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Cholecystectomy
Cholecystectomy is the surgical removal of the gallbladder.
Despite the development of nonsurgical techniques, gallbladder
surgery, or cholecystectomy, is the most common method for treating
gallstones. Each year more than 500,000 Americans have gallbladder
surgery. Surgery options include the standard procedure, called
laparoscopic cholecystectomy, and an older more invasive procedure,
called open cholecystectomy.
Traditional open cholecystectomy is a major abdominal surgery in which
the surgeon removes the gallbladder through a 5- to 8-inch incision.
Patients may remain in the hospital about a week and may require
several additional weeks to recover at home.
Laparoscopic cholecystectomy
Laparoscopic cholecystectomy has now replaced open cholecystectomy as
the first-choice of treatment for gallstones unless there are
contraindications against the laparoscopic approach.
Laparoscopic cholecystectomy requires several small incisions in the
abdomen to allow the insertion of surgical instruments and a small
video camera. The camera sends a magnified image from inside the body
to a video monitor, giving the surgeon a close-up view of the organs
and tissues. The surgeon watches the monitor and performs the
operation by manipulating the surgical instruments through separate
small incisions. The gallbladder is identified and carefully separated
from the liver and other structures. Finally, the cystic duct is cut
and the gallbladder removed through one of the small incisions. This
type of surgery requires meticulous surgical skill.
Laparoscopic cholecystectomy does not require the abdominal muscles to
be cut, resulting in less pain, quicker healing, improved cosmetic
results, and fewer complications such as infection. Recovery is
usually only a night in the hospital and several days recuperation at
home.
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Complications
The most common complication with the new procedure is injury to the
common bile duct, which connects the gallbladder and liver. An injured
bile duct can leak bile and cause a painful and potentially dangerous
infection. Many cases of minor injury to the common bile duct can be
managed nonsurgically. Major injury to the bile duct, however, is a
very serious problem and may require corrective surgery. At this time
it is unclear whether these complications are more common following
laparoscopic cholecystectomy than following standard cholecystectomy.
Complications such as abdominal adhesions and other problems that
obscure vision are discovered during about 5 percent of laparoscopic
surgeries, forcing surgeons to switch to the standard cholecystectomy
for safe removal of the gallbladder.
A Consensus Development Conference panel, convened by the National
Institutes of Health in September 1992, endorsed laparoscopic
cholecystectomy as a safe and effective surgical treatment for
gallbladder removal, equal in efficacy to the traditional open
surgery. The panel noted, however, that laparoscopic cholecystectomy
should be performed only by experienced surgeons and only on patients
who have symptoms of gallstones.
In addition, the panel noted that the outcome of laparoscopic
cholecystectomy is greatly influenced by the training, experience,
skill, and judgment of the surgeon performing the procedure.
Therefore, the panel recommended that strict guidelines be developed
for training and granting credentials in laparoscopic surgery,
determining competence, and monitoring quality. According to the
panel, efforts should continue toward developing a noninvasive
approach to gallstone treatment that will not only eliminate existing
stones, but also prevent their formation or recurrence.
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