Gallstones and Gallbladder Disease - Surgery

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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)

When cholecystectomy is performed as an elective surgery, the mortality rates are very low. (Even in the elderly, mortality rates are only 0.7 - 2%.)
Emergency cholecystectomy has a much higher mortality rate (as high as 19% in ill elderly patients).

Long-Term Effects of Gallbladder Removal. Removal of the gallbladder has not been known to cause any long-term adverse effects, aside from occasional diarrhea.

Laparoscopic Cholecystectomy

The Procedure. With laparoscopy, gallbladder removal is typically performed as follows:

Laparoscopic cholecystectomy requires general anesthesia, although it is now mostly done as outpatient surgery.
The surgeon inserts a needle through the navel and pumps carbon dioxide gas through it to create space in the abdomen. This step may raise blood pressure. Antihypertensive drugs may be helpful during surgery to protect patients who have high blood pressure or heart or kidney disease.
One or two 10 - 12 mm (about one-half inch) and three 5 mm (about one-fifth of an inch) incisions are made in the abdomen.
The surgeon inserts a laparoscope (a thin fiber optic scope), which contains a small surgical instrument and a tiny camera that relays an image to a video monitor.
The surgeon separates the gallbladder from the liver and other areas, and removes it through one of the incisions.
Evidence suggests that the use of cholangiography during the operation helps prevent injury in the bile ducts, a serious complication of cholecystectomy. With this procedure, dye is injected into the bile duct, and moving x-rays are used to view the duct.
Often patients will need to stay in the hospital overnight. However, some patients can go home the same day.

Robot-assisted surgery. Laparoscopic surgery may be performed using tiny keyhole incisions and 3 - 4 tiny robotic arms. A computerized program guides the arms during surgery. A systematic review comparing robot-assisted and human assisted removal of the gallbladder showed no difference in morbidity, conversion to open surgery, total operating time, or hospital stay. Robot-assisted surgery requires longer overall surgical time and is more costly.