“Cholecystectomy” means removal of the gall bladder and “laparoscopy” means
inspection of the abdomen, both words are greek.
Cholecystectomy is done to remove the gallstones because they can cause not
only unpleasant symptoms (pain and nausea) but also many severe or life-
threatening complications such as jaundice, empyema, cholangitis, perforation
of gall bladder, pancreatitis, gallstone ileus (obstruction of bowel), peritonitis etc.
A few questions that many patients ask are the following:
a. Can only the stones be removed?
Yes, but if the gallbladder is not removed then stones will be reformed sooner or
later.
b. what are the consequences of living without a gallbladder?
Practically nil. The gallbladder is a remnant of the pre-historic times when
humans lived in the wild and ate infrequent very large meals when they
managed to hunt down an animal. In those times having an extra reservoir of bile
in the gallbladder helped with digestion. With today’s diet habitis the constant
flow of bile from the liver is more than enough to secure normal digestion without
any problems.
c. Can the gallstones be removed without surgery?
Essentially not. Lithotripsy (breaking the stones with ultrasound waves has been
tried but (unlike kidney stones) it has very poor results with gallstones and has
been abandoned. Medication such as bile salts is available but has to be taken
for years, has poor results and is toxic for the liver.
d. What are the consequences of not having surgery?
Although gallstones do not always cause symptoms, almost 50% of the patients
will have recurrence of symptoms within a year. For many of them the symptoms
will be so severe that they will affect their quality of life. More importantly, some
will develop serious complications which may even be life threatening. This is
why the standard medical advice in case of gallstones is to have surgery. This
may not be the case only if the patient is too elderly or unfit for surgery.
Laparoscopic cholecystectomy was invented in the late 1980s as a method of
removing the gallbladder through small “keyholes” and avoiding large incisions.
The advantages of laparoscopic cholecystectomy over the traditional or “open”
cholecystectomy are :
The advantages are quite obvious and laparoscopic cholecystectomy has
become the method of choice of gallstones. More than 90% of gallbladder
operations are performed nowadays in modern hospitals laparoscopically.
However there are cases which cannot or should not be done laparoscopically.
These are cases where the patient has had previous extensive abdominal
operations. In such cases there are usually multiple adhesions which make
impossible the laparoscopic performance of the surgery but also there is an
increased risk of accidental bowel damage.
In about 5% a cholecystectomy starts as “laparoscopic” but has to be
“converted” to an “open”. This usually has to do with the presence of adhesions,
the presence or suspicion of congenital anomalies of the anatomical parts of the
biliary tree, technical difficulties or equipment failure. Conversion to open is for
safety purposes and the operation remains the same internally –the only
difference is the presence of an external scar which causes more pain and
requires longer recovery.
The complications of laparoscopic cholecystectomy had caused concerns at the
early stages of the development of laparoscopic surgery. Since then many large
studies have been conducted which show that laparoscopic cholecystectomy is
more than 99% safe surgery. There is a 0.4% risk , or 1 in 250 chance of
accidental “bile duct injury”. This is damage of either the Common Bile Duct or
one of the other ducts and can be caused by extensive inflammation of the area,
adhesions, technical errors or the presence of congenital variations in the
anatomy of the area (quite coomon) which can mislead occasionally the surgeon.
Bile duct injuries present as obstruction or transaction of the bile ducts or in a
more minor form as holes which leak bile.
The patient may present with a bile collection and abdominal pain, fever,
jaundice or sepsis. Bile duct injuries are almost always correctable but they
require a specialist hepatobiliary surgeon and can sometimes cause long term
problems.
Adequate training of the surgeon in the laparoscopic technique is paramouint for
the prevention of bile duct injuries and it is now thought that the majority of the
early complications were due to inadequate training of the previous generation
of surgeons.
Laparoscopic Cholecystectomy can be associated with other complications such
as perforation of bowel or major vessel or organ during the insertion of the
ports, port site hernias, surgical emphysema etc. However the cumulative risk of
all such complications is quite low in experienced hands.
inspection of the abdomen, both words are greek.
Cholecystectomy is done to remove the gallstones because they can cause not
only unpleasant symptoms (pain and nausea) but also many severe or life-
threatening complications such as jaundice, empyema, cholangitis, perforation
of gall bladder, pancreatitis, gallstone ileus (obstruction of bowel), peritonitis etc.
A few questions that many patients ask are the following:
a. Can only the stones be removed?
Yes, but if the gallbladder is not removed then stones will be reformed sooner or
later.
b. what are the consequences of living without a gallbladder?
Practically nil. The gallbladder is a remnant of the pre-historic times when
humans lived in the wild and ate infrequent very large meals when they
managed to hunt down an animal. In those times having an extra reservoir of bile
in the gallbladder helped with digestion. With today’s diet habitis the constant
flow of bile from the liver is more than enough to secure normal digestion without
any problems.
c. Can the gallstones be removed without surgery?
Essentially not. Lithotripsy (breaking the stones with ultrasound waves has been
tried but (unlike kidney stones) it has very poor results with gallstones and has
been abandoned. Medication such as bile salts is available but has to be taken
for years, has poor results and is toxic for the liver.
d. What are the consequences of not having surgery?
Although gallstones do not always cause symptoms, almost 50% of the patients
will have recurrence of symptoms within a year. For many of them the symptoms
will be so severe that they will affect their quality of life. More importantly, some
will develop serious complications which may even be life threatening. This is
why the standard medical advice in case of gallstones is to have surgery. This
may not be the case only if the patient is too elderly or unfit for surgery.
Laparoscopic cholecystectomy was invented in the late 1980s as a method of
removing the gallbladder through small “keyholes” and avoiding large incisions.
The advantages of laparoscopic cholecystectomy over the traditional or “open”
cholecystectomy are :
- less pain
- fewer wound complications
- shorter hospital stay
- faster recovery
- better cosmetic results.
The advantages are quite obvious and laparoscopic cholecystectomy has
become the method of choice of gallstones. More than 90% of gallbladder
operations are performed nowadays in modern hospitals laparoscopically.
However there are cases which cannot or should not be done laparoscopically.
These are cases where the patient has had previous extensive abdominal
operations. In such cases there are usually multiple adhesions which make
impossible the laparoscopic performance of the surgery but also there is an
increased risk of accidental bowel damage.
In about 5% a cholecystectomy starts as “laparoscopic” but has to be
“converted” to an “open”. This usually has to do with the presence of adhesions,
the presence or suspicion of congenital anomalies of the anatomical parts of the
biliary tree, technical difficulties or equipment failure. Conversion to open is for
safety purposes and the operation remains the same internally –the only
difference is the presence of an external scar which causes more pain and
requires longer recovery.
The complications of laparoscopic cholecystectomy had caused concerns at the
early stages of the development of laparoscopic surgery. Since then many large
studies have been conducted which show that laparoscopic cholecystectomy is
more than 99% safe surgery. There is a 0.4% risk , or 1 in 250 chance of
accidental “bile duct injury”. This is damage of either the Common Bile Duct or
one of the other ducts and can be caused by extensive inflammation of the area,
adhesions, technical errors or the presence of congenital variations in the
anatomy of the area (quite coomon) which can mislead occasionally the surgeon.
Bile duct injuries present as obstruction or transaction of the bile ducts or in a
more minor form as holes which leak bile.
The patient may present with a bile collection and abdominal pain, fever,
jaundice or sepsis. Bile duct injuries are almost always correctable but they
require a specialist hepatobiliary surgeon and can sometimes cause long term
problems.
Adequate training of the surgeon in the laparoscopic technique is paramouint for
the prevention of bile duct injuries and it is now thought that the majority of the
early complications were due to inadequate training of the previous generation
of surgeons.
Laparoscopic Cholecystectomy can be associated with other complications such
as perforation of bowel or major vessel or organ during the insertion of the
ports, port site hernias, surgical emphysema etc. However the cumulative risk of
all such complications is quite low in experienced hands.
Laparoscopic cholecystectomy
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