Laparoscopic Cholecystectomy

Gallbladder pathology commonly presenting as right upper quadrant abdominal pain/discomfort after meals, nausea, vomiting, and colicky epigastric pain is the most common cause of needing gallbladder removal, also known as cholecystectomy. Laparoscopic cholecystectomy is a very common procedure done in the United States by general surgeons and liver surgeons. This procedure is very well tolerated by patients and it is considered a minor hepatobiliary operation. A small percentage of patients experience temporary diarrhea or loose bowel movements (1-2 weeks after surgery) and long-term side effects of cholecystectomy are almost non-existent.

Even though it is considered a minor hepatobiliary operation, laparoscopic cholecystectomy can carry significant morbidity, when it is not performed well. Bile duct injury and bile leak are commonly reported after a routine laparoscopic cholecystectomy for benign gallbladder stones, gallbladder inflammation/infection. Bile duct injury after a laparoscopic cholecystectomy ranges from a minor nick in the bile duct wall to a complete transection of the main biliary duct. Acute cholecystitis with severe inflammatory changes around the gallbladder increases the technical difficulty of the gallbladder operation and this can in turn increase the incidence of bile duct injury. When the biliary duct anatomy is not clear, a contrast imaging (fluoroscopic cholangiogram) should be obtained. A failure to recognize the biliary anatomy can lead to a bile duct injury. Therefore, it is important to find a surgeon with adequate experience in performing this operation. Biliary anomaly and aberrant biliary duct branches were not uncommonly found. They are often seen during the laparoscopic cholecystectomy and must be recognized by the operating surgeon to avoid complications.

When patients present with a chronic cholecystitis from gallstones, a complete removal of the gallbladder is necessary, instead of only removing the gallstones. While it may sound intuitive to only remove the gallstones (and leave the gallbladder behind), recurrence of gallstone formation within the gallbladder is uniformly expected/seen. A smaller percentage of patients present with jaundice (yellowing of skin and eyes) from a spontaneous gallstone migration into the common bile duct. In this situation, an ERCP (an endoscopic procedure to clear the bile duct) is needed to remove the gallstone prior to performing the laparoscopic cholecystectomy. In many community hospitals in Florida, technical expertise to do ERCP is not available. Our liver surgery center is the referral destination in Tampa Bay Area for complicated gallbladder diagnoses.
After an uneventful laparoscopic cholecystectomy, most patients can be discharged to home after 4-6 hours of observation. In most hospitals, laparoscopic cholecystectomy is undertaken via four laparoscopic trocar incisions. This is the conventional laparoscopic approach for a gallbladder removal surgery, described in the early 1990s. There have been several technical variations in laparoscopic cholecystectomy since then to try reduce to the number of incision, without compromising the safety of the operation. The gallbladder specimen is sent to pathology for a permanent section examination to rule out a potential presence of premalignant or malignant cells within the gallbladder.

Dr. Iswanto Sucandy has significant experience in performing this operation minimally invasively using a single incision technique with excellent outcomes. This is called laparoscopic single site cholecystectomy via an umbilical incision. In our program, we have developed a protocol to perform the cholecystectomy using either general anesthesia or epidural anesthesia. Epidural anesthesia is anticipated to improve the postoperative pain control and minimize the side effects of general anesthesia. Following the laparoscopic cholecystectomy, patients are seen in the office in about 2 weeks for their first postoperative visit.