The gallbladder surgery (cholecystectomy)

The gallbladder is located in the right upper abdomen below the liver and has an elongated, bag-like shape. It stores the bile produced by the liver (bile). Sometimes the gallbladder itself is incorrectly called gallbladder. In healthy condition, the small hollow organ can not be felt from the outside. The gallbladder lies as a pear-shaped sack of about ten centimeters in length directly under the liver. It serves as a storage location for the bile produced in the liver (bile). This leaves the liver via the common hepatic duct, which then branches: A branch (called the gallbladder) leads into the gallbladder, the other branching as a large bile duct (ductus choledochus) to the duodenum. Shortly before its confluence, the large bile duct in most people still combines with the pancreatic duct to the gall-pancreatic duct (ductus choledochopancreaticus), which then enters the duodenum. In some people, the large bile duct and the duct of the pancreas separate separate into the intestine.

What is the function of the gallbladder?

Function of the gallbladder is the storage and concentration of bile, which is produced in the liver. The hollow organ can absorb 30 to 50 cubic centimeters of fluid. A sphincter (sphincter) at the mouth of the bile duct into the duodenum regulates the influx of bile into the intestine. When the sphincter is occluded, the gallbladder fills with the backlog with the bile coming out of the liver, which is then thickened by dehydration to about one-tenth of its volume. When you eat high-fat foods, the production of the hormone cholecystokinin in the small intestine is stimulated. This hormone causes the gall bladder to contract, forcing the bile into the large bile duct. The muscles around the mouth of the bile duct in the duodenum relax at the same time, so that the bile can flow into the intestine.

What problems can the gallbladder cause?

When cholesterol, bile pigments and limes precipitate in the gallbladder and the ducts, gallstones of different composition and form are formed. Such stones in most cases go unnoticed and cause no symptoms. But they can also hinder the outflow of bile into the intestine and trigger attacks of epigastric pain with nausea and vomiting (biliary colic). Other possible consequences include jaundice (jaundice) and inflammation of the biliary tract (cholangitis) or gallbladder (cholecystitis). Due to the union of the bile duct and pancreatic duct (in most people), an unfavorable gallstone can also lead to inflammation of the pancreas (pancreatitis).

In rare cases, a malignant tumor may develop in the gallbladder or biliary tract.

The gallbladder surgery (cholecystectomy)

Cholecystectomy is the surgical removal of the gallbladder. It is mainly due to complications of gallbladder inflammation (cholecystitis) and gallstones that are otherwise untreatable.

In cholecystectomy, the gallbladder is removed by surgery. The operation is performed in Germany almost 200,000 times a year and nowadays mostly by a small incision in the abdominal wall (minimally invasive, laparoscopic cholecystectomy). In some cases, however, an open-surgical procedure (conventional cholecystectomy) is still necessary.

When do you perform a cholecystectomy?

Cholecystectomy is mainly used in the case of discomforting gallbladder inflammation (cholecystitis), especially when there are complications. The procedure usually leads to a permanent healing success. Other diseases that require gallbladder removal include:

• Gallbladder perforation (for example in the context of an accident)
• Connecting passages between the biliary tract and the gastrointestinal tract (so-called biliodigestive fistulas)
• large stones in the bile ducts, which lead to a congestion of bile (cholestasis) and otherwise can not be removed.
• Gallbladder or bile duct tumors (removal usually occurs in the context of a larger operation)
• Asymptomatic cholecystitis alone is no reason for gallbladder removal. In this case, one can first treat medication and wait for an improvement.

What do you do with cholecystectomy?

Basically, gallbladder removal can be done in two ways: conventional open-operative cholecystectomy and minimally invasive laparoscopic cholecystectomy.

Conventional cholecystectomy

Conventional surgery generally opens the surgical area under general anesthesia by cutting below the