Laparoscopic Cholecystectomy

Cholecystectomy is the surgical removal of a patient's gallbladder. It is most commonly used in the management of gallstones. It was one of the first operations to be performed with laparoscopic surgery in the late eighties and early nineties and is now the standard approach.

Patients with abdominal pain due to gallstones, typically suffer from pain in the upper abdomen, usually on the right of the midline spreading into the back. The pain is often triggered by eating fatty foods, usually occurs in the late evening, lasting into the early hours of the morning. It is an intense pain that patients cannot get comfortable with; in and out of bed or chair and pacing the room until the pain subsides. It is often associated with nausea and vomiting. Sometimes the pain becomes constant, worse on moving, if the patient develops cholecystitis. Gallstones can also cause obstructive jaundice and pancreatitis.

Laparoscopic cholecystectomy is usually performed as a day-case or with an overnight stay, under general anaesthetic. Four incisions are needed, three are half a centimetre or less in the lenght, the fourth is a little longer, but hidden in the patient's umbilicus. During the procedure it is usual to perform an x-ray to check that no gallstones have escaped from the gallbladder and become trapped in the bile duct.

Most patients will be back to normal in a week to ten days. Complications are unusual. Occasionally it is not possible to complete the surgery laparoscopically and instead an open horizontal incision below the ribs on the right side will be used. Bleeding is an uncommon complication; patients will occasionally get a wound infection in the umbilicus. From a surgeon's perspective the main concern is avoiding an injury to the bile duct; this is a one in a thousand risk. These operations although common can be very difficult, inflammation around the gallbladder can make it difficult to identify the normal anatomical landmarks. For this reason patients' should choose an experienced laparoscopic surgeon.

Guy Slater FRCS


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