What is cholecystectomy?
Cholecystectomy is an operation in which the gallbladder is removed, including any contained therein gallstones. Today (2011), surgery is usually done by laparoscopy, although in a few cases still to be reverted to the traditional surgery with a large incision under the right costal arch (this is conversion / convert named).
The reason for such an operation is usually symptomatic gallstones, sometimes cholecystitis (inflammation of the gallbladder).
Feature
After a scheduled uncomplicated laparoscopic cholecystectomy patients can usually go home the next day. Recovery after a converted or intent classic cholecystectomy takes a few days longer. The patient is after a laparoscopic operation usually in a week again well on the bone, and will be of the lack of a gall bladder usually experience no appreciable discomfort, although some people report that they fat food a little less well tolerated.
In the past, some attempts have been made to remove gallstones or dissolve without having to remove the gallbladder, but almost always relapses occurred then on.
The gall bladder acts as a kind of reservoir for the bile, which is produced by the liver. When the gallbladder is removed, this function is taken over by the liver and bile ducts.
Indications
The most common disorder of the gallbladder is the formation of gallstones. Gallstones are not abnormal - one in four people has - and do not always give rise to complaints. A patient may thus for years gallstones have no problems there previously have encountered.
Only in case of complaints about the gallstones is often chosen for the removal of the gall bladder. This is also possible if the gallbladder has been ignited.
Methods
- keyhole surgery 4 small incisions - laparoscopic cholecystectomy
- scar-less surgery (keyhole surgery with one small incision through the navel) -LESS surgery cholecystectomy
- open abdominal surgery - open (conventional) cholecystectomy
Laparoscopic cholecystectomy
During the operation, the surgeon makes use of a video camera, and special tools to remove the gallbladder without making an incision in the abdomen. Instead, the surgeon makes three to four small incisions. A laparoscope is a long straight pipe on which is mounted a small video camera fitted with a light source. Before the instruments are placed in the abdominal cavity in order to perform the surgery, the abdominal cavity is first filled up with carbon dioxide, a harmless gas. This is necessary in order to get more space in the abdominal cavity and a good overview. The gas may slightly irritate the diaphragm, via a nerve that runs to the shoulder, this can have the result that the patient after the surgery for a few days at a significant shoulder. If this discomfort occurs, it will disappear and the patient does not need to worry about that.
Via an incision of about 2 to 3 cm at the navel, the laparoscope is introduced into the abdominal cavity, with which the surgeon can look into the abdomen via a video monitor. After this, the other incisions are made in the abdominal wall. All incisions are used for special instruments that are necessary for the operation to bring in the abdominal cavity, the gall bladder is packed with this, moved and removed. In some cases, the surgeon will find it advisable to have after the removal of the gall bladder behind a wound drain.
Sometimes it happens that a nose / nasogastric tube is inserted while preparing for this operation. If it is chosen to a nose / gavage to insert than this is done if the patient is already under anesthesia and it is usually removed again immediately after the surgery.
If the surgeon determines during the operation that it is not (safe) is possible to remove the gallbladder laparoscopically (for example, if the gallbladder is severely inflamed, or because there are too many littekenverklevingen are in the vicinity of the gall bladder), it is necessary in the conventional way to remove the gallbladder. This can occur because the surgeon gallbladder prior to surgery does not actually (this can only after the laparoscope is inserted), some situations are unpredictable and can be discovered only after the operation has already started.
LESS cholecystectomy
In principle, the LESS cholecystectomy (LESS surgery / or single site surgery) a further development of the standard laparoscopic cholecystectomy. Only the manner in which access to the abdomen is made is different, the actual surgical procedure that takes place inside the body, is the same as the standard laparoscopy.
Where perform at the standard laparoscopic cholecystectomy 3-5 small incisions (cuts) from 1 to 3 cm spread must be made on the abdomen, can the LESS cholecystectomy, the surgeon full operation through a single incision. If the incision is made in the belly button, the scar is usually hidden and almost invisible. In standard laparoscopic surgery are always several visible scars afterwards. Besides the cosmetic difference would be the LESS technique also theoretically possible to reduce pain and promote recovery after surgery because less damage is made to the entire abdominal wall (skin, blood vessels, muscle, peritoneum (peritoneum)). However, this is not yet proven in comparative studies (2010).
Open cholecystectomy
In an open cholecystectomy, the surgeon makes an incision of about ten to fifteen cm, middle or upper abdomen on the right side below the rib cage to remove the gallbladder along that road.
Preparation and anesthesia
For the benefit of an optimal operation, the anesthesiologist / anesthetist to be aware of the medical history of the patient. Based on that information, the anesthesiologist can ensure that the anesthetic is as good as possible to the patient and the surgery, it usually occurs during a Pre-Operative Consultation, which the patient receives an invitation from the hospital. The operation to remove the gall-bladder is a common operation which is associated with a recording of at least 1 day (day and night), the majority of patients, the day after the operation again be discharged from the hospital.
Gallstones in the bile ducts
If there are indications that there are gallstones in the bile duct, these are preferably removed prior to the operation with the aid of an endoscope (ERCP). Such an operation takes place under a roesje through the stomach, liver and bowel-doctor, but in some cases, it appears at the end of the surgery to remove the gall-bladder pass that there are stones in the bile ducts. In common cases not chosen to remove stones in the bile duct surgery. In addition, the surgeon opens the bile duct in order to remove the stones, then the bile ducts to be closed again, wherein there is a drain (small) will leave behind which is led to the outside through the abdominal wall via an opening (T-drain). Via this drain the bile can be led out of the body.
The removal of bile will prevent the first period after the operation results in a too high pressure in the biliary tract. In addition to these small drain, there is often also a wound drain in the abdomen also left behind it is led to the outside through a separate opening in the abdominal wall. However, the ERCP gives much less discomfort and complications and, therefore, is preferred over the surgical opening of the bile ducts.
Cholecystectomy possible complications
No surgery is without risk. As with any surgery is also in the removal of the gall bladder, the present normal probability of complications, such as thrombosis, pneumonia, secondary bleeding, or a wound infection. A potentially serious complication in the removal of the gallbladder is an injury to the bile ducts. This happens fortunately not often. The consequences of damage to the bile ducts are dependent on the lesion and the time at which the damage is determined. It may be that a repair operation is possible and / or necessary.
After the operation
The first days after the operation, the wounds will be sensitive. It is a normal consequence that most of the movements are painful, including deep breathing and coughing. It is understandable that this pain is worse after open cholecystectomy. Counter pain medications may be prescribed. The operation sometimes has the result that the patient is immediately afterwards what is nauseous and thirsty. Medication can be prescribed for this purpose. Drinking may immediately after the operation is usually not. In order to ensure that the patient receives sufficient moisture, this one has a drip in the arm / hand. Once again, the patient can drink sufficiently, the infusion may be removed. Most patients can on the night of the operation back to normal food. Sometimes there is a small tube (catheter) placed through the nose into the stomach, it causes the stomach shortly after the operation remains empty and it prevents the patient to vomit. Usually, this tube can be removed shortly after surgery and the patient can have a drink, depending on the progress drinking and then eating expanded.
If there is a tube (drain) is left in the wound area, then it is needed to blood and fluid to be discharged. As soon as no more moisture comes out of the drain, the drain can be removed, which is often two or three days after this far. If the bile ducts have been opened during the operation, there is a second tube (drain). As you read this drain drains bile. In that case, there are made one week after the operation, X-rays, wherein there through that tube contrast medium is injected into the bile ducts. On the X-rays will be on display or the bile flow to the intestine well, and whether there are no stones have been left in the bile duct, on the basis of the result of the X-rays, the drain can be removed. In general, this is usually ten days after surgery.