Cholecystectomy (Gallbladder Removal)

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Overview

Cholecystectomy is the surgical removal of the gallbladder, a small pear-shaped sac that is located directly beneath the liver in the upper right side of the abdomen. The gallbladder's main function is to store bile, which is produced by the liver, and to release it as needed for digestion. The gallbladder's function is important, but it is not an essential organ.

Surgical removal is the most common therapy for gallbladder disorders. Gallstones (small, solid formations composed of cholesterol and bile salts) can cause problems in the gallbladder and the entire biliary system, including the pancreas.

They are often responsible for very painful and potentially serious inflammation of the gallbladder called acute cholecystitis. Cholecystectomy is the treatment of choice for this condition. Over 500,000 of these procedures are performed each year in the United States.

Surgical Procedures

Two procedures are utilized to surgically remove the gallbladder: open cholecystectomy and laparoscopic cholecystectomy. The laparoscopic method is utilized more frequently, but some patients, particularly if they are obese, have a bleeding disorder, are pregnant and near the due date, or have extensive scarring from previous abdominal surgeries are not candidates. The choice of procedure is made on an individual basis.

Open Cholecystectomy
The surgery is performed under general anesthesia, which renders the patient unconscious. After the anesthesia is administered, the abdomen is cleaned with an antiseptic solution to reduce the risk for infection. The surgeon makes a 4- to 6-inch incision in the right upper portion of the abdomen. The liver is lifted out of the way and the gallbladder is carefully removed. The incision is closed and sutured.

The disadvantages of this procedure are longer hospitalization and recovery period, significant postoperative pain, and a large scar. However, the surgery is safe and carries a low risk for complications. Open cholecystectomy is used when laparoscopy is unsuitable for the patient.

Laparoscopic Cholecystectomy
Laparoscopic cholecystectomy is the method of choice, provided the patient meets the criteria. The surgery is performed using general anesthesia and the abdomen is cleaned with an antiseptic solution. Instead of making one large incision, the surgeon makes four tiny cuts in the abdomen. One incision is made right under the navel (umbilicus) and a laparoscope is inserted. The laparoscope is a miniature telescope attached to a camera, and through its lens the surgeon can see the interior of the abdomen.

Instruments are inserted through the other incisions to perform the surgery. The gallbladder is cut free and pulled through one of the incisions. Before removing it, the surgeon sometimes shrinks the gallbladder by suctioning out the bile. Incisions are sutured or stapled closed at the end of the surgery. The procedure usually takes 30 to 60 minutes.

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