Dr. Singh is Board certified in both laparoscopic and open gallbladder surgeries.
What is the Gallbladder? The gallbladder is a pear-shaped organ that rests beneath the right side of the liver. Its main purpose is to collect and concentrate a digestive fluid (bile) produced by the liver. Bile is released from the gallbladder after eating and travels through a narrow tubular channel (bile duct) into the small intestine, aiding digestion. Removal of the gallbladder is not associated with any impairment of digestion in most people. The only known side effect from removal of the gallbladder is loose bowel movements or infrequently diarrhea. This can occur in about 5% of patients and is usually transient. Rarely it is long lasting and may require medications to control.
What Causes Gallbladder Problems? Gallbladder problems are usually caused by the presence of gallstones: small hard masses consisting primarily of cholesterol and bile salts that form in the gallbladder or in the bile duct. It is uncertain why some people form gallstones. There is no known means to prevent gallstones. These stones may block the flow of bile from the gallbladder, causing it to swell and resulting in sharp abdominal
Pain, vomiting, indigestion, and occasionally fever.
How are these Problems Found and Treated? After the patient has symptoms: Ultrasound is most commonly used to find gallstones. In a few complex cases, other X-ray tests may be used to evaluate gallbladder disease. Gallstones do not go away on their own. Some can be temporarily managed with drugs or by making dietary adjustments, such as cutting down on fat intake. This treatment has a low, short-term success rate and symptoms will usually persist until the gallbladder is removed. Surgical removal of the gallbladder is the safest, most effective treatment of gallbladder disease.
How is Laparoscopic Gallbladder Removal Performed? General anesthesia is used; therefore the patient is asleep throughout the procedure. In a laparoscopic operation, surgeons insert cannulas (narrow tubes) through small incisions (1/4 to 1/2 inch) to enter the abdomen. The laparoscope, which is connected to a tiny video camera, is inserted through the cannula, and gives the surgeon a clear, magnified view of the patient’s internal organs on a television screen. Instruments such as forceps and scissors are inserted through other incisions and the entire operation is performed “inside” without making a large incision. The surgeon separates the gallbladder from its attachments then removes it through one of the incisions. An intraoperative x-ray (called a cholangiogram) or an ultrasound is sometimes performed to identify stones in the main bile duct or to insure that the main bile duct has been properly identified. If the surgeon finds one or more stones in the common bile duct, these may be removed with a special scope during the operation or may be removed later under mild sedation using a second minimally invasive procedure called an ERCP (Endoscopic Retrograde CholangioPancreatography). After the gallbladder is removed, the small incisions are closed with absorbable stitches under the skin and a liquid like glue called collodion on the surface of the skin. The collodion will eventually wear off.
What happens if the Operation Cannot be performed by the Laparoscopic Method? In a small number of patients (about 5%) the laparoscopic method is not feasible because of an inability to identify the anatomy adequately or handle the organs safely. Factors that may increase the possibility of converting to “open” procedure include obesity, a history of prior abdominal surgery causing dense scar tissue, bleeding problems during the operation, or intense inflammation around the gallbladder and bile ducts, obscuring the normal anatomy. The decision to convert to an open procedure is made by your surgeon during the operation and is based strictly on patient safety.
What are the Complications of Laparoscopic Gallbladder Removal? Complications can occur with any operation and include bleeding, blood clots, and infection, which are uncommon with laparoscopic gallbladder removal (1% or less). An even less common, but very serious, complication is an unintended injury to the common bile duct or duodenum. This may require conversion to an open operation. Finally, bile leakage from the bile duct into the abdomen may occur and may necessitate further intervention.
What are the Complications of an Open Gallbladder Removal? These are the same as for the laparoscopic operation. There is however a higher chance of pneumonia, wound infections, and clots forming in the deep veins of the leg. Of course, there is more pain after an open abdominal operation and recovery is much
Longer.
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