Gallstone disease surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Surgery is the first line treatment option in patients with symptomatic gallstones and willing to undergo surgery or patients with gallstone-related complications or patients that are at risk of gallbladder cancer and having symptomatic recurrent attacks, and diabetic patients. Asymptomatic gallstones are not recommended for surgery.

Surgery is usually reserved for patients with:^[1]

• Complications related to gallstones
• Experience of intermittent biliary colic
• Experience of recurrent biliary colic
• Risk of gallbladder cancer
• Diabetes mellitus
• Liver cirrhosis

• Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of gallstone disease.^{[2][3][4][5][6]}
• Only symptomatic patients must be indicated for surgery.
• The lack of a gallbladder does not seem to have any negative consequences in many patients.
• However, there is a significant proportion of the population, between 5-40%, who develop a condition called postcholecystectomy syndrome.
• Symptoms include gastrointestinal distress and persistent pain in the upper right abdomen.
• There are two surgical options:
  • Open procedure
  • Laparoscopic procedure

• This involves a large incision into the abdomen (laparotomy) below the right lower ribs.
• The patient is hospitalized for one-week post-surgery, with a return to normal diet and activities one week after release.
• Indications for an open procedure include:
  • Suspected or confirmed gallbladder cancer
  • Type II Mirizzi syndrome (cholecystobiliary fistula)
  • Gallstone ileus
  • Severe cardiopulmonary disease

• Laparoscopic cholecystectomy: About 4 small puncture holes are made for the insertion of a camera and instruments.
• Laparoscopic surgery has the advantage of:
  • A shorter hospital stay, typically one day
  • Shorter recovery time
  • Less post-operative pain
• This procedure is as effective as the more invasive open cholecystectomy, provided the stones are accurately located by cholangiogram prior to the procedure so that they can all be removed. *The procedure also has the added benefit of reducing operative complications such as bowel perforation and vascular injury.

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