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)

Risk Factors for Conversion from Laparoscopy to an Open Procedure. In about 5 - 10% of laparoscopies, conversion to open cholecystectomy is required during the procedure. The rate of conversion to open surgery is higher in men than in women. This may be due to the higher rate of inflammation and fibrosis in men with symptomatic gallstones. Other reasons for conversion from laparoscopic to open surgery include:

Possible or known injury to major blood vessels
Internal structures are not clearly visible
Unexpected problems that cannot be corrected with laparoscopy
Common bile duct stones that cannot be removed with laparoscopy or subsequent ERCP
Previous endoscopic sphincterotomy
A thickened gallbladder wall

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Complications and Side Effects of Surgery

Pain and fatigue are common side effects of any abdominal surgery. Patients should avoid light recreational activities for about 2 days and from work and more strenuous activities for about a week.
There is a relatively high incidence of nausea and vomiting after laparoscopic cholecystectomy, which can be treated with injections of metoclopramide. Patients may take anti-nausea medications such as granisteron before surgery to help prevent these effects. Local anesthesia at the incision sites (in addition to general anesthesia) before surgery may reduce pain and nausea afterwards.
Injury to the bile duct is the most serious complication of laparoscopy. It can include leakage, tears, and the development of narrowing (strictures) that can lead to liver damage. In order to minimize such injuries, some experts recommend that surgeons perform laparoscopy with cholangiography. Bile duct injury has been a more common problem in laparoscopy compared to the open procedure, but increasing surgical experience and the use of cholangiography is reducing this complication. Studies are reporting more comparable rates between the two procedures.
In about 6% of procedures, the surgeon misses some gallstones, or they spill and remain in the abdominal cavity. In a small percentage of these cases, the stones cause obstruction, abscesses, or fistulas (small channels) that require open surgery.
As with all surgeries, there is a risk for infection, but it is very low.