Cholecystectomy (removal of the gallbladder because of stone disease) is one of the most frequently performed operations in this country, and one of the safest. Recovery from the operation is only limited by the discomfort and healing time of the incision. In 1990, a new technique of operation, "laparoscopic cholecystectomy", became available. It is now possible to remove the gallbladder and gallstones without making a surgical incision. Recovery is significantly quicker and less painful than previously. This pamphlet is meant to help you understand this operation, and let you know what to expect.

Q. WHAT IS GALLSTONE DISEASE?

A. Your liver makes bile, a digestive juice which flows through the "common duct" into your intestine. When you're not eating, bile is stored and concentrated in the gallbladder, which is shaped like a small balloon attached to the common duct. After eating, the stomach signals the gallbladder to contract, and it squeezes the bile into the common duct and out into the intestine. In some people, as the gallbladder concentrates the bile, a muddy precipitate of cholesterol occurs, which forms "stones". These stones can block the neck of the gallbladder, causing it to go into spasm when it tries to empty itself. This causes pain, which can be severe and can last for several hours.

Other problems can occur. Sometimes the stones get into the common duct and block the flow of bile from the liver. This causes "jaundice" (yellowness of the skin). If the stone blocks the flow of digestive juice from the pancreas, it can cause inflammation of that gland, or "pancreatitis."

Q. WHAT TREATMENT IS NEEDED?

A. Once you have symptoms from gallstones, they almost always continue to cause problems until they are treated. The best method of treating gallstones and preventing further problems is surgical removal of the gallbladder and gallstones. Removing the gallbladder prevents more stones from developing,and does not usually cause any digestive problems, since bile continues to flow through the common duct into the intestine. Alternatives to operation are shock-wave lithotripsy (shattering the gallstones), and medications which are given to dissolve gallstones. These alternative treatments are much less successful than operation and are only recommended for people who cannot undergo anesthesia.

Q. WHAT DOES THE OPERATION INVOLVE?

A. You will be wheeled into the operating room on a stretcher and moved over to the bed. The anesthesiologist will start an i.v., and put you to sleep. Then the surgeon will make a small incision below the belly button and inflate your abdomen with carbon dioxide gas. A video camera about the size of a long pencil is inserted through the incision. The telescope is connected to a video screen, on which the surgeon can see what is going on inside the belly. Three or four other very small incisions are made in the upper portion of the abdomen, and instruments are inserted into the belly. With these, the surgeon and his assistant perform the operation, cutting the duct and artery to the gallbladder after blocking them with metal clips, and then cutting the gallbladder away from the liver. If, at any time, there is difficulty with the operation, such as bleeding, or if there is too much scarring or inflammation for the operation to be done safely with the laparoscope, or if a stone is found in the common duct, the surgeon will simply make an incision about 4 inches long just below the right ribcage and do the operation in the conventional way.

Once the gallbladder is separated from the liver, it is removed through the incision in the belly button. The small incisions are closed, usually with dissolving stitches.

After the operation, you will spend about two hours in the recovery room. Most people have some discomfort, usually belly soreness, and sometimes back or shoulder aching, for which pain medication is needed. Sometimes there is some nausea, and this is normal. All of these symptoms improve quickly, and are usually completely gone by two or three days after the operation. Most people are able to leave the hospital on the same day as the operation. If there is severe nausea or pain, the surgeon will keep you in the hospital until it is better - usually just overnight. (Of course, if you needed to have the conventional, "open" operation, you will need to stay two or three days.)

Once you are home, do not overdo it. You should take it easy for at least two days, until you are sure you have recovered. Most people are able to return to normal activity within a week or so, but you should not try to set any records! There are no restrictions in diet or activity - just use common sense.

Q. WHAT ARE THE RISKS OF THE OPERATION?

A. Laparoscopic cholecystectomy does carry the same sort of risks as the standard operation. These include bleeding, infection, leakage of bile, retained stones in the common duct, and injury to the main bile duct. These problems are rare, but do occur, and may require an operation to correct. If at any time after the operation you develop severe abdominal pain, nausea and vomiting (more than three times), fever over 100.5, or any other worrisome symptoms, you should contact our office at (781) 331-4432 or the hospital emergency room immediately.

BEFORE YOUR OPERATION:
1. Read the Gallbladder book and the printed information several times; if you have any questions, write them down, then call for answers.
2. Shower daily with Hibiclens soap (buy it at the pharmacy) for two days before operation, to reduce the risk of infection.
3. Do not take aspirin, Bufferin, Anacin, Advil, Nuprin, or similar medications within a week of the operation. Tylenol (acetaminophen) is OK. If you take coumadin, you should stop taking it four days before operation; make sure you notify us if you are on this medication.
5. If you take any other medications, check with us about taking them before the operation. In most cases, we will want you to continue.
6. Do not eat or drink anything (except for specified medications with a sip of water) after midnight before the operation.

AFTER THE OPERATION:
1. After discharge, go home and take it easy. There will be some "hangover" - nausea, dizziness, dry mouth - from the anesthesia for about 24 hours after the operation. This is normal. If excessive vomiting (more than three times) occurs, or if you develop fever over 101, or severe abdominal pain, call immediately.
2. Any activity which does not cause pain is OK. Do not drive or operate machinery while taking pain medication.
3. There is normally some abdominal soreness and bruising near the incisions and beside the belly button. You may also notice some shoulder or back discomfort (from the gas) for wo or three days. Take the pain medication as prescribed to keep yourself comfortable.
4. You may shower the next day. Change the dressings if they are soiled or wet. If any incision begins draining excessively or looks infected (red, hot, swollen, and tender), call immediately.
5. You may resume normal diet and activity whenever you feel like it, including returning to work.
6. Make sure you call to make a postoperative appointment, at which the surgeon will check your incisions, remove stitches if necessary, and answer any questions you may have.