Anyone who has gallstones and repeatedly suffers from painful colic is well advised to have the gallbladder removed. It is the only way to remove gallstones in the long term and prevent them from forming again.
What is cholecystectomy?
Cholecystectomy is the surgical removal of the gallbladder via laparoscopy. Cholecystectomy is the surgical removal of the gallbladder via laparoscopy. A cholecystectomy is indicated whenever gallstones cause discomfort and repeated colic. It can be performed in two different ways, both under general anesthesia: open cholecystectomy with an abdominal incision and laparoscopic cholecystectomy, in which special laparoscopic instruments are inserted through tiny incisions. Most cholecystectomies today are performed laparoscopically because they are gentler on patients. They are now routine procedures, and the risk of complications is low.
Function, effect, and goals
The gallbladder is a storage organ for bile produced in the liver. During heavy and fatty meals, bile is sent through the bile ducts to the intestines for digestion. Because it is primarily a storage organ for bile formed in the liver, the body can do without it and many patients feel little restriction after cholecystectomy. Complete removal of the gallbladder is the only sure way to prevent recurrence of stone formation. After the operation, the liver takes over its function. Removal of the gallbladder is always mandatory for the following complaints:
- In the case of gallstones that block the bile ducts and cause bile stasis.
- In fistulas between the bile and gastrointestinal tract.
- In case of perforation of the gallbladder (due to accident, etc.)
- In the case of tumors in the gallbladder or bile ducts.
For gallstones, surgery is performed only if they cause discomfort such as colic and could threaten complications. Today, a cholecystectomy is performed as standard laparoscopic surgery via laparoscopy. As with all surgical procedures in minimally invasive keyhole surgery, special surgical instruments are inserted into the abdomen through 3 to 4 tiny skin incisions and the operation is performed under the view of a camera, which transmits the images to a monitor during the operation. For better visibility and mobility of the instruments, the abdomen is inflated with carbon dioxide. The bile duct and supplying artery are then clamped, and the gallbladder is removed from the bile bed and removed from the body in a retrieval bag through one of the accesses. Advantages are that there are only tiny, barely visible scars and a shorter hospital stay. Newer laparoscopic procedures use the single-port technique, in which surgery is performed through only one approach at the belly button. Sometimes it may be necessary to switch from laparoscopic to conventional cholecystectomy during surgery if there is a risk of injury to organs or adjacent tissue from the laparoscopic instruments. In conventional open surgery, an incision is made under the right costal arch to open the surgical area. The supplying artery and bile duct are then clamped, and the gallbladder is removed. To reduce the risk of infection, a wound drain is usually placed and an antibiotic is given before surgery. Thrombosis prevention is given only if needed. Most patients can leave the hospital after 3 to 5 days. The disadvantage of conventional gallbladder removal is the larger scar and slightly longer hospital stay.
Risks, side effects, and hazards
In general, surgical removal of the gallbladder is a standard, routine procedure and is not associated with any particular risks unless problems arise from unfavorable physical conditions such as adhesions in the surgical area. Complications can arise if adjacent tissue or other organs are injured during surgery. In the bile ducts, this can result in leaks to other organs and into the abdominal cavity, which must be treated. After biliary surgery, wound healing problems may occur due to pre-existing inflammation.If surgery is performed as part of a laparoscopy and the gallbladder is inadvertently opened, peritonitis can develop, which in the worst case can be fatal. On the bile ducts, scarring can cause narrowing with bile stasis, which can cause jaundice and liver damage. Sometimes stones remain in the bile ducts or, in rare cases, new stones form in them. In addition, bleeding and secondary bleeding may occur, as well as pain and nerve injury with numbness. If gallstones remain in the bile ducts after surgery, they must be removed endoscopically during ERCP. However, these risks and complications occur only in very rare cases. Since the gallbladder serves only as a storage organ for the bile produced in the liver, the body can do without it. Shortly after surgery, patients can resume eating normally, and most have little or no restrictions after gallbladder removal unless they regularly eat meals that are too high in fat. Diarrhea may occur with some foods such as coffee, dairy products, very fatty or sweet foods. Here it helps to pay attention to the triggers and to eat or drink less of them accordingly. There is usually no need for further therapy. Fat metabolism can be supported with artichoke preparations if necessary.
