Biliary Surgery: Laparoscopic Cholecystectomy

Gallbladder Anatomy

The gallbladder is a small pear-shaped storage organ located under the liver on the right side of the abdomen. It stores bile (yellowish-brown fluid) produced by the liver, which is required to digest fat. As food enters the small intestine, cholecystokinin (a hormone) is released, which signals the contraction of the gallbladder to release bile into the small intestine through the common bile duct (a small tube connecting liver and intestine).

Disease Overview

Although the gallbladder helps in digestion, it is not an essential part of the body as bile can reach the small intestine in many other ways. Therefore, gallbladder removal is a safe treatment for gallbladder problems. Major gallbladder diseases include gallstones (concentrated bile) that can block the ducts (biliary colic), and cholecystitis (inflammation of the gallbladder). The removal of the gallbladder is performed by a procedure called cholecystectomy and is the most effective way to treat gallstones or other gallbladder diseases.

Laparoscopic Cholecystectomy Procedure

Surgical removal of the gallbladder can be done one of two ways:

Open Cholecystectomy

Open method involves a 5-7-inch incision in the upper right-hand side of the abdomen, below the ribs. Your surgeon removes the gallbladder through the large, open incision.

Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is a less invasive surgical method that uses a device called a laparoscope. The laparoscope is a small, thin tube with a light and tiny video camera (connected to a television monitor) attached at the end, which helps visualise inside the abdomen during the operation.

The surgery is performed under general anaesthesia. Your surgeon makes 3-4 small incisions in the abdomen. The laparoscope is inserted into the body through one of the incisions. The television monitor will guide the surgeon to insert other surgical instruments through the other incisions. Air or carbon-dioxide is injected into the abdomen to inflate the abdominal cavity so that the gallbladder and other adjacent organs can be visualised easily. Your surgeon first cuts the bile duct and blood vessels leading to the gallbladder, and then removes the gallbladder.

Your surgeon may also perform a procedure called a cholangiogram during the surgery, which uses X-rays and a dye injected into the body to view the bile ducts. This is done to identify gallstones that could have been missed, obstructions or narrowing of the bile ducts. If stones are present, the surgeon uses a special instrument and removes them.

Postoperative Care Following Laparoscopic Cholecystectomy

Following laparoscopic surgery, you can go home on the same day or the next day after recovering from the effects of anaesthesia. You can return to normal activities within 24 hours and resume work in a week. However, you should not engage in strenuous activities for a few more weeks.

Risks and Complications of Laparoscopic Cholecystectomy

The removal of the gallbladder is generally a safe procedure, but like all operations, there are risks and complications associated with the procedure. Some of these include bleeding, infection, injury to the bile duct, leakage of bile fluid, and damage to the bowel and large blood vessels when surgical instruments are inserted through the abdominal incisions.

Advantages of Laparoscopic Cholecystectomy

The advantages of laparoscopic cholecystectomy when compared to open surgical technique include shorter hospital stay, smaller incisions, less post-operative pain and faster recovery.