by Chwistek M

Surgical Procedures for Gallstones

Surgery to remove the gallbladder is the most common method of treating gallstones that have become problematic. When the gallbladder is removed, the surgeon also examines the bile ducts and removes any stones that are present there. The ducts are not removed, so the liver can continue to secrete bile into the intestine to assist with digestion.
Laparoscopic Cholecystectomy vs. Open Cholecystectomy
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Laparoscopic Cholecystectomy

In the United States, laparoscopic cholecystectomy has become a very common procedure for removing the gallbladder, accounting for approximately 75% of the surgical procedures. This procedure should not be done if you:
  • Are on blood thinners
  • Had previous stomach surgery
  • Have pancreatitis (inflammation of the pancreas)
The surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. While watching the monitor, the surgeon inserts instruments through a second incision to carefully separate the gallbladder from the liver, ducts, and other structures. The cystic duct is then cut and the gallbladder is removed.
Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer complications than they do after major abdominal surgery. Recovery usually requires only a few days of restricted activity at home.
This procedure has a success rate around 95%. Approximately 10% of the patients will have the following complications:
  • Aspiration of stomach content
  • Pancreatitis
  • Bleeding
  • Perforated bowel or bile ducts
  • Recurrent stone
In about 5%-10% of laparoscopies, the doctor needs to switch to an open cholecystectomy.

Open Cholecystectomy

If there are any obstacles to the laparoscopic procedure—such as infection or scarring from other operations—your surgeon may do "open" surgery. It is called "open" surgery because the surgeon has to make a 4- to 8-inch incision (opening) in the abdomen to remove the gallbladder. Open cholecystectomy is very safe, but is considered major surgery and may take several weeks recovery time at home. This procedure accounts for approximately 25% of all the surgical procedures for gallstones.
This procedure should not be done if you have:
  • Uncontrolled bleeding disorder
  • Chronic lung disease or heart failure
Postoperative complications include the following:
  • Hernia
  • Diarrhea
  • Wound infection
  • Perforated bowel
  • Injury to the liver or kidney

References

Adler DG, Baron TH, et al. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc. 2005;62:1-8.

Ahmed A, Cheung RC, et al. Management of gallstones and their complications. Am Fam Physician. 2000;61:1673-1678.

Clayton ES, Connor S, et al. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg. 2006;93:1185-1191.

Keus F, Broeders IT, et al. Gallstone disease: surgical aspects of symptomatic cholecystolithiasis and acute cholecystitis. Best Pract Res Clin Gastroenterol. 2006:20:1031-1051.

Portincasa P, Moschetta A, et al. Cholesterol gallstone disease. Lancet. 2006;368:230-239.

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