UW CVES: LAPAROSCOPIC CHOLECYSTECTOMY


		LAPAROSCOPIC CHOLECYSTECTOMY The normal function of the gallbladder is to store and concentrate bile which is produced by the liver to aid in the absorption of various food elements. Removal of the gallbladder is advocated for patients who develop gallstones that result in symptoms. The most common symptom is pain in the right upper abdomen, and is the result of intermittent or partial obstruction of the bile duct leading to the gallbladder. Other problems such as pancreatitis or jaundice may occur, but they are relative uncommon. Gallstones form in the gallbladder as a result of an imbalance of concentrated bile salts and cholesterol which make up bile. Medications and shock waves have been used in the past to dissolve or break up gallstones, but this only partially or temporarily removes the stones, and does not address the underlying cause of gallstone formation. Medications have also been used to prevent gallstone formation, but this requires the continual use of medications which may have significant side effects. The most common treatment for gallstones that cause pain has been and remains surgery, in an operation termed cholecystectomy. This is a one-time treatment that results in resolution of symptoms in the vast majority of patients. In the past, cholecystectomy was performed through a large midline or right upper abdominal incision. The patient would require hospitalization for about three to seven days for pain control and to await for return of intestinal function. In the past 10 years, a new approach has evolved for operative treatment of gallstones which utilizes a videoendoscopic approach through very small incisions. Generally in this approach, four small 1/2 inch incisions are made in the skin to place ports which allow passage of instruments to dissect the gallbladder off the liver. An x-ray cholangiogram is performed by injecting a dye solution into the duct which empties the gallbladder to further define the anatomy of the region and to check for the presence of a retained gallstone. If the cholangiogram is normal, the gallbladder is then removed through one of these ports. The removal of the gallbladder thus addresses the problem of stone formation, but still allows bile from the liver to reach the intestines to aid in fat absorption. On occasion, the videoendoscopic approach needs to be converted to the traditional open operation secondary to unusual anatomy, scarring or inflamed tissues, or bleeding. This occurs less than 5% of the time, and is usually necessary as an added safety measure to avoid unnecessary complications. However, even when one or more of these conditions occur, a videoendoscopic approach may be safely carried out in skilled hands. The videoendoscopic approach has revolutionized the surgical treatment of gallstones. Because of the small incisions, patients have considerably less pain and intestinal function is altered only minimally. Most patients who undergo this elective operation are able to be treated on an outpatient basis, or go home the day after surgery. This approach has become so reliable and effective, that it has become the standard for surgical treatment of gallstones that are symptomatic.


This page last updated 07/28/98 Comments to CVESWebmaster@u.washington.edu ©1996, 1997 University of Washington Department of Surgery Center for Videoendoscopic Surgery Home Page University of Washington Department of Surgery Home Page University of Washington Home Page