Cholecystectomy is a surgical procedure involving the removal of the gallbladder to treat gallbladder-related diseases. It is primarily indicated for patients with severe symptoms such as gallstones, chronic cholecystitis, or gallbladder dysfunction, effectively alleviating pain, preventing bile duct obstruction, and complications. The surgery can be performed via laparoscopic or traditional open approaches, with the most suitable method chosen based on the patient's condition and the surgeon's judgment.
The key to the procedure is the complete removal of the gallbladder to prevent residual tissue from causing recurrent episodes. Advances in laparoscopic technology have made it the preferred minimally invasive technique, significantly reducing recovery time and becoming the first-line treatment for gallbladder diseases.
Laparoscopic cholecystectomy (LC) is the primary method, involving 3-4 small incisions in the abdomen through which a camera and instruments are inserted. The instruments are guided by imaging to remove the gallbladder and confirm that the bile duct structure is intact. This technique uses high-resolution cameras and precise instruments to minimize tissue damage.
Traditional open cholecystectomy requires a 10-centimeter incision in the right upper abdomen and is suitable for patients with complex anatomy, previous abdominal surgeries, or difficult laparoscopic procedures. Both methods require general anesthesia, with an operative time of approximately 1-2 hours. However, laparoscopic surgery results in smaller wounds and faster recovery.
Main indications include recurrent gallstone attacks, acute or chronic cholecystitis, gallbladder polyps larger than 1 centimeter, and diagnosed gallbladder hypokinesis. Emergency surgery is necessary when gallstones obstruct the bile duct, causing pancreatitis or jaundice.
In special cases, such as suspicion of gallbladder malignancy, intraoperative tissue biopsy can be performed to confirm the extent of the lesion. Elderly patients with severe complications (e.g., acute suppurative cholecystitis) require immediate surgery to prevent perforation or sepsis.
This is a surgical procedure, so there are no drug dosages involved. The process includes establishing laparoscopic access after general anesthesia, identifying the Calot's triangle, dissecting tissues, ligating blood vessels and bile ducts with energy devices, and removing the gallbladder. Open surgery involves direct tissue dissection and vessel ligation.
Postoperative hospitalization typically lasts 1-3 days. Patients undergoing laparoscopic surgery can usually resume diet the next day, while open surgery patients are observed for 3-5 days. During recovery, strenuous activity should be avoided, and normal activities should be gradually resumed under medical guidance.
Compared to medication, surgery provides immediate resolution of obstruction issues and reduces the risk of malignant transformation due to bile stasis. The laparoscopic approach offers better cosmetic results with nearly invisible scars.
Potential complications include:
Serious risks include intra-abdominal bleeding or anastomotic leaks, with an incidence of about 1-2%. A small number of patients may develop "post-cholecystectomy syndrome," characterized by persistent upper abdominal pain, possibly due to postoperative digestive function adjustments.
Preoperative assessments include abdominal ultrasound, liver function tests, and coagulation studies. Contraindications include uncontrolled sepsis, severe cardiopulmonary diseases, or extensive intra-abdominal adhesions preventing laparoscopic surgery.
Pregnant women in late pregnancy, patients with diabetes or hematologic disorders require medication adjustments. Postoperatively, close monitoring for fever, severe abdominal pain, or other abnormal symptoms is essential.
Anticoagulants such as aspirin or warfarin may need to be temporarily discontinued before and after surgery. A low-fat diet is recommended postoperatively, and short-term use of analgesics or antibiotics may be necessary.
Unlike endoscopic retrograde cholangiopancreatography (ERCP), which involves removing stones from the bile duct, this surgery involves directly removing the organ. If bile duct stones are present, ERCP may be performed first to extract stones. Pharmacological litholytic therapy is only suitable for a few patients and is less effective than surgery.
Multiple clinical studies report a success rate of up to 98% for laparoscopic cholecystectomy, with complication rates below 5% within 90 days post-surgery. Long-term follow-up shows nearly zero recurrence of gallstones, and patient satisfaction surveys indicate over 85% experience complete symptom relief.
Compared to conservative management, surgery reduces the re-admission rate by 70% and lowers the risk of gallbladder cancer (annual incidence approximately 0.1-0.3%). The American Surgical Association recommends this procedure as the standard treatment for symptomatic gallstone disease.
Medications such as ursodeoxycholic acid (UDCA) can dissolve certain cholesterol stones, but it takes 6-18 months to see effects and is only suitable for select patients. Extracorporeal shock wave lithotripsy (ESWL) may cause stone displacement and bile duct obstruction.
Observation and wait-and-see strategies are only suitable for asymptomatic stones, with regular follow-up required. When symptoms worsen or complications arise, surgery remains the definitive treatment.
Before laparoscopic cholecystectomy, patients typically undergo liver function tests, abdominal ultrasound, and blood tests. Fasting for 8 hours before surgery and stopping medications that affect coagulation (such as aspirin) as advised by the doctor are necessary. On the day of surgery, bring medical records and arrange for a family member to accompany you home, as anesthesia may temporarily impair judgment.
How can postoperative abdominal pain or discomfort be alleviated? What symptoms require immediate medical attention?Mild abdominal pain or shoulder soreness are normal and can be managed with painkillers as directed. If severe abdominal pain, a fever over 38.5°C, persistent vomiting, or wound redness and pus occur, seek medical attention immediately, as these may indicate infection or internal bleeding.
What dietary principles should be followed after surgery? When can normal eating resume?Initially, a low-fat, high-fiber diet is recommended, avoiding greasy or spicy foods, and eating small portions to reduce gastrointestinal burden. Usually, normal diet can gradually resume after 2-4 weeks, but high-fat intake should still be avoided to reduce the risk of bile duct inflammation.
What are the differences in recovery between open and laparoscopic surgery?Laparoscopic surgery involves minimal trauma, with hospital stays of about 1 to 3 days and a return to normal activities within 2 to 4 weeks. Open surgery involves larger incisions, with hospital stays of about 5 to 7 days and a recovery period that may extend up to 6 weeks. The choice depends on the severity of inflammation or anatomical abnormalities.
Why do some patients experience right upper abdominal discomfort after gallbladder removal, and how can it be resolved?Some patients may experience discomfort due to postoperative gastrointestinal motility issues or nerve sensitivity, which usually improves within weeks. If symptoms persist, further examination is necessary to check for bile duct injury or residual stones. The doctor may recommend ultrasound or endoscopy to identify the cause.
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