What is a cholecystectomy?
In cholecystectomy, the gallbladder is removed by means of surgery. The operation is performed very frequently and predominantly through small incisions in the abdominal wall (minimally invasive, laparoscopic cholecystectomy). However, in some cases, an open surgical procedure (conventional cholecystectomy) is still necessary.
The gallbladder
Bile is released into the small intestine during the digestive process and is essential for the absorption and processing of dietary fats. Inflammation of the gallbladder (cholecystitis) is most often caused by gallstones, which can form when cholesterol levels are elevated, for example.
When is a cholecystectomy performed?
- Gallbladder perforation (e.g. in the course of an accident)
- connecting ducts between the bile ducts and the gastrointestinal tract (so-called biliodigestive fistulas)
- large stones in the bile ducts that lead to a back-up of bile (cholestasis) and cannot be removed in any other way.
- Gallbladder or bile duct tumors (removal is then usually performed as part of a larger operation).
What is done during a cholecystectomy?
Basically, gallbladder removal can be done via two procedures: conventional cholecystectomy (open-surgical) and laparoscopic cholecystectomy (minimally invasive).
The conventional cholecystectomy
Before surgery, the administration of an antibiotic reduces the risk of infection. Thrombosis prevention may be necessary under certain circumstances, but is not administered as standard. Patients are usually able to leave the hospital after three to five days.
The laparoscopic cholecystectomy
The abdominal cavity is expanded by pumping in carbon dioxide, thus ensuring better visibility and mobility for the operating physicians (so-called pneumoperitoneum). Then, with the help of the instruments, the gallbladder can be removed under visual control and transported to the outside through one of the incisions.
Newer procedures use only a single access route through which all instruments are introduced into the abdominal cavity (“single-site approach”) or natural orifices, for example the gastrointestinal tract or the vagina (“NOTES” = “natural orifice transluminal endoscopic surgery”). These surgical methods are usually performed only in very experienced surgical centers.
Laparoscopic gallbladder removal should not be performed under the following circumstances:
- in the case of a severe cardiovascular condition, because the introduced air increases the pressure in the abdominal cavity and thus makes it more difficult for blood to return to the heart.
- in patients who have a blood clotting disorder, because effective hemostasis is much more difficult with a laparoscopic cholecystectomy than with an open surgical technique.
- in patients who have already undergone abdominal surgery and who are therefore at risk of adhesions in the abdominal cavity.
Change of surgical technique (conversion)
What are the risks of cholecystectomy?
Cholecystectomy is a relatively safe procedure, but complications cannot be completely ruled out. These include bleeding, infection or injury to adjacent organs are rare, however. Studies have shown an increased rate of complications in patients who have undergone conventional gallbladder surgery.
What do I need to keep in mind after a cholecystectomy?
Diet after gallbladder removal
Immediately after gallbladder removal, clear liquids can already be drunk. Normal food intake (light food) can usually be started on the first day after surgery. To avoid the diarrhea described above, it is necessary to observe several things in the long term:
- Increase fiber content: Cereals such as wheat and barley contain a lot of dietary fiber and have a positive effect on intestinal motility. However, the amount of fiber should first be increased slowly over several weeks, otherwise it can lead to unpleasant flatulence and cramps.
- Eat smaller meals spread throughout the day: This helps the gastrointestinal tract to better utilize the nutrients.
The performance and follow-up of a cholecystectomy are now part of routine medical practice, making it a safe therapy.
