food or drink after midnight.

• Tell your provider if you are pregnant or think you may be pregnant.

• Tell your provider if you are sensitive to or allergic to any medicines, latex, tape, and anesthesia medicines (local and general).

• Tell your provider about all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.

• Tell your provider if you have a history of bleeding disorders. Let your provider know if you are taking any blood-thinning medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.

• If this is an outpatient procedure, you will need to have someone drive you home afterward. You won’t be able to drive because of the medicine given to relax you before and during the procedure.

• Follow any other instructions your provider gives you to get ready.

What happens during a cholecystectomy?

You may have a cholecystectomy as an outpatient or as part of your stay in a hospital. The way the surgery is done may vary depending on your condition and your healthcare provider’s practices.

A cholecystectomy is generally done while you are given medicines to put you into a deep sleep (under general anesthesia).

Generally, a cholecystectomy follows this process:

1. You will be asked to take off any jewelry or other objects that might interfere during surgery.

2. You will be asked to remove clothing and be given a gown to wear.

3. An intravenous (IV) line will be put in your arm or hand.

4. You will be placed on your back on the operating table. The anesthesia will be started.

5. A tube will be put down your throat to help you breathe. The anesthesiologist will check your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

6. If there is a lot of hair at the surgical site, it may be clipped off.

7. The skin over the surgical site will be cleaned with a sterile (antiseptic) solution.

Open method cholecystectomy

1. An incision will be made. The incision may slant under your ribs on the right side of your abdomen. Or it may be made in the upper part of your abdomen.

2. Your gallbladder is removed.

3. In some cases, 1 or more drains may be put into the incision. This allows drainage of fluids or pus.

Laparoscopic method cholecystectomy

1. About 3 or 4 small incisions will be made in your abdomen. Carbon dioxide gas will be put into your abdomen so that it swells up. This lets the gallbladder and nearby organs be easily seen.

2. The laparoscope will be put into an incision. Surgical tools will be put through the other incisions to remove your gallbladder.

3. When the surgery is done, the laparoscope and tools are removed. The carbon dioxide gas is let out through the incisions. Most of it will be reabsorbed by your body.

Procedure completion, both methods

1. The gallbladder will be sent to a lab for testing

2. The incisions will be closed with stitches or surgical staples

3. A sterile bandage or dressing or adhesive strips will be used to cover the wounds

What happens after a cholecystectomy?

In the hospital

After the procedure, you will be taken to the recovery room to be watched. Your recovery process will depend on the type of surgery and the type of anesthesia you had. Once your blood pressure, pulse, and breathing are stable and you are awake and alert, you will be taken to your hospital room.

A laparoscopic cholecystectomy may be done on an outpatient basis. In this case, you may be discharged home from the recovery room.

You will get pain medicine as needed. A nurse may give it to you. Or you may give it to yourself through a device connected to your IV (intravenous) line.

You may have a thin plastic tube that goes through your nose into your stomach. This is to remove air that you swallow. The tube will be taken out when your bowels are working normally. You won’t be able to eat or drink until the tube is removed.

You may have 1 or more drains in the incision if an open procedure was done. The drains will be removed in a day or so. You might be discharged with the drain still in and covered with a dressing. Follow your provider’s instructions for taking care of it.

You will be asked to get out of bed a few hours after a laparoscopic procedure or by the next day after an open procedure.

Depending on your situation, you may be given liquids to drink a few hours after surgery. You will slowly be able to eat more solid foods as tolerated.

Arrangements will be made for a follow-up visit with your provider. This is usually 2 to 3 weeks after surgery.

At home

Once you are home, it’s important to keep the incision clean and dry. Your provider will give you specific bathing instructions. If stitches or surgical staples are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and usually will fall off within a few days.

The incision and your abdominal muscles may ache, especially after long periods of standing. If you had a laparoscopic surgery, you may feel pain from any carbon dioxide gas still in your belly. This pain may last for a few days. It should feel a bit better each day.

Take a pain reliever as recommended by your provider. Aspirin or other pain medicines may raise your risk of bleeding. Be sure to take only medicines your healthcare provider has approved.

Walking and limited movement are generally fine. But you should avoid strenuous activity. Your provider will tell you when you can return to work and go back to normal activities.

Call your provider if you have any of the following:

• Fever or chills

• Redness, swelling, bleeding, or other drainage from the incision site

• More pain around the incision site

• Yellowing of your skin or the whites of your eyes (jaundice)

• Belly or abdominal pain, cramping, or swelling

• No bowel movement or gas for 3 days

• Pain behind your breastbone

Infections and bacteriological data after laparoscopic and open gallbladder surgery

. 1998 May;39(1):27-37.

doi: 10. 1016/s0195-6701(98)90240-7.

