Laparoscopic Cholecystectomy

WHAT YOU SHOULD KNOW:

• Laparoscopic (lapah-ROS-ko-pik) cholecystectomy (ko-le-sis-TEK-to-me) is surgery to treat gallbladder and bile duct diseases. These diseases include cholecystitis (swelling of the gallbladder) and cholelithiasis (stones in the gallbladder or bile ducts). The gallbladder is a pear-shaped organ located under the liver on the right side of your upper abdomen (stomach). It stores bile that comes from the liver and helps in the digestion of food. Bile is carried by the bile duct to the intestines. If left untreated, gallstones may block the flow of bile and cause more swelling, infection, and abdominal pain.
  
  
• In a laparoscopic cholecystectomy, small incisions (cuts) are made in your abdomen. Caregivers will insert special tools and a laparoscope through these incisions to do the surgery. A laparoscope is a long metal tube with a light and tiny video camera on the end. This gives caregivers a clear view of the abdominal area while watching the images on a monitor. During this surgery, your gallbladder and gallstones will be removed (taken out). With a laparoscopic cholecystectomy, cholecystitis and cholelithiasis may be cured and the symptoms they cause relieved.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• Problems may happen during your laparoscopic cholecystectomy that may lead to an open surgery. Your stomach, liver, intestines, blood vessels, or nerves may get injured while having the surgery. This may cause too much bleeding and a large amount of blood loss. You could also have trouble breathing or an infection during or after surgery. The special gas used during your surgery may cause shoulder or chest pain for 1 to 2 days after your surgery.
  
  
• Without treatment, the symptoms of cholecystitis and cholelithiasis may get worse. The bile flow may get blocked or the gallbladder tissue may die. This may lead to serious medical problems, such as peritonitis (infection of abdominal wall membrane) and sepsis (blood infection). Ask your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Enema: You may need to have an enema before your surgery. This is liquid put into your rectum (rear end) to help empty your bowel.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
  
  
• Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.
  
  
• Nasogastric (NG) tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty. You may need a NG tube if your stomach gets too full or if you throw up a lot after surgery. You may also need it if you cannot use your mouth to eat. An NG tube may also be used to help get your bowels working. Food or medicine may be given through your NG tube.

During your surgery:

• Your abdomen will be cleaned with soap and water. Sheets will be put over you to keep the surgery area clean.
  
  
• During your surgery, a small incision is made in your belly button to insert the laparoscope through. Caregivers will insert other instruments by making 2 to 3 smaller incisions at different places on your abdomen. The abdomen is then inflated with a gas (carbon dioxide) to make the abdomen swell. This lifts the abdominal wall away from the internal organs and allows your caregiver more space to work. Clips are used to separate your gallbladder and bile ducts from where they are attached.
  
  
• A special device is used to suck up the bile and other contents of the gallbladder. The gallbladder, bile duct and blood vessels are tied and cut off using scissors. The abdomen is then thoroughly irrigated (washed out). The incisions are closed with stitches (threads) or surgical tapes and covered with bandages. A T-tube (thin rubber tube) connected to a small bag may be placed to drain bile from your abdomen.

After your surgery: You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your incisions. Ask your caregiver for more information about ways to prevent bleeding and take care of your incision.

• Activity: Caregivers may help you get out of bed to walk on the same day of surgery, or the day after. Ask caregivers if there are exercises that you may do while in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.
  
  
• Medicines: You may need any of the following:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
  
  
• Monitoring: Caregivers may check for pulses on your arms or wrists. This helps caregivers learn if you have problems with blood flow after your surgery. You may also have any of the following:
  
  
  • Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
    
    
  • Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
  
  
• Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.
  
  
• Tubes and drains:
  
  
  • Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
    
    
  • T-Tube: A thin rubber tube may come out of your abdomen after surgery. This tube drains bile onto a bandage or into a small bag. The T-tube is removed when the amount of bile draining is already very little.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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