A laparoscopic cholecystectomy with cholangiogram is a minimally invasive surgery to remove the gallbladder. “Laparoscopic” refers to the technique using a camera and instruments inserted through small incisions, while “cholecystectomy” is the medical term for gallbladder removal. The “cholangiogram” is a special X-ray of the bile ducts taken during the operation to check for obstructions. This procedure removes a diseased gallbladder while verifying the health of the surrounding bile ducts.
Reasons for the Procedure
The most common reason for this surgery is the presence of gallstones, which are hard deposits that form inside the gallbladder. Gallstones can cause biliary colic, which is intense, recurrent abdominal pain that occurs when a stone temporarily blocks the gallbladder’s duct. This pain often happens after meals.
A persistent blockage or a stone that travels can lead to more serious conditions, including:
- Cholecystitis: An inflammation of the gallbladder causing prolonged pain, fever, and tenderness.
- Choledocholithiasis: A gallstone lodged in the main bile duct, which can cause jaundice and infection.
- Pancreatitis: A painful inflammation of the pancreas caused by a blocked pancreatic duct.
- Biliary dyskinesia: A condition where the gallbladder does not empty properly.
- Large gallbladder polyps: Abnormal growths inside the gallbladder.
The Surgical Process
The procedure is performed under general anesthesia. The surgeon makes several small incisions in the abdomen, typically around four, using one near the navel to inflate the abdominal cavity with carbon dioxide gas. This process creates space for the surgeon to work and improves visibility of the organs.
A laparoscope, a thin tube with a high-resolution camera and light source, is inserted through one incision to provide a magnified view on a video monitor. Through the other incisions, the surgeon introduces specialized long, thin instruments for grasping, cutting, and dissecting tissue. The surgeon carefully separates the gallbladder from its attachments to the liver and other tissues.
The surgeon then dissects the tissue to clearly see the cystic duct, which connects the gallbladder to the main bile duct, and the cystic artery, which supplies blood to the gallbladder. Before removing the organ, metal clips are placed on the artery and duct to seal them. This prevents bleeding and bile leakage after the gallbladder is detached.
Before the cystic duct is permanently clipped and divided, the cholangiogram is performed. A small, flexible tube called a catheter is inserted into the duct, and a contrast dye is injected, which makes the bile ducts visible on an X-ray. This imaging confirms the ducts are clear of gallstones, which can be removed during the same operation if found. Once confirmed, the cystic duct is divided, and the gallbladder is detached and removed through an incision site.
Post-Operative Recovery
After surgery, patients are monitored in a recovery area as the anesthesia wears off. Pain at the incision sites and in the shoulder is common. The shoulder pain is from the carbon dioxide gas used during surgery, which can irritate nerves that refer pain to the shoulder, and resolves within a day or two. Most patients can go home the same day or after a one-night hospital stay.
At home, recovery involves rest and avoiding strenuous activity for several weeks to allow the incisions to heal. Walking is encouraged to promote circulation and prevent blood clots. Patients receive instructions on caring for the small wounds, which are often closed with dissolvable stitches or surgical glue.
Immediately after surgery, a diet of clear liquids or bland foods is recommended. Patients should gradually reintroduce foods, starting with a low-fat diet and eating smaller, more frequent meals. This helps the digestive system adjust to the absence of the gallbladder. Most people can return to a normal diet over a few weeks.
Living Without a Gallbladder
The gallbladder’s function is to store bile, a fluid produced by the liver to help digest fats. After its removal, the body adapts. Bile flows in a continuous trickle from the liver into the small intestine, allowing the digestive system to function effectively.
For most people, life without a gallbladder is normal, and a special long-term diet is not needed. After an initial adjustment, most individuals can eat the same foods they enjoyed before surgery. Removing the gallbladder resolves the pain and complications it was causing.
A small percentage of people may experience minor, long-term digestive changes, such as more frequent or looser stools after fatty meals. This happens because the continuous flow of bile can act as a mild laxative. These symptoms often lessen over time and can be managed with modest dietary adjustments.