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Gallbladder Surgery

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. Gallbladder surgery may be necessary when gallstones 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.

Gallstones are 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, and there is no known means to prevent gallstones.

Ultrasound is most commonly used to locate gallstones, and in 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, Cholecystectomy, is the time honored and safest treatment of gallbladder disease. There are a number of advantages to performing Cholecystectomy Laparoscopically, including:

• Rather than a five to seven inch incision, the operation requires only four small openings in the abdomen.

• Patients usually have minimal post-operative pain.

• Patients usually experience faster recovery than open gallbladder surgery patients.

• Most patients go home within one day and enjoy a quicker return to normal activities.

A thorough medical evaluation by your personal physician, in consultation with a surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal is an appropriate procedure for you.

HOW TO PREPARE

In preparing for a Laparoscopic Cholecystectomy, each patient and surgeon is unique, and the following general preparation information may be adjusted by the surgeon. Always follow your surgeon’s guidelines.

• Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.

• After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.

• Your surgeon may request that you completely empty your colon and cleanse your intestines prior to surgery. You may be requested to drink clear liquids, only, for one or several days prior to surgery.

• After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon 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.

• Quit smoking and arrange for any help you may need at home.

RESULTS

Gallbladder removal is a major abdominal operation and a certain amount of postoperative pain occurs. Nausea and vomiting are not uncommon. Once liquids or a diet is tolerated, patients leave the hospital the same day or day following the laparoscopic gallbladder surgery.

Activity is dependent on how the patient feels. Walking is encouraged. Patients can remove the dressings and shower the day after the operation. 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 the patient 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. Your surgeon should be contacted in these instances.

Most patients who have a laparoscopic gallbladder removal go home from the hospital the day after surgery. Some may even go home the same day the operation is performed.

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.

RISKS

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. It is important to remember that before undergoing any type of surgery–whether laparoscopic or open you should ask your surgeon about his/her training and experience.

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

Numerous medical studies show that the complication rate for laparoscopic gallbladder surgery is comparable to the complication rate for open gallbladder surgery when performed by a properly trained surgeon.

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