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.

GETTING READY:

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medicines. These may include aspirin, ibuprofen, or blood thinners.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• Dye may be used during your surgery to help caregivers see the gallbladder and bile duct better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
• You may need to have abdominal or chest x-rays, ultrasound, or blood, urine, or stool tests. Other tests may also be needed, such as a liver and gallbladder scan or endoscopic retrograde cholangiopancreatography (ERCP). Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.
  
  
• Depending on your health status and results of the blood tests, you may need to donate your own blood no later than three days before surgery. Your own blood may be used when a possible blood transfusion during surgery is needed. You may also ask a family member or friend with the same blood type to donate their blood. Talk to your caregiver for more information on blood donations.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• Your bowel may need to be emptied and cleaned out before the surgery. Caregivers may give you a liquid medicine called an enema. This will be put into your rectum (rear end) to help empty your bowel. Your caregiver will teach you how to do this.
  
  
• You may be given a pill to help you sleep.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Do not wear contact lenses on the day of your surgery. You may wear glasses. Wear socks to help you stay warm.
  
  
• If you are staying in the hospital after your surgery, bring your personal belongings with you. These may include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.
  
  
• Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before the surgery.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do surgery. It also explains the problems that may happen with the surgery, and your choices. Be sure all your questions have been answered before you sign this form.

TREATMENT:

What will happen:

• You may be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room and then moved onto a special bed. Your abdomen will be cleaned with soap and water. Caregivers may give a general anesthesia to keep you asleep during surgery. An endotracheal (ET) tube connected to a breathing machine may be put into your mouth. This will go down the windpipe to keep your airway open and help you breathe during you surgery. A catheter may be inserted to drain your urine. A nasogastric (NG) tube may also be inserted into your nose down into your stomach. This tube keeps air and fluid out of the stomach during surgery.
  
  
• During your surgery, a small incision will be made near 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 will then be 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 may be used to separate your gallbladder and bile ducts from where they are attached.
  
  
• A special device may be used to suck up the bile and other contents of the gallbladder. The gallbladder, bile duct and blood vessels will be tied and cut off using scissors. The abdomen will then be thoroughly irrigated (washed out). The incisions may be 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. The ET tube may be removed after you are awake and can breathe well on your own. A tube going into your stomach may remain for a while. 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 wound, tubes, or drains. Ask your caregiver for more information about ways to prevent bleeding and take care of your tubes and incision.

Waiting room: This is a room where your family and friends can wait until you are ready for visitors. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

• You cannot make it to your surgery appointment on time.
  
  
• You have a fever (increased body temperature).
  
  
• Your skin is itchy, swollen, or has a rash.
  
  
• You have questions or concerns about your surgery.

SEEK CARE IMMEDIATELY IF:

• You are not able to eat or drink, or are urinating less or not at all.
  
  
• You have more jaundice (yellowing of the skin or the whites of the eyes) than before.
  
  
• You have trouble breathing or your heart beats faster.
  
  
• Your abdomen becomes tender and hard.
  
  
• Your vomit (throw up) has blood or bile in it.
  
  
• Your signs and symptoms are getting worse.

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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