Gallstones and Gallbladder Disease - Surgery

Highlights	Prevention	Extracorporeal Shock Wave Lithotripsy
Introduction	Diagnosis	Other Procedures
Symptoms	Treatment	Resources
Prognosis and Complications	Surgery	References
Risk Factors	Open or Laparoscopic Common Bile Duct Exploration (Choledocholithotomy)

Surgery

The gallbladder is not an essential organ, and its removal is one of the most common surgical procedures performed on women. It can even be performed on pregnant women with low risk to both the baby and mother. The primary advantages of surgically removing the gallbladder over nonsurgical treatment are that it can eliminate gallstones and prevent gallbladder cancer.

Open Procedures Versus Laparoscopy. Open cholecystectomy involves the removal of the gallbladder through a wide 6-8 inch abdominal incision. Small-incision surgery, using a 2 - 3 inch incision is a minimally invasive altrnative.

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However, laparoscopic cholecystectomy (commonly called lap choly), which uses small incisions, is the most commonly used surgical approach. First performed in 1987, lap choly is now used in most cholecystectomies in the United States. Of concern is a significant increase in its use in patients who have inflammation in the gallbladder but no infection or gallstones, and in those who have gallstones but no symptoms.

Laparoscopy has largely replaced open cholecystectomy because it offers some significant advantages:

The patient can leave the hospital and resume normal activities earlier, compared to open surgery.
The incisions are small, and there is less postoperative pain and disability than with the open procedure.
There are fewer complications.
It is less expensive than open cholecystectomy over the long term. The immediate treatment cost of laparoscopy may be higher than the open procedure, but the more rapid recovery and fewer complications translate into shorter hospital stays and fewer sick days, and therefore a greater reduction in overall costs.

Some experts believe, however, that the open procedures, including small-incision, still have a number of advantages compared to laparoscopy:

It is faster to perform.
It poses less of a risk for bile duct injury compared with laparoscopy. However, open surgery has more overall complications than laparoscopy, and bile-duct injury rates with laparoscopy are declining.