P T den Hoed 
¹
, R U Boelhouwer, H F Veen, W C Hop, H A Bruining

Affiliations

Affiliation

• ¹ Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands.

• PMID:

  9617682

• DOI:

  10.1016/s0195-6701(98)90240-7

P T den Hoed et al.

J Hosp Infect.

1998 May.

. 1998 May;39(1):27-37.

doi: 10.1016/s0195-6701(98)90240-7.

Authors

P T den Hoed 
¹
, R U Boelhouwer, H F Veen, W C Hop, H A Bruining

Affiliation

• ¹ Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands.

• PMID:

  9617682

• DOI:

  10.1016/s0195-6701(98)90240-7

Abstract

In two hospitals 637 patients undergoing cholecystectomy between June 1989 and June 1993 were entered into a prospective audit. The aim of this study was to determine the incidence of postoperative infections, especially wound infections, after open and laparoscopic biliary surgery and to assess the bacteriological data on these patients. The incidence of minor wound infection was 10.4% (66/637), of major wound infection 3.6% (23/637) and the overall incidence was 14% (89/637). The incidence of wound infection after laparoscopic cholecystectomy was 5.3% (10/189) and all were minor. Significant specific risk factors for developing a wound infection after laparoscopic cholecystectomy were emergency of the operation (P = 0. 046) and acute cholecystitis (P = 0.014). Overall, bile cultures were positive in 22%. There were 85 patients (13.3%) with positive bile from the gallbladder. From the laparoscopically operated patients 2.8% had a positive bile culture. The predominant micro-organisms from gallbladder bile were Escherichia coli (56 isolates), Klebsiella spp. (20 isolates) and Streptococcus spp. (16 isolates). There was no relationship between positive gallbladder cultures and wound infection. The consequences of wound infections can be serious and this study showed a morbidity rate comparable with the literature. The incisions used in laparoscopic gallbladder surgery are less susceptible to major problems. This combined with the significantly lower incidence of wound infections after laparoscopic cholecystectomy suggests that routine antibiotic prophylaxis as recommended for biliary surgery in general is now questionable.

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Cancer treatment

Gallbladder cancer

Gallbladder cancer (GBC) is a rare disease that develops with cholelithiasis, chronic cholecystitis. Among malignant tumors of the gastrointestinal tract, gallbladder cancer is in fifth place. The tumor process is detected in most cases in women after 50 years. In 70% of cases, gallbladder cancer is represented by adenocarcinoma, in other cases – by papillary or squamous cell carcinoma.

The tumor is located on the neck and bottom of the bladder. The disease must be diagnosed and treated as early as possible, because the tumor can quickly progress and affect other organs. The peculiarity of RZHP is precisely in its pronounced malignancy and local spread to the liver. Metastasis occurs along the paths of lymphatic drainage to the nearest tissues, the parietal peritoneum, pancreas, and para-aortic tissue. The prognosis in such cases is usually unfavorable. In order not to start the disease, you need to contact an oncologist at the first alarming signs. LISOD specialists know the latest methods of gallbladder cancer treatment.

Diagnosis

LISOD uses world medical standards to diagnose gallbladder cancer.

• Laboratory research is carried out in a clinical laboratory equipped with modern equipment. For diagnostics, a special spectral system is used, which allows obtaining results with high accuracy. An increase in bilirubin levels indicates the presence of liver or gallbladder disease, including gallbladder cancer. Also, the study of the levels of alkaline phosphatase and aspartate aminotransferase helps to identify gallbladder disease.
• Ultrasound allows not only to detect a tumor, but also its spread to the walls of the gallbladder and liver. This method is especially effective when used during endoscopy or laparoscopy. This technique makes it possible to examine the gallbladder at close range.
• Computed tomography (CT) is used for both initial diagnosis and tumor staging. In addition, the state of the pancreas and liver is specified. This allows LISOD specialists to properly plan surgical treatment.
• Cholangiography (contrast examination of the bile ducts) also helps in the diagnosis of gallbladder tumors.
• Laparoscopy. Through a small incision in the anterior abdominal wall, a laparoscope is inserted into the abdominal cavity to examine the internal organs, including the gallbladder. During this study, a biopsy is taken (taking a suspicious piece of tissue for microscopic examination) and the stage (prevalence) of the tumor is specified.
  In LISOD, when performing such operations, modern endoscopic and laparoscopic equipment is used, which employs leading specialists – endoscopic surgeons who are proficient in these techniques (both diagnostics and performing surgical interventions in full). The laparoscopic method allows you to make an accurate and correct diagnosis, determine the volume and stage of the process, and also choose the tactics of treatment.

The Comprehensive Examination allows LISOD specialists to confirm or refute the diagnosis of gallbladder cancer.

Treatment

Surgery is the main method in the treatment of gallbladder cancer.

Cholecystectomy is the surgical removal of the gallbladder and its surrounding tissues for cancer of the gallbladder. It is also possible to remove regional (neighboring) lymph nodes. For gallbladder surgery, LISOD uses the laparoscopic method. Laparoscopy of the gallbladder consists in the fact that through small incisions (0.5 – 1.5 cm) with a special optical device, a laparoscope (a telescopic tube containing a lens system and attached to a video camera) penetrates into the abdominal cavity. Thus, the surgeon sees the surgical field on the monitor screen and has the opportunity to excise the neoplasm with very thin special instruments. Then the excised tissues are placed in special bags-containers and removed. Laparoscopy of the gallbladder is a low-traumatic method, easier tolerated by patients, and there are fewer adverse reactions.

For inoperable cases, chemotherapeutic treatment is carried out, and sometimes, if indicated, radiotherapy is prescribed.

Symptoms

Common signs of gallbladder cancer are pain , liver enlargement , palpable tumor-like mass in the abdomen . Sometimes there is gastric dyspepsia , pain in the gallbladder . The pain is localized in the right hypochondrium and epigastric region, gives to the right shoulder. Similar pains occur with stone and tubeless cholecystitis. In most cases, gallbladder cancer is combined with cholelithiasis and cholecystitis.

Due to obstruction of the common bile duct, jaundice appears , which, unlike blockage of the duct by a stone, develops without previous hepatic colic and fever. Anemia is rare, there is no noticeable weight loss.

Risk factors

Several risk factors are now known to increase the risk of gallbladder cancer. However, the presence of one or even several of these factors does not necessarily mean the development of cancer.

• Gallbladder stones and inflammation. 75-90% of patients with gallbladder tumors had stones or signs of chronic inflammation of this organ. People with large gallbladder stones were more likely to develop a tumor than those with multiple small gallstones. However, keep in mind that most people with gallstones will never develop cancer.
• “Porcelain” gallbladder. In patients with severe inflammation of the gallbladder, the walls of the gallbladder may be covered with calcium overlays, which significantly increases the risk of developing cancer. Therefore, we recommend the removal of such a gallbladder.
• Typhoid fever. People infected with the bacterium Salmonella, which causes typhoid fever, have a 6-fold increased risk of developing gallbladder cancer. However, typhoid fever is a rare disease.
• Common bile duct cysts contain bile, may increase in size and contain areas of precancerous changes, which increase the risk of developing gallbladder cancer.
• Cigarette smoking also increases the risk of gallbladder cancer.
• Professional hazards. Workers in the rubber and steel industries have an increased risk of developing gallbladder cancer as a result of exposure to a number of chemicals, such as nitrosamines.
• Malformations of the pancreatobiliary zone at the confluence of the ducts of the liver, gallbladder, and pancreas increase the risk of developing gallbladder cancer.
• Age. Most patients with gallbladder cancer are over 70 years of age.
• Gallbladder polyps of 1 cm or more often turn into a malignant tumor. Therefore, we recommend removal of the gallbladder in this category of people.
• Obesity is also a risk factor for gallbladder cancer.
• Diet. The high carbohydrate and low fiber content increases the likelihood of gallbladder tumors.
• Helicobacter pylori. The presence of such an infection increases the risk of developing both stomach and duodenal ulcers, as well as the occurrence of stones and gallbladder cancer.

Prevention

In most cases, gallbladder cancer cannot be prevented. However, some risk factors can be avoided.

• Maintaining a normal weight is one of the ways to reduce the risk of both cancer of this localization and other tumors (colon, prostate, uterus, kidney, breast).
• Adequate consumption of fruits and vegetables and limiting animal fat intake may reduce the risk of developing gallbladder cancer.
• Daily physical activity is another way to reduce the risk of gallbladder cancer.
• Smoking cessation also reduces the risk of developing gallbladder cancer.
• Treatment of gallbladder stones reduces the likelihood of chronic inflammation and the risk of cancer.

Questions and Answers

Questions from patients and answers from our specialists are published in this section. Each person’s question concerns a specific problem related to their disease. Israeli clinical oncologists and the head doctor of LISOD, MD, Professor Alla Vinnitskaya answer the patients.

The answers of specialists are based on knowledge of the principles of evidence-based medicine and professional experience. The answers correspond solely to the information provided, are for informational purposes only and do not constitute medical advice.

The main purpose of section is to provide information to the patient and family so that they can decide with their doctor about the type of treatment. The tactics of treatment offered to you may differ from the principles set forth in the answers of our specialists. Feel free to ask your doctor about the reasons for the differences. You must be sure that you are receiving the correct treatment.

Ask your doctor

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August 13, 2012
Why laparoscopy? Question price.

Gallbladder removal – EMC

In our medical center, gallbladder removal is carried out in different ways. An operation to remove the gallbladder is called a cholecystectomy.

Main types of surgeries performed at the Yekaterinburg Medical Center:

1. Laparoscopic cholecystectomy
2. Mini-approach cholecystectomy
3. Cholecystectomy with choledochotomy, intraoperative ultrasound, removal of stones from the choledochus and drainage of the choledochus according to Kehr and Pikovsky

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is most often used by the surgeons of the medical center as the newest and most promising method of removing the gallbladder. This method is more difficult to implement than the classic open cholecystectomy method, but has several advantages.

What is a laparoscope?

The laparoscope is used for laparoscopic operations, being, in fact, an endoscope for manipulations in the abdominal cavity. It consists of a tube equipped with a lens system, an optical cable and a halogen lamp. To perform laparoscopic cholecystectomy, the surgeon, along with the laparoscope, uses a set of endoscopic equipment: an endovideo system, an illuminator, an aspirator, an electrosurgical apparatus, and a monitor. Laparoscopic instruments are also needed – trocars, clamps, grippers, forceps, scissors, electrocoagulators.

Benefits of laparoscopic surgery

• low trauma and fast recovery
• less blood loss
• no need for analgesics after surgery
• discreet postoperative scars

Indications for surgery

• acute cholecystitis not amenable to medical treatment
• chronic cholecystitis
• cholelithiasis
• gallbladder blocked with stones

Contraindications for laparoscopic cholecystectomy

• abdominal adhesive disease
• diseases of the abdominal organs
• chronic diseases of organs and systems in the stage of decompensation

The course of the operation to remove the gallbladder

The surgeon during laparoscopic cholecystectomy first of all makes punctures in four places:

• in the epigastric region below the xiphoid process up to 5 mm in size
• in the right hypochondrium size 5 mm
• two punctures in the umbilical region – for inserting a video camera and extracting the gallbladder up to 10 mm in size

Through the punctures, the surgeon passes special instruments – trocars, through the trocars you can enter the instruments necessary for manipulation. It is necessary to introduce carbon dioxide into the abdominal cavity so that the surgeon can clearly see all the organs on the monitor.

The surgeon dissects the gallbladder neck, duct and cystic artery, which he crosses with the instrument. Then the gallbladder is cut off from the liver with the help of an electrocoagulator, which makes the operation bloodless. After excision of the gallbladder, its bed is examined, bleeding stops, and the bladder itself is removed by the surgeon through an incision in the umbilical region. Seams are applied. Sometimes it becomes necessary to apply drainage, which is removed on the second or third day after the operation. The whole operation lasts about 40-50 minutes and takes place under general anesthesia.

Consequences of gallbladder removal

Complications after laparoscopic cholecystectomy are rare, but possible. These include:

• accidental injury to abdominal organs
• damage to the biliary tract
• outflow of bile from bile ducts
• minor bleeding of the removed bladder bed

The surgeons of our medical center are taking measures to prevent the development of postoperative complications, the main of which, of course, is the operation with strict adherence to the methodology and technique.

Rehabilitation period

Many patients of our center can be discharged from the hospital on the third day after the operation, having the strength to return to their daily activities. The stitches are removed on the seventh day after the operation, cosmetic stitches dissolve on their own. After two weeks, the patient can start work.

In the multidisciplinary Medical Center, our surgeons perform gallbladder removal using other surgical techniques.

Mini-approach cholecystectomy

In this technique, a retractor-manipulator is used, the use of which allows to reduce the depth of the surgical approach and increase the angle of the surgical action by almost four times. The surgeon makes a 4 cm long incision in the region of the right hypochondrium and inserts a retractor-manipulator into the wound, then spreads the instruments and fixes them with a screw. Then the retractor-manipulator moves to the bottom of the gallbladder to its body and neck. The surgeon performs cholecystectomy with simultaneous suturing of the bed and insertion of a drainage tube, which significantly reduces the time of the operation.

This technique does not use carbon dioxide, and the operation is performed through a micro-incision, which significantly expands the indications for cholecystectomy for patients suffering from chronic respiratory and cardiovascular diseases.

Cholecystectomy with choledochotomy

Surgeons of our medical center often have to operate on patients with acute cholecystitis and obstructive jaundice. In this case, the operation of choledochotomy is used, in which the surgeon removes the holedoch. Bile is removed from it by suction, stones are groped and pushed to the opening in the duct. If possible, they are removed by the tool. At the end of the operation, the patency of the excretory ducts is checked.

Cholecystectomy with choledochotomy and removal of stones from the choledochus, intraoperative ultrasound, drainage of the choledochus according to Kerr, Pikovsky

intestinal fistula.