Laparoscopic Gallbladder Cholecystectomyबैंगलोर में : An Overview

Laparoscopic gallbladder cholecystectomy is a surgical procedure that is used to remove the gallbladder. 

The gallbladder is a little pear-shaped organ in the right upper abdomen, sitting below the liver. It is responsible for the storage of bile, a digestive juice produced by the liver that helps break down fat and aids in digestion.

When the gallbladder becomes infected, inflamed, or painful for any reason, it may need to be removed. Laparoscopic gallbladder cholecystectomy is one of the most common procedures performed for the removal of the gallbladder. Let’s find out in detail about this surgery.

Laparoscopic gallbladder cholecystectomy, or laparoscopic cholecystectomy, is a minimally invasive surgical procedure to remove an infected or diseased gallbladder. It is also known informally as “lap cholecystectomy”, “lap chole”, and “lap chole surgery”.

As the name suggests, this gallbladder removal surgery is performed with the help of a laparoscope. A laparoscope is a short tube with a light and camera attached at one end, that can be inserted into the body by the surgeon through a tiny incision. The device enables the surgeon to get a live view of the gallbladder and neighboring structures.
Laparoscopic gallbladder cholecystectomy is most commonly performed when the individual is suffering from symptomatic gallstones. Gallstones are hardened deposits that form in the gallbladder. They are typically made up of cholesterol or bilirubin, a pigment produced during the breakdown of red blood cells. Gallstones can vary in size, ranging from as small as a grain of sand to as large as a golf ball. Laparoscopic cholecystectomy is now the preferred method for gallbladder removal over open cholecystectomy, which requires larger incisions and a longer recovery time. 

After carefully monitoring your condition and symptoms, your doctor will decide between laparoscopic cholecystectomy and open cholecystectomy. However, laparoscopic gallbladder cholecystectomy has the following advantages over open cholecystectomy:

• Quick recovery: The recovery time for laparoscopic gallbladder cholecystectomy is shorter than that following open cholecystectomy since only small incisions are made during this technique, facilitating quick wound healing. The majority of the time, you can return home the same day as the surgery.
• Less pain: Laparoscopic gallbladder cholecystectomy is minimally painful because it employs small incisions that heal quickly and cause little discomfort.
• Less or no scarring: Laparoscopic gallbladder cholecystectomy leaves no scars behind as it is a minimally invasive procedure that doesn't involve much cutting. It doesn’t leave any nasty scars behind. 
• Lower risk of complications: Smaller incisions, better visualization during surgery, less tissue trauma, and a shorter hospital stay mean that laparoscopic cholecystectomy has a reduced risk of complications than open cholecystectomy.

A laparoscopic gallbladder cholecystectomy is performed most often to treat gallstones and their complications. It is mainly what people may refer to as a “gallstone operation”.

However, the surgical procedure can be used to remove a gallbladder that is infected, inflamed, or diseased by other causes as well. 

The surgery may also be used for removing the gallbladder and thus treating:

• Choledocholithiasis: A condition in which gallstones are found in the common bile duct,  the duct that carries bile from the liver and gallbladder to the small intestine.
• Cholecystitis: Swelling and inflammation of the gallbladder.  It is most commonly caused by gallstones blocking the cystic duct, which is the tube that connects the gallbladder to the common bile duct. 
• Pancreatitis: Inflammation of the pancreas due to the presence of gallstones. Other factors such as trauma, certain medications, infections, or genetic factors can also contribute to its development
• Biliary dyskinesia: Biliary dyskinesia, also known as gallbladder dyskinesia. It is a condition characterized by abnormal or impaired motility (movement) of the gallbladder or when the gallbladder does not empty bile correctly. 
• Large gallbladder polyps: Gallbladder polyps are abnormal growths or lesions that develop on the inner lining of the gallbladder. Most polyps are benign (non-cancerous), but in rare cases, they can be malignant (cancerous).

Let’s see what steps are included in a laparoscopic cholecystectomy procedure. 

What Happens Before The Surgery? 

• Before finalizing on gallbladder operation, you should attend a consultation with your surgeon to discuss the entire procedure as well as your expectations from it. Take your time to talk about the benefits, risks, and any questions you may have about the procedure. 
• The surgeon will also use this consultation to discuss your medical and surgical history and any medication you take. You may be asked to discontinue certain medications (e.g., any blood thinner like aspirin) that may increase the risk of bleeding during the surgery
• You might be asked to make certain healthy dietary changes during the days preceding the surgery. You will also be given instructions to fast for a few hours before the procedure. 
• A few diagnostic tests will be prescribed to confirm that you are fit for the procedure. It may include the following:
  • A complete physical examination
  • Abdominal ultrasound ( an imaging technique that uses sound waves to diagnose the internal anatomy of organs)
  • Urine analysis 
  • Blood tests 
• Make sure to arrange to have a family member or a friend with you who can take care of you and drive you back home after the procedure.

What Happens During The Surgery? 

• Laparoscopic gallbladder cholecystectomy is an outpatient procedure, which means you can leave the hospital on the very same day and go back home. In some cases, the doctor may require the patient to spend 1 or 2 days in the hospital after the surgery. 
• The laparoscopic surgery might take between one to two hours. 
• To start the laparoscopic cholecystectomy steps, you will receive general anesthesia so that you experience no pain during the procedure. 
• A tube is placed down your throat to help you breathe and an intravenous (IV) line is placed in your arm to deliver fluids and medications.
• Your doctor makes a few small incisions in your abdomen. Carbon dioxide gas is gently introduced into the abdomen through one of the incisions. This inflates the abdominal cavity, creating space for the surgeon to work and improving visibility. Through another incision the surgeon would insert a laparoscope
• The laparoscope enables the surgeon to get a live view of the gallbladder and the surrounding structures. Other surgical instruments are guided through the incisions while looking at the monitor and being guided by the images captured by the laparoscope.
• Specialized instruments are inserted through the other incisions. These instruments are used to manipulate and dissect tissues, clamp blood vessels, and remove the gallbladder.
• After the gallbladder removal, the surgeon carefully inspects the surgical area for any bleeding or bile leakage. The incisions are closed using sutures, adhesive strips, or surgical staples. In some cases, absorbable sutures are used, eliminating the need for suture removal.

What Happens After The Surgery? 

• Right after the surgery, you will be sent to a recovery room and monitored for a few hours. 
• Your vital indicators, such as blood pressure, body temperature, breathing rate, heart rate, and ability to urinate, are carefully observed for the next few hours.
• If the doctor finds no complications after monitoring your vitals and everything is well, you can return home.
• The doctor may prescribe medications, provide post-surgery care instructions, and fix a schedule of follow-up appointments before you go home.
• Once home, you should walk around regularly to prevent the formation of blood clots. 
• You should be able to go back to most normal activities within a week.
• Follow the doctor’s instructions about showering, keeping the wound clean, and avoiding rigorous activities until you have fully recovered. 

Like any other surgical procedure, laparoscopic gallbladder cholecystectomy also carries certain risks or chances of possible complications. The major risks include:

• Bleeding: In rare cases, bleeding might occur as a procedure complication.
• Bile leakage: When the bile duct gets damaged during gallbladder surgery, this is called a bile duct injury. In that case, the bile duct may be burned, damaged, or squeezed. The bile duct will not be able to function properly, leaking bile into the abdomen or obstructing the regular passage of bile from the liver.
• Anesthesia Risks: In rare cases, people might develop certain signs such as nausea, vomiting, headaches, difficulty breathing, and blood clots, indicating an adverse reaction to anesthesia.
• Hernia: Hernias are masses of tissues that protrude through a weak muscular wall. Incisional hernias can occasionally occur as a result of incisions created during surgery.
• Injury to the surrounding tissues: During laparoscopic gallbladder cholecystectomy, surgical tools are inserted inside your abdomen, which might cause injuries to the surrounding tissues and organs, such as the bile duct, liver, or intestines.
• Peritonitis: The surgery can sometimes lead to inflammation and infection in the abdomen.

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