Laparoscopic gallbladder surgery for gallstones

Surgery Overview

Laparoscopic gallbladder surgery (cholecystectomy) removes the gallbladder and gallstones through several small incisions in the abdomen. The surgeon inflates your abdomen with air or carbon dioxide in order to see clearly.

The surgeon inserts a lighted scope attached to a video camera (laparoscope) into one incision near the belly button. The surgeon then uses a video monitor as a guide while inserting surgical instruments into the other incisions to remove your gallbladder.

Before the surgeon removes the gallbladder, you may have a special X-ray procedure called intraoperative cholangiography, which shows the anatomy of the bile ducts.

You will need general anesthesia for this surgery, which usually lasts 2 hours or less.

After surgery, bile flows from the liver (where it is made) through the common bile duct and into the small intestine. Because the gallbladder has been removed, the body can no longer store bile between meals. In most people, this has little or no effect on digestion.

In about 2 out of 10 laparoscopic gallbladder surgeries, the surgeon needs to switch to an open surgical method that requires a larger incision.¹ Examples of problems that can require open rather than laparoscopic surgery include unexpected inflammation, scar tissue, injury, or bleeding.

What To Expect After Surgery

You may have gallbladder surgery as an outpatient, or you may stay 1 or 2 days in the hospital.

After surgery you may have:

• Pain in your shoulder and abdomen that lasts 24 to 72 hours (from gas used to inflate the abdomen during surgery). It may last as long as a week.
• Widespread muscle aches from anesthesia.
• Diarrhea.
• Minor inflammation or drainage at the surgical wound sites.
• Loss of appetite and some nausea.

Most people can return to their normal activities within a week to 10 days. People who have laparoscopic gallbladder surgery are sore for about a week, but within 2 to 3 weeks they have much less discomfort than people who have open surgery. No special diets or other precautions are needed after surgery.

Why It Is Done

Laparoscopic gallbladder surgery is the best method of treating gallstones that cause symptoms, unless there is a reason that the surgery should not be done.

Laparoscopic surgery is used most commonly when no factors are present that may complicate the surgery. Conditions that may require an open surgery instead of a laparoscopic surgery include:

• Severe inflammation or infection of the bile duct (cholangitis).
• Inflammation of the abdominal lining (peritonitis).
• High pressure in blood vessels in the liver. This is caused by cirrhosis of the liver (portal hypertension).
• Being in the third trimester of pregnancy.
• A major bleeding disorder or use of medicines to prevent blood clotting (blood thinners or anticoagulants).
• Scar tissue from previous abdominal surgeries. Scar tissue may make laparoscopic surgery more difficult.
• A severe lung disease, such as emphysema, because the way the abdomen is inflated with air for surgery may make it harder to breathe.

Depending on the surgeon's experience and how severe your condition is, laparoscopic surgery also may not be an option if you have:

• Sudden (acute) inflammation or infection of the gallbladder (although laparoscopic surgery is being done more often in this situation).
• Active inflammation or infection of the pancreas (pancreatitis).
• A minor bleeding disorder.
• Gallstones in the common bile duct. A separate procedure called endoscopic retrograde cholangiopancreatography that is done before or after the laparoscopic surgery can remove stones in the common bile duct.
• Excessive body weight.

How Well It Works

Laparoscopic gallbladder surgery is safe and effective.¹ Surgery gets rid of gallstones located in the gallbladder. It does not remove stones in the common bile duct. Gallstones can form in the common bile duct years after the gallbladder is removed, although this is rare.

Risks

The overall risk of laparoscopic gallbladder surgery is very low. The most serious possible complications include:

• Infection of an incision.
• Internal bleeding.
• Injury to the common bile duct.
• Injury to the small intestine by one of the instruments used during surgery.
• Risks of general anesthesia.

Other uncommon complications may include:

• Injury to the cystic duct, which carries bile from the gallbladder to the common bile duct.
• Gallstones that remain in the abdominal cavity.
• Bile that leaks into the abdominal cavity.
• Injury to abdominal blood vessels, such as the major blood vessel carrying blood from the heart to the liver (hepatic artery). This is rare.
• A gallstone being pushed into the common bile duct.
• The liver being cut.

More surgery may be needed to repair these complications.

After gallbladder surgery, some people have ongoing abdominal symptoms, such as pain, bloating, gas, and diarrhea (post-cholecystectomy syndrome).

What To Think About

Recovery is much faster and less painful after laparoscopic surgery than after traditional open surgery.^{1, 2}

• The hospital stay after laparoscopic surgery is shorter than after open surgery. People generally go home the same day or within 1 day, compared with 2 to 4 days or longer for open surgery.
• Recovery is faster after laparoscopic surgery.
• You will spend less time away from work and other activities after laparoscopic surgery (about a week to 10 days compared with 4 to 6 weeks).

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Author:	Monica Rhodes	Last Updated: September 21, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Anne C. Poinier, MD - Internal Medicine Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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