Our Summary

This review paper discusses various aspects of cholecystectomy, which is the surgical removal of the gallbladder. Different grading systems for diagnosing gallbladder inflammation are covered. The paper also talks about the best time to perform this surgery, ideally within 72 hours of the patient being admitted to the hospital, but it can be done up to the seventh day.

The authors stress the importance of the surgeon having a thorough understanding of the patient’s anatomy to avoid complications during surgery. If this isn’t possible in 15% of operations, the surgeon should change their approach to ensure patient safety.

In cases where the operation is particularly challenging, the paper advises to minimize the risk of injury by performing a subtotal cholecystectomy (partial removal of the gallbladder) or a top-down cholecystectomy (a particular technique of gallbladder removal), rather than attempting to dissect the hepatocystic triangle (an area of the body that can be risky to operate on).

The paper also notes that the most severe injuries tend to occur when the surgery is switched from a laparoscopic cholecystectomy (performed with small incisions and a camera) to a traditional open surgery. Lastly, the authors discuss the circumstances and techniques for performing a subtotal cholecystectomy, which is currently the outcome for 7% to 10% of gallbladder removal surgeries for acute gallbladder inflammation.

FAQs

  1. What is the ideal time frame for performing a cholecystectomy after a patient is admitted to the hospital?
  2. What alternative techniques are suggested for challenging cholecystectomy operations?
  3. What is the risk associated with switching from a laparoscopic cholecystectomy to a traditional open surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laparoscopic cholecystectomy is to follow their post-operative instructions carefully, including taking pain medications as prescribed, avoiding heavy lifting or strenuous activities for a certain period of time, and watching for signs of infection such as fever or increased pain. It is important to attend follow-up appointments with your surgeon to ensure proper healing and to address any concerns or complications that may arise.

Suitable For

Patients who are typically recommended for laparoscopic cholecystectomy include those with symptomatic gallstones, acute cholecystitis (inflammation of the gallbladder), biliary colic (abdominal pain caused by gallstones), and choledocholithiasis (stones in the bile duct). Additionally, patients who are fit for surgery and do not have contraindications to laparoscopic surgery are good candidates for this procedure.

Timeline

Before laparoscopic cholecystectomy:

  • Patient experiences symptoms of gallbladder issues such as abdominal pain, nausea, vomiting, and bloating
  • Patient undergoes diagnostic tests such as ultrasound or CT scan to confirm the presence of gallstones or inflammation
  • Surgeon evaluates the patient’s condition and decides on the best course of treatment
  • Patient may be admitted to the hospital and given antibiotics and pain medication to manage symptoms

After laparoscopic cholecystectomy:

  • Patient undergoes minimally invasive surgery to remove the gallbladder
  • Surgery is typically completed within a few hours, and the patient is monitored in the recovery room before being discharged the same day or the next day
  • Patient may experience some pain and discomfort at the incision sites, which can be managed with pain medication
  • Patient is advised to rest and avoid heavy lifting for a few weeks
  • Patient may be instructed to follow a special diet to help with digestion and prevent complications
  • Follow-up appointments are scheduled to monitor the patient’s recovery and address any concerns or complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about laparoscopic cholecystectomy include:

  1. What are the potential risks and complications associated with this surgery?
  2. How experienced is the surgeon in performing laparoscopic cholecystectomy?
  3. What is the expected recovery time and post-operative care needed?
  4. Are there any alternative treatment options available for my condition?
  5. Will I need to make any lifestyle changes after the surgery?
  6. How long will I need to stay in the hospital after the procedure?
  7. What type of anesthesia will be used during the surgery?
  8. Will I need to follow any specific diet restrictions before or after the surgery?
  9. What should I do if I experience any unusual symptoms after the surgery?
  10. How soon can I return to my normal activities and work after the surgery?

Reference

Authors: Seshadri A, Peitzman AB. Journal: J Trauma Acute Care Surg. 2024 Sep 1;97(3):325-336. doi: 10.1097/TA.0000000000004337. Epub 2024 Apr 10. PMID: 38595229