Surgical Procedures for Gallstones
by Editorial Staff and Contributors
Surgery to remove the gallbladder is the most common method of treating gallstones that have become problematic. The timing and type of surgery depends on the severity of the disease.
When the gallbladder is removed, the surgeon also examines the bile ducts and removes any stones that are present. The ducts are not removed so the liver can continue to secrete bile into the intestine to assist with digestion.
Laparoscopic Cholecystectomy vs. Open CholecystectomyCopyright © Nucleus Medical Media, Inc. |
Laparoscopic Cholecystectomy
In the US, laparoscopic cholecystectomy has become a very common procedure for removing the gallbladder, accounting for approximately 75%-90% of the surgical procedures.
This procedure should not be done if you:
- Are on blood thinners
- Had previous stomach surgery with alot of scarring
- Have pancreatitis
This procedure may be delayed if you have acute inflammation or infection
The surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. While watching the monitor, the surgeon inserts instruments through a second incision to carefully separate the gallbladder from the liver, ducts, and other structures. The cystic duct is then cut and the gallbladder is removed.
Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer complications than they do after major abdominal surgery. Recovery usually requires only a few days of restricted activity at home.
This procedure has a success rate around 95%. Approximately 10% of the patients will have the following complications:
- Aspiration of stomach content
- Pancreatitis
- Bleeding
- Perforated bowel or bile ducts
- Recurrent stone
In about 5%-10% of laparoscopies, the doctor needs to switch to an open cholecystectomy.
Open Cholecystectomy
If there are any obstacles to the laparoscopic procedure—such as infection or scarring from other operations—your surgeon may do an open surgery. During an open surgery, the surgeon has to make an incision in the abdomen to remove the gallbladder. Open cholecystectomy is very safe, but is considered major surgery and may take several weeks recovery time at home. This procedure accounts for approximately 10%-25% of all the surgical procedures for gallstones.
This procedure should not be done if you have:
- Uncontrolled bleeding disorder
- Chronic lung disease or heart failure
Postoperative complications include the following:
- Hernia
- Diarrhea
- Wound infection
- Perforated bowel
- Injury to the liver or kidney
REFERENCES:
Clayton ES, Connor S, Alexakis N, Leandros E. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg. 2006;93(10):1185-1191.
Gallstones. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/articles/gallstones. Accessed September 1, 2017.
Gallstones. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114033/Gallstones . Updated July 22, 2016. Accessed September 1, 2017.
Gallstones. National Institute of Diabetes and Digesrive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones. Updated November 2013. Accessed September 1, 2017.
Keus F, Broeders IT, van Laarhoven CJ. Gallstone disease: surgical aspects of symptomatic cholecystolithiasis and acute cholecystitis. Best Pract Res Clin Gastroenterol. 2006:20(6):1031-1051.
McVeigh G, Dobinson Evans E, Dwerryhouse S, et al. Gallstone disease: diagnosis and management. Available at: https://www.nice.org.uk/guidance/cg188/chapter/Introduction. Updated October 2014.
Portincasa P, Di Ciaula A, de Bari O, Garruti G, Palmieri VO, Wang DQ. Management of gallstones and its related complications. Expert Rev Gastroenterol Hepatol. 2016;10(1):93-112.
Last reviewed September 2018 by
EBSCO Medical Review Board
Michael Woods, MD, FAAP
Last Updated: 9/1/2017