Gallbladder Removal

• The gallbladder is a pear-shaped organ that rests beneath the right side of the liver.
• Its main purpose is to collect and concentrate a digestive liquid (bile) produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through narrow tubular channels (bile ducts) into the small intestine.
• Removal of the gallbladder is not associated with any impairment of digestion in most people.

• Gallbladder problems are usually caused by the presence of gallstones: small hard masses consisting primarily of cholesterol and bile salts that form in the gallbladder or in the bile duct.
• It is uncertain why some people form gallstones.
• There is no known means to prevent gallstones.
• These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting, indigestion and, occasionally, fever.
• If the gallstone blocks the common bile duct, jaundice (a yellowing of the skin) can occur.

Ultrasound is most commonly used to find gallstones.

• In a few more complex cases, other X-ray tests may be used to evaluate gallbladder disease.
• Gallstones do not go away on their own. Some can be temporarily managed with drugs or by making dietary adjustments, such as reducing fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue unless the gallbladder is removed.
• Surgical removal of the gallbladder is the time honored and safest treatment of gallbladder disease.

• Rather than a five to seven inch incision, the operation requires only four small openings in the abdomen. And for most patients, Dr. Khosravi is now performing the procedure through only one tiny incision.
• Patients usually have minimal post-operative pain.
• Patients usually experience faster recovery than open gallbladder surgery patients.
• Most patients go home the same day of surgery and enjoy a quicker return to normal activities.

Virtually All Patients Are Candidates for Laparoscopic Gallbladder Removal

Dr. Khosravi is able to perform laparoscopic gallbladder removal even for patients who have had multiple previous abdominal surgeries, with an extremely low conversion rate to open surgery.

The advantage of the laparoscopic approach is that it usually provides:

• reduced postoperative pain
• shorter hospital stay
• a faster return to work
• improved cosmetic result

The following includes typical events that may occur prior to laparoscopic surgery; however, since each patient is unique, what will actually occur may be different:

• Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
• After Dr. Khosravi reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
• It is recommended that you shower the night before or morning of the operation.
• After midnight the night before the operation, you should not eat or drink anything except medications that Dr. Khosravi or his office staff has told you are permissible to take with a sip of water the morning of surgery.
• Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
• Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.

• Under general anesthesia, so you is asleep throughout the procedure.
• Using a cannula (a narrow tube-like instrument), Dr. Khosravi enters the abdomen in the area of the belly-button.
• A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving Dr. Khosravi a magnified view of you’s internal organs on a television screen.
• Other cannulas are inserted which allow Dr. Khosravi to delicately separate the gallbladder from its attachments and then remove it through one of the openings.
• In select patients, Dr. Khosravi performs and x-ray called a cholangiogram, to identify stones, which may be located in the bile channels, or to insure that structures have been identified.
• If Dr. Khosravi finds one or more stones in the common bile duct, (s)he may remove them with a special scope, may choose to have them removed later through a second minimally invasive procedure.
• After Dr. Khosravi removes the gallbladder, the small incisions are closed with a stitch or two or with surgical tape.

• Gallbladder removal is a major abdominal operation and a certain amount of postoperative pain occurs. Nausea and vomiting are not uncommon.
• The vast majority of patients leave the hospital the same day, once they are able to tolerate a diet. A small percentage of patients stay overnight due to nausea and vomiting from the anesthetics. Occasionally, patients with a significant pre-existing medical condition may require monitoring overnight.
• Activity is dependent on how you feels. Walking is encouraged. Patients may shower the day after the operation. Dressing are to be removed by the patient 4-5 days after the surgery.
• Patients will probably be able to return to normal activities within a week’s time, including driving, walking up stairs, light lifting and working.
• In general, recovery should be progressive, once you is at home.
• The onset of fever, yellow skin or eyes, worsening abdominal pain, distention, persistent nausea or vomiting, or drainage from the incision are indications that a complication may have occurred. Dr. Khosravi should be contacted in these instances.
• Most patients can return to work within seven days following the laparoscopic procedure depending on the nature of your job. Patients with administrative or desk jobs usually return in a few days while those involved in manual labor or heavy lifting may require a bit more time. Patients undergoing the open procedure usually resume normal activities in four to six weeks.
• Make an appointment with Dr. Khosravi within 2 weeks following your operation.

While there are risks associated with any kind of operation, the vast majority of laparoscopic gallbladder patients experiences few or no complications and quickly return to normal activities.

Complications of laparoscopic cholecystectomy are infrequent, but include bleeding, infection, pneumonia, blood clots, or heart problems. Unintended injury to adjacent structures such as the common bile duct or small bowel may occur and may require another surgical procedure to repair it. Unintended injury to adjacent structures, such as the common bile duct or intestines is extremely rare. Another surgical procedure may be required to repair it.

Bile leakage into the abdomen from the tubular channels leading from the liver to the intestine may rarely occur.

Be sure to call Dr. Khosravi if you develop any of the following:

• Persistent fever over 101 degrees F (39 C)
• Bleeding
• Increasing abdominal swelling
• Pain that is not relieved by your medications
• Persistent nausea or vomiting
• Chills
• Persistent cough or shortness of breath
• Purulent drainage (pus) from any incision
• Redness surrounding any of your incisions that is worsening or getting bigger
• You are unable to eat or drink liquids