Cholecystectomy is a surgical procedure used to remove diseased gallbladders, primarily to treat gallstones, chronic cholecystitis, gallbladder polyps, and other related conditions. This operation effectively relieves gallbladder-related symptoms such as right upper quadrant pain, indigestion, or recurrent inflammation. Depending on the severity of the patient's condition, surgeons may choose between laparoscopic or traditional open surgery.
The goal of the surgery is to completely remove the affected organ to prevent gallstone obstruction of the bile ducts or complications such as pancreatitis. In recent years, advances in laparoscopic techniques have made it the mainstream choice, characterized by smaller incisions and faster recovery, significantly increasing patient acceptance.
Cholecystectomy mainly falls into two types: Laparoscopic Cholecystectomy (LC) and traditional open cholecystectomy. Laparoscopic surgery involves four small incisions of 0.5-1 cm in the abdomen, using a camera and specialized instruments to remove the gallbladder. The mechanism involves precise separation of the gallbladder from the liver and bile ducts, confirming no bleeding from blood vessels before completing the procedure.
Open surgery is suitable for patients with abnormal anatomy or severe intra-abdominal adhesions, requiring a 10-15 cm incision in the right upper abdomen. Both methods require general anesthesia, with a surgical duration of approximately 1-3 hours, depending on complexity. The key is to ensure the bile duct is not damaged to avoid bile leakage or strictures.
Main indications include recurrent abdominal pain caused by gallstones, acute or chronic cholecystitis, gallbladder polyps larger than 1 cm, gallbladder hydrops, or functional abnormalities. If patients exhibit jaundice, acute pancreatitis, or suspected precancerous conditions of the gallbladder, surgery is also recommended.
Special cases such as previous upper abdominal surgery leading to severe adhesions or concurrent organ diseases require careful assessment of surgical risks and necessity. This surgery is not suitable for patients with incidental, asymptomatic small gallstones.
The procedure is usually performed under general anesthesia. Patients need to fast for 8 hours and undergo blood tests, liver function tests, and abdominal ultrasound. The laparoscopic process includes establishing pneumoperitoneum, inserting the camera, dissecting the Calot's triangle, and finally cutting tissues with energy devices. If anatomical structures are unclear during surgery, conversion to open surgery may be necessary.
Postoperative hospitalization typically lasts 1-3 days. Patients undergoing laparoscopic surgery can usually get out of bed the next day. Recovery time varies by procedure type: about 2 weeks for laparoscopic patients to return to normal life, and 4-6 weeks for open surgery. Dietary instructions include a low-fat diet initially.
Patients no longer suffer from gallstone obstruction after surgery, and chronic abdominal pain and digestive issues are alleviated. Statistics show that over 90% of patients experience complete symptom relief postoperatively, with significant improvements in quality of life.
Potential complications include:
Long-term risks include "Post-Cholecystectomy Syndrome," where about 5-40% of patients may experience persistent upper abdominal discomfort. Rare cases may involve injury to the common hepatic duct or right hepatic artery, requiring emergency treatment.
Contraindications include:
Preoperative management includes controlling comorbidities such as diabetes and cardiopulmonary diseases. Postoperative monitoring of wound healing is essential; if high fever or jaundice occurs, immediate medical attention is necessary. Pregnant women in late pregnancy should have their surgical timing carefully evaluated to ensure fetal safety.
This surgery is typically the final option after medication treatments (such as litholytic drugs) or endoscopic stone removal. Patients on anticoagulants require medication adjustments to reduce bleeding risk. Postoperative diet usually involves low-fat foods to avoid affecting gastrointestinal metabolism.
For patients with intrahepatic bile duct stones, combined medical or endoscopic treatments may be necessary. The surgery does not directly interact with chemotherapy or immunosuppressants, but general anesthesia considerations include other medication metabolism.
Clinical studies show that laparoscopic cholecystectomy has a symptom relief rate exceeding 95%, and open surgery over 90%. Long-term follow-up indicates a significant reduction in gallstone-related acute episodes. A 5-year satisfaction survey shows 90% of patients are satisfied with the surgical outcomes.
Compared to conservative treatment, surgery prevents complications from recurrent episodes, such as acute pancreatitis or bile duct obstruction. Randomized controlled trials confirm that the recurrence rate of symptoms is 70% lower in the surgical group than in the medication group.
Non-surgical alternatives include:
However, drug therapy has a low cure rate and may lead to stone reformation. ESWL carries a 10-20% risk of complications. Alternatives should be carefully evaluated; for severe or recurrent cases, surgery remains the gold standard treatment.
What preparations are needed before surgery?
Preoperative assessments include blood tests, abdominal ultrasound or CT scans to confirm the diagnosis. Patients should fast for 8 hours and avoid water for 4 hours before surgery, and inform the medical team of current medications, especially anticoagulants. For diabetes or cardiopulmonary conditions, medication adjustments should be coordinated with the healthcare team.
How to relieve abdominal or shoulder pain after laparoscopic cholecystectomy?
Postoperative pain usually subsides within 3-5 days, with painkillers prescribed by the doctor. Shoulder and neck soreness is caused by residual carbon dioxide gas in the abdomen and can be alleviated by side-lying rest and gentle activity to promote gas absorption. If pain suddenly worsens or persists beyond a week, medical attention should be sought immediately.
What dietary adjustments are recommended after surgery?
Initially, a low-fat, high-protein diet is advised, avoiding greasy and high-fiber foods to reduce digestive discomfort. Eating small, frequent meals and gradually resuming normal diet is recommended. Keeping a food diary to monitor foods that trigger bloating or diarrhea for 3-6 months is beneficial.
What are signs of postoperative complications?
If high fever (over 38.5°C), wound redness or pus, persistent vomiting, severe abdominal distension, or jaundice occurs, it may indicate infection or bile duct injury, requiring immediate medical attention. The complication rate for laparoscopic surgery is approximately 0.1-2%, but early detection allows effective treatment.
What are the criteria for choosing between laparoscopic and open surgery?
Laparoscopic surgery is suitable for patients without severe intra-abdominal adhesions, uncomplicated gallbladder inflammation, with a recovery time of about 1-2 weeks. In cases of severe obesity, previous major abdominal surgeries, or intraoperative anatomical uncertainty, conversion to open surgery may be necessary, extending hospitalization to 5-7 days.
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