Cholecystectomy Health Article

Definition

A cholecystectomy is the surgical removal of the gallbladder. The two basic types of this procedure are open cholecystectomy and the laparoscopic approach. It is estimated that the laparoscopic procedure is currently used for approximately 80% of cases.

Purpose

A cholecystectomy is performed to treat cholelithiasis and cholecystitis. In cholelithiasis, gallstones of varying shapes and sizes form from the solid components of bile. The presence of these stones, often referred to as gallbladder disease, may produce symptoms of excruciating right upper abdominal pain radiating to the right shoulder. The gallbladder may become the site of acute infection and inflammation, resulting in symptoms of upper right abdominal pain, nausea, and vomiting. This condition is referred to as cholecystitis. The surgical removal of the gallbladder can provide relief of these symptoms. Cholecystectomy is used to treat both acute and chronic cholecystitis when there are significant pain symptoms. The typical composition of gallstones is predominately cholesterol, or a compound called calcium bilirubinate.

Cholelithiasis

Most patients with cholelithiasis have no significant physical symptoms. Approximately 80% of gallstones do not cause significant discomfort. Patients who develop biliary colic generally do have some symptoms. When gallstones obstruct the cystic duct, intermittent, extreme, cramping pain typically develops in the right upper quadrant of the abdomen. This pain generally occurs at night and can last from a few minutes to several hours. An acute attack of cholecystitis is often associated with the consumption of a large, high-fat meal.

The medical management of gallstones depends to a great degree on the presentation of the patient. Patients with no symptoms generally do not require any medical treatment. The best treatment for patients with symptoms is usually surgery. Laparoscopic cholecystectomy is typically preferred over the open surgical approach because of the decreased recovery period. Patients who are not good candidates for either type of surgery can obtain some symptom relief with drugs, especially oral bile salts.

Cholecystitis

Cholecystitis is an inflammation of the gallbladder, both acute and chronic, that results after the development of gallstones in some individuals. The most common symptoms and physical findings associated with cholecystitis include:

• pain and tenderness in the upper right quadrant of the abdomen
• nausea
• vomiting

• fever
• jaundice
• history of pain after eating large, high-fat meals

Demographics

Overall, cholelithasis is found in about 20,000,000 Americans. An overwhelming majority of these individuals do not ever develop symptoms. Overall, about 500,000 to 600,000 (2–3%) are treated with cholecystectomies every year. Typically, the incidence of cholelithasis increases with age. The greatest incidence occurs in individuals between the ages of 40 and 60 years. The following groups are at an increased risk for developing choleliathiasis:

• pregnant women
• female sex
• family history of gallstones
• obesity
• certain types of intestinal disease
• age greater than 40 years
• oral contraceptive use
• diabetes mellitus
• estrogen replacement therapy
• rapid weight loss

Overall, patients with cholelathiasis have about a 20% chance of developing biliary colic (the extremely painful complication that usually requires surgery) over a 20-year period.

Acute cholecystitis develops most commonly in women between the ages of 40 and 60 years. Some ethnic groups such as Native Americans have a dramatically higher incidence of cholecystitis.

Description

The laparoscopic cholecystectomy involves the insertion of a long, narrow cylindrical tube with a camera on the end, through an approximately 0.4 in (1 cm) incision in the abdomen, which allows visualization of the internal organs and projection of this image onto a video monitor. Three smaller incisions allow for insertion of other instruments to perform the surgical procedure. A laser may be used for the incision and cautery (burning unwanted tissue to stop bleeding), in which case the procedure may be called laser laparoscopic cholecystectomy.

In a conventional or open cholecystectomy, the gallbladder is removed through a surgical incision high in the right abdomen, just beneath the ribs. A drain may be inserted to prevent accumulation of fluid at the surgical site.