Laparoscopic Cholecystectomy

What is Laparoscopic Cholecystectomy?

Laparoscopic cholecystectomy is a minimally invasive surgical procedure using a laparoscope to remove the gallbladder for the treatment of gallbladder problems.

The gallbladder is a small, hollow organ situated below the liver. Bile juice produced by the liver is stored in the gall bladder and transported to the small intestine through ducts for the digestion of fats. 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.

Laparoscopic cholecystectomy procedure involves making a few small incisions on the abdomen and passing a laparoscope - a thin fibre-optic instrument with a camera and lens attached to it – and miniature surgical instruments through the incisions to remove the problematic gallbladder. It is a less invasive surgical method than an open surgery that involves making a large incision on the abdomen.

Indications for Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is recommended by your doctor if you are suffering from gallbladder conditions including inflammation of the gallbladder (cholecystitis) gallstones in the bile duct or the gallbladder, gallbladder infection, gallbladder cancer, or inflammation of the pancreas, all of which are unresponsive to antibiotics or other treatments.

Preparation for Laparoscopic Cholecystectomy

In general, preparation for laparoscopic cholecystectomy will involve the following steps:

  • Preoperative workup, such as medical evaluation, blood work, and imaging will be done.
  • Additional tests may be advised if required depending on your medical history.
  • An anesthesiologist will meet you to discuss the type of anaesthesia that will be used during surgery.
  • You should inform your doctor of any medications or supplements that you are taking or any medical conditions you have such as lung or heart disease.
  • If you are on any medicines such as blood thinners or any supplements, they may need to be stopped temporarily prior to surgery.
  • You will be asked if you have allergies to medications, anaesthesia, or latex (surgical gloves).
  • You may take a shower the night prior to or the morning of the operation.
  • You should refrain from food or drink at least 8 hours prior to your surgery.
  • Refrain from smoking and alcohol at least a week before surgery and several weeks after surgery.
  • Arrange for someone to drive you home after surgery.
  • Your surgeon will thoroughly explain the procedure in detail and obtain your written consent for surgery.

Procedure for Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is a less invasive surgical method that uses a device called a laparoscope and takes about an hour or two. 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 procedure is performed under general anaesthesia. Your surgeon makes 3 to 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. At the end of the procedure, the scope and the surgical instruments are withdrawn, and the incisions are closed with sutures and bandaged.

Postoperative Care and Instructions

In general, postoperative care instructions and recovery after laparoscopic cholecystectomy will involve the following steps:

  • You will be transferred to the recovery room where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs as you recover from the effects of anaesthesia.
  • You may go home the same day of the surgery or require an overnight stay in the hospital before being discharged home the next day.
  • You may experience pain and discomfort in the abdominal area, as well as in the shoulder area due to the air or carbon dioxide used during the operation. Medications are prescribed as needed to manage these.
  • Application of ice on the operated area is also recommended for additional comfort.
  • Your doctor may prescribe antinausea medications for risks associated with anaesthesia such as nausea and vomiting.
  • Antibiotics are also prescribed to address the risk of surgery-related infection.
  • Refrain from smoking and alcohol for a specific period of time as it can hinder the healing process.
  • Refrain from strenuous activities and lifting anything heavier than 5 pounds until the first follow-up visit. These activities include housework, yard work, gardening, mowing, etc.
  • Instructions on surgical site care, diet, and bathing will be provided. Refrain from fatty foods and include a diet rich in fruits and vegetables.
  • You should be able to resume your normal daily routines and return to work in a week’s time.
  • A follow-up appointment will be scheduled to monitor your progress.

Benefits of Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy has several benefits over traditional open cholecystectomy. These include:

  • Small surgical cuts
  • Minimal pain and bleeding
  • Shorter hospital stay
  • Faster recovery time
  • Minimal muscle trauma
  • Reduced scarring
  • Reduced risk of infection
  • Quick return to normal activities
  • Minimal damage to surrounding tissues

Risks and Complications

Laparoscopic cholecystectomy is a relatively safe surgery; however, as with any surgery, some risks and complications may occur, such as:

  • Infection
  • Bleeding
  • Hernias
  • Blood clots
  • Leakage of bile fluid
  • Allergic/anaesthetic reactions
  • Injury to nerves and blood vessels
  • Damage to the liver, bile ducts, or intestines.
  • The Clementine Churchill Hospital
  • NHS Royal Free London
  • UCL
  • NHS London North West
  • Royal College of Surgeons of England