Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy

It is the process of removing the gallbladder. The procedure is made through several small holes instead of a single large incision. A laparoscope is a thin and long tube with a camera at the end. The surgeon performs the operation by watching the image reflected on this camera on the TV screen. The gallbladder is taken out of the abdomen through a small hole.

Gall bladder

The gallbladder is a pear-shaped organ located in the lower right part of the liver. Its main task is to collect and concentrate bile, a digestive fluid produced by the liver. Bile is secreted after eating to aid digestion and travels through narrow, tubular ducts (bile ducts) to the small intestine. Removal of the gallbladder does not cause a digestive disorder in most people.

What Causes Gallbladder Problems?

  • The cause of gallbladder problems is usually the presence of gallstones. Gallstones are small, hard masses of bile salts and cholesterol in the gallbladder or duct.
  • It is not known why it develops in some people.
  • There is no known method of preventing gallstones.
  • These stones may prevent bile from flowing out of the gallbladder, so the gallbladder swells, abdominal pain, vomiting, indigestion and occasional fever may occur.
  • If gallstones obstruct the main bile duct, jaundice may occur.

How Are These Problems Revealed And Treated?

Ultrasound is often used to find gallstones.

  • In some more complex situations, other x-ray tests may be preferred to evaluate gallbladder disease.
  • Gallstones do not disappear on their own. Some can be temporarily eliminated with medications or a diet to reduce fat intake.
  • The success rate of this treatment is low.
  • Surgical removal of the gallbladder is the safest and most timely way to treat gallbladder disease.

What are the Advantages of Performing the Surgery Laparoscopically?

  • Instead of a 10-15 cm incision, only four small openings are created in the abdomen.
  • Generally, patients have less postoperative pain.
  • They heal faster than patients who have had open gallbladder surgery.
  • Most patients are discharged within a day and can return to normal activities more quickly.

Laparoscopic Surgery of the Gallbladder Is It Suitable For You?

Although laparoscopy has many advantages, it may not be suitable for patients who have had previous abdominal surgery or have certain medical conditions.

After a medical evaluation with a surgeon who has been trained in laparoscopy and your own doctor, it is decided whether the gallbladder can be removed laparoscopically.

What Preparation Is Required?

Possible preparations to be made before laparoscopy surgery are listed below, but since each patient and doctor has a unique situation, different pictures may occur:

  • Preoperative preparation requires blood values, medical evaluation, chest x-ray, and ECG, depending on age and medical condition.
  • The surgeon evaluates the potential risks and benefits, and you must provide written consent.
  • After midnight the night before the surgery, you should not eat or drink anything. You can only use medications that the surgeon says you can take with some water on the morning of the surgery.
  • Blood thinners and anti-inflammatory drugs should be temporarily discontinued a few days or a week before surgery.
  • Dietary drugs should not be taken during the two weeks prior to surgery.
  • Smoking should be stopped.

Surgery Summary

  • General anesthesia is applied and the patient remains asleep throughout the surgery.
  • Using a cannula (narrow, tubular instrument), the surgeon enters the abdomen through the belly button area.
  • The laparoscope (a small telescope) connected to a special camera is inserted through the cannula so that the surgeon can view the patient’s internal organs magnified on the television screen.
  • Other cannulas are inserted into the body so that the surgeon can carefully separate the gallbladder from the surrounding tissues and remove it using one of the openings.
  • Many surgeons use cholangiography to determine the location or structures of stones that can be found in the bile ducts.
  • If one or more stones are found in the common bile duct, the surgeon can remove them with a special endoscope, choose to remove them later with a second minimally invasive surgery, or have the surgery open at that time to remove all stones.
  • After the gallbladder is removed, it is closed with a small incision or with tape.

What Happens If the Surgery Cannot Be Performed Laparoscopically or Cannot Be Completed?

The laparoscopic method cannot be applied to very few patients. Obesity, a previous history of abdominal surgery causing serious scar tissue, inability to see the organs, or bleeding during the surgery may require an “open” operation.

The decision to perform open surgery is a decision made by the surgeon before or during surgery. If the surgeon thinks that it is safer to switch from a laparoscopic procedure to an open one, this is considered a rational decision, not a complication. The decision to switch to open surgery is strictly made for patient safety.

Post-operative Procedures

The removal of the gallbladder is a serious abdominal surgery and there will be a certain level of pain afterward. Nausea and vomiting are common conditions.

  • When liquids or diet are tolerated, the patient is discharged on the day of or the day after laparoscopic gallbladder surgery.
  • Activities depend on how the patient feels. The patient is asked to walk. You can take a shower the day after the operation.
  • Various normal activities such as driving, climbing stairs, lifting or working can be started within a week.
  • The onset of fever, yellow skin or eyes, progressively worsening abdominal pain, swelling, persistent nausea, vomiting or pruritus may indicate a complication. In such cases, you should contact your doctor.
  • Most patients can return to work within seven days after laparoscopic surgery, depending on the work they are doing.
  • It takes 4-6 weeks for those undergoing open surgery to return to their normal activities.
  • You need to make an appointment with your surgeon two weeks after the operation.

What Kinds of Complications Can Be Seen?

Every surgery has various risks, but the vast majority of laparoscopic gallbladder patients have had little or no complications. Before any surgery, whether laparoscopic or open, be sure to ask your doctor about his education and experience in that area.

Laparoscopic cholecystectomy complications are uncommon, but bleeding, infection, pneumonia, blood clotting, or heart problems may occur. Unwanted damage to adjacent structures such as the common bile duct or small intestine may occur, and a separate surgery may be required to correct this situation. Bile leakage as a result of unwanted damage from the bile ducts leading from the liver to the intestine is rare.

Many studies show that the complication rate for laparoscopic gallbladder surgery is much lower than the complication rates of open gallbladder surgery when performed by a properly trained surgeon.

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