Cholecystectomy, also known as gall bladder removal surgery, is the surgical removal of the gall bladder.
Gallstones (bile salt crystals) may develop in the gallbladder due to improper ratio in the bile of cholesterol, bile salts, or bilirubin. This can result in blockage of the gallbladder or liver. This can cause severe pain in the upper abdomen (biliary colic).
Laparoscopic (keyhole) cholecystectomy is the standard of care for patients with symptomatic gallstones. The surgery is done using small instruments and a video camera, which are inserted into the abdomen through a few small keyholes.
WHAT IS CHOLECYSTECTOMY ?
The way to treat gallstones and other diseases that these stones may cause is surgical operation.
The most preferred method of gallbladder surgery is cholecystectomy. This operation, which is performed open or closed, is performed under general anesthesia and aims to remove the gallbladder. Today, primarily closed, that is, laparoscopic cholecystectomy, is preferred in gallbladder surgeries.
Laparoscopic cholecystectomy, which is much more advantageous than open surgery, is performed by creating four small holes in the abdomen without opening large incisions. After the gallbladder surgery performed with the help of a video camera, the bladder is completely removed. In this way, stones in the gallbladder and bile ducts, gallbladder inflammations, polyps and pancreatic inflammations are treated.
IN WHICH CASES CHOLECYSTECTOMY IS PERFORMED ?
If your gallstones are not causing symptoms, you do not need surgery. You will only need surgery if a stone enters one of your bile ducts or if your biliary tract is blocked. The blockage causes a severe, knife-like pain in your abdomen that can last for several hours.
Cholecystectomy is usually performed to treat gallstones and the complications they cause. Your doctor may recommend cholecystectomy if:
Gallstones in the gallbladder (cholelithiasis)
Gallstones in the bile duct (choledocholithiasis)
Gallbladder inflammation (cholecystitis)
large gallbladder polyps
Inflammation of the pancreas due to gallstones (pancreatitis)
Before your doctor chooses to have the surgery, he or she will do several tests to see the effect your gallstones have on your health. Tests may include:
MRI scan - to create images of clogged ducts
Endoscopic ultrasonography - an imaging device is placed in your mouth and down your digestive tract so sound waves can create a detailed picture of your small intestine.
HOW IS CHOLECYSTECTOMY
Cholecystectomy is performed under general anesthesia, so you will not be aware of what is being done during the procedure. Anesthetic drugs are given through a vein in your arm. Once the medications start to work, your healthcare team will insert a tube down your throat to help you breathe.
Depending on your situation, your surgeon will recommend one of two surgical approaches:
Minimally invasive (laparoscopic) cholecystectomy
During a laparoscopic cholecystectomy, the surgeon makes four small incisions in your abdomen. A tube with a small video camera is inserted into your abdomen through one of the incisions. In the operating room, your surgeon monitors the area with a video monitor while using surgical instruments inserted through other incisions in your abdomen to remove your gallbladder.
Then, if your surgeon is concerned about possible gallstones or other problems with your bile duct, you may undergo an imaging test such as an X-ray or ultrasound. Your incisions will then be sutured and you will be taken to your room. Laparoscopic cholecystectomy takes an hour or two.
Laparoscopic cholecystectomy is not suitable for everyone. In some cases, your surgeon may start with a laparoscopic approach and may find it necessary to make a larger incision because of scar tissue from previous surgeries or complications.
Traditional (open) cholecystectomy
During an open cholecystectomy, the surgeon makes a 6-inch (15-centimeter) incision in your abdomen under your ribs on your right side. The muscle and tissue are pulled back to reveal your liver and gallbladder. Your surgeon then removes the gallbladder.
The incision is sutured and you will be taken to your room. Open cholecystectomy surgery takes an hour or two.
Gallbladder stone is common in the following people ;
In overweight people
For those who lose weight fast
Those who use cholesterol medication
In patients with hereditary spherocytosis
It is not possible to reduce or completely eliminate gallstones by using medication. The only treatment for gallstones is surgical operations. Gallbladder surgeries are performed by experienced surgeons with a 95% closed method (laparoscopic cholecystectomy). Inflammation, previous surgeries and anatomical problems may cause this surgery to be performed open in some patients.
Most patients with no complaints can live for years without any problems. Surgery is not recommended, especially for elderly patients who do not have any complaints.
However, 5% of these patients have to apply to the hospital every year because their complaints start to appear. In general, it is necessary to stay closer to the option of surgery in diabetic patients. Because gallbladder inflammation in diabetics can progress rapidly and easily lead to decay and perforation.
The difficulty of the operation to be performed increases as recurrent inflammation attacks are experienced in patients who postpone the operation even though it is necessary.
Before gallbladder stone surgery, various tests are performed, taking into account the age range of the patients. In addition to blood and urine tests, chest and heart radiography, different tests are also required for patients suffering from various chronic diseases. In particular, asthma, diabetes and blood pressure patients are directed to the relevant departments about whether they can have surgery or not. Control by anesthesiologists is also of great importance. Blood thinners should be discontinued at least 7 days in advance and patients should not consume food or water after midnight before the surgery.
Today, laparoscopic cholecystectomy operations take a very short time. The operations, which take an average of 45 minutes, may take longer depending on the age and weight of the patients. However, this time may be more than 1 hour in traditional open surgeries or very delayed operations.
After laparoscopic cholecystectomy operations, patients are completely out of the effect of anesthesia within 5-6 hours and can return to their daily life after 1 day of rest. It is normal to experience pain in the first few days after closed surgeries with a very short recovery time. Pain under the right rib is one of the most common symptoms after gallbladder surgery. However, closed surgeries, which make up approximately 95% of gallbladder surgeries, are much less painful than open surgeries in which large incisions are made. Painkillers recommended by the doctor can be used for pain after gallbladder surgery.
One of the advantages of the laparoscopic cholecystectomy method is that there are either indistinct or completely hidden scars in the abdominal region after the operation. While small incision scars may remain in operations involving four holes and navel, scars are not left in operations performed only from the navel.
Nutrition after gallbladder surgery is also one of the points that patients should pay attention to. Patients who can be fed with liquid foods a few hours after the surgery and solid foods the next day should follow a diet for at least 1 month to avoid problems such as indigestion. During this period, it is important not to consume excessively fatty or gas-forming foods, to give priority to fibrous foods that facilitate digestion, to consume at least 2 liters of water a day, to stay away from chocolate, eggs and acidic beverages.
After gallbladder surgery, there is no change in the daily life of the patients. The gallbladder is not needed for the movement of bile between the liver and the intestines. In this sense, patients can continue their lives without any nutritional restriction or diet after their gallbladder is removed.
FREQUENTLY ASKED QUESTIONS
What are the Risks of Cholecystectomy ?
As with any surgery, there are some risks in gallbladder surgeries. However, if the gallbladder is not treated, it can cause much more serious complications. In this sense, the risks of gallbladder surgery are much less than diseases such as infections and cancer that can be caused by diseases. Although rarely, infections in the wound areas and lungs, vascular deformations and clots in the biliary tract and liver can be seen in the surgeries. The risk of death from gallbladder surgery is also very low with cholecystectomy methods performed with modern techniques today. The risk of death is greater with diseases caused by stones.
How are the Results of Surgery ?
In patients with gallbladder removal, the problems that develop due to gallstones and inflammation are completely resolved. Since the pouch is completely removed, there is no stone and mud formation again.
The gallbladder is not an indispensable vital organ for bodily functions. It can be sacrificed when the risks it creates increase. The absence of the gallbladder is easily tolerated by other organs and systems. No significant change in general health conditions is expected.
How will I Feel After Surgery ?
Patients with closed gallbladder surgery can fully recover and walk a few hours after the surgery. After three to four hours, they can start taking food by mouth and they do not need to take serum.
It is sufficient to give painkillers a few times to prevent complaints such as mild abdominal pain and back pain that may occur on the night of the surgery.
Wound sites are 3-4 one-cm incisions. No significant problems are expected in terms of wound pain or wound healing.
How to Feed After Gallbladder Surgery?
Patients should avoid fatty foods for six weeks after surgery. It is also recommended not to consume foods such as chocolate and eggs. Nutrition and diet experts also offer suggestions on this subject.
Can Pregnant Women Have Gallbladder Surgery?
Pregnancy has an aggravating effect on gallstones, if it goes into the bile duct, the risks are high.
Therefore, laparoscopic surgery is recommended for gallbladder stones if the person with gallbladder stones is not pregnant and a baby is planned.
Surgery should be performed in mandatory cases, but the risk of the first 3 months and the last 3 months is higher; The safest period is between 3-6 months.