Laparoscopic cholecystectomy: what to know
The gallbladder, located underneath the liver, is an accessory organ that can be afflicted by conditions which necessitate its removal. In this article, a consultant general surgeon explains common maladies of the gallbladder, and the process of surgically removing the gallbladder.
What is the gallbladder?
The gallbladder is an organ in the right of the abdomen, beneath the liver, that is used to store and release bile that breaks down fats in the digestive system. When we start eating, the gallbladder contracts in order to release bile into the small intestine, where it mixes with the food waiting to be digested.
Why would the gallbladder need surgery?
The gallbladder is a small, pear-shaped sac that stores and concentrates the bile produced in the liver, received via the common hepatic duct. When we eat, the gallbladder begins contracting, releasing bile into the small intestine via the common bile duct. This aids in breaking down substances like fats within food so that they can pass through the digestive system.
Gallbladders can commonly be afflicted by gallstones, which are hard crystalline deposits of excess cholesterol and bilirubin. Typically, they are very small and do not cause symptoms and may pass through the body easily, but they can also be as large as a ping pong ball, which can cause obstruction and a great deal of pain, leading to further complications that are typically treated with the surgical removal of the gallbladder in what is called a cholecystectomy.
These complications include:
- Cholecystitis: gallstones block the flow of bile from the gallbladder, which causes inflammation, leading to pain, fever, and possibly sepsis.
- Biliary colic: the gallbladder contracts around gallstones, which causes debilitating pain that can flare up after eating, lasting for hours at a time.
- Obstructive jaundice: when the common bile duct becomes blocked by a stone that has escaped from the gallbladder.dssavr
- Gallstone pancreatitis: inflammation of the pancreas due to a gallstone passing through the common bile duct and interfering with pancreatic function.
- Gallbladder cancer: a thankfully very rare cause for gallbladder surgery
What happens during a cholecystectomy?
The surgery to remove the gallbladder is called a cholecystectomy, and it is typically performed using minimally invasive techniques such as laparoscopy or by robotic-assisted surgery. Surgeons are able to access the internal structures and organs of the body through smaller incisions, around 1-2cm long, which are placed around the abdomen. Through these incisions, they can insert their tools – including the laparoscope, which is a long and thin tube with a camera and light at the end, granting the surgeon clear visualisation of the gallbladder. With the laparoscope, the surgeons can remove or investigate the gallbladder with less blood loss and a faster recovery time for the patient, as opposed to the traditional open technique. When removing the gallbladder, it is carefully separated from blood vessels and bile ducts that anchor it in place, and it can be extracted through one of the incisions.
Afterwards, the incisions are closed with sutures and the skin sealed with tissue glue. A large proportion of patients can return home on the same day as surgery and expect to return to their normal activities within one to two weeks.
The gallbladder is not an essential organ; its removal will not cause major disruption to bodily function, and patients who have had their gallbladder removed can still live a normal life and enjoy a normal diet. When removed, instead of bile being stored in the gallbladder, bile will be transferred directly into the small intestines.