Is Laparoscopic Cholecystectomy Major Surgery?

During a minimally invasive laparoscopic cholecystectomy to remove a gallbladder, the surgeon must make several one-inch incisions in the abdomen.

Laparoscopic cholecystectomy is a minimally invasive surgery to remove the gallbladder. In an open cholecystectomy, the surgeon removes the gallbladder through a 5- to 8-inch long incision made on the right side of the abdomen below the ribs.  In a laparoscopic cholecystectomy the surgeon makes several small 1 inch long incisions. The surgeon inserts a thin tube with a camera (laparoscope) into the incision and removes the gallbladder with tiny surgical tools, guided by the images on the camera.

Laparoscopic cholecystectomy is a common but major surgery. It carries a few risks and potential complications and may not be the best solution in particular situations.

The gallbladder is an organ in the abdomen that produces bile which helps in breaking down the food in the stomach. The most common reason for removal of the gallbladder is the presence of gallstones. Gallstones are hard deposits which form in the gallbladder.

Gallbladder removal is generally not recommended for people without symptoms unless there is a high risk of developing complications from the gallstones, such as when there is associated diabetes. Gallbladder removal is considered for patients with symptoms.

The symptoms of gallstones may include:

• abdominal pain
• indigestion
• nausea and vomiting
• fever
• jaundice

A laparoscopic cholecystectomy may considered in the following situations:

• Gallstones in the gallbladder (cholelithiasis)
• Inflammation of the gallbladder (cholecystitis)
• Gallstones in the bile duct (choledocholithiasis)
• Inflammation of the pancreas (pancreatitis) caused by gallstones
• When the liver’s duct is compressed by gallstones, causing jaundice
• When a gallstone penetrates into the duodenum
• Gallbladder inflammation without gallstones (acalculous cholecystitis)
• Large polyps are present in the gallbladder

If the doctor finds gallbladder or bile duct cancer during a laparoscopic cholecystectomy, they might convert the method to an open procedure.

A gastrointestinal surgeon usually performs a laparoscopic cholecystectomy under general anesthesia. The surgery may take up to two hours.

Preparation

• The patient will undergo blood tests and imaging tests such as CT and HIDA scans.
• The patient must not eat or drink 8 hours before the procedure.
• The patient must stop taking blood thinners some days prior to the surgery as per the doctor’s advice.
• The patient must check with the doctor before taking any regular medications and inform of any allergies.
• The patient is usually given antibiotics prior to the surgery.

Procedure

• The patient lies on their back.
• An anesthesiologist administers general anesthesia and monitors the patient’s blood pressure, pulse and heart rate during the surgery.
• The doctor inflates the abdomen with carbon dioxide to improve visibility.
• The surgeon makes small incisions (usually four) in the skin on the right side of the abdomen below the ribs.
• The surgeon inserts the laparoscope and clips the blood vessels and tubes connected to the gallbladder, guided by images in a monitor.
• The surgeon cuts and removes the gallbladder through one of the incisions.
• The surgeon stops any bleeding, removes the laparoscope and sutures the incisions.

Post-procedure

• The anesthesiologist brings the patient out of anesthesia and administers painkillers.
• The patient is monitored for four to six hours in the recovery room.
• The patient may be discharged the same day or the next if all is stable.

The side effects of a laparoscopic cholecystectomy usually resolve on their own in a couple of days. Side effects include:

• Anesthetic side effects such as headache, nausea and confusion
• Pain at the incision sites, and in the shoulders due to the gas used to inflate the abdomen
• Gas and bloating
• Diarrhea or constipation
• Difficulty in digesting fat while the body gets used to functioning without a gallbladder -- this may become permanent.

It usually takes about a week to ten days to get back to normal activities after a laparoscopic cholecystectomy, however, heavy lifting and strenuous activities must be avoided for up to six weeks. Post-surgery, following a high-fiber diet and drinking plenty of water are important.

Laparoscopic cholecystectomy is one of the most commonly performed surgeries worldwide and is relatively safe. It is minimally invasive with little post-surgical pain and short recovery period.

Like any major surgery, a laparoscopic cholecystectomy entails a few risks and complications:

• Infection
• Pneumonia
• Blood clots
• Bleeding caused by injury to blood vessels
• Injury to surrounding organs such as the liver, stomach or bowel
• Bile leak from bile duct injury which may require further surgery
• Persistent abdominal pain and flatulence (postcholecystectomy syndrome) caused by retained bile duct stone, inflammation, or blocked flow of bile and digestive juices into the bowel (sphincter of Oddi dysfunction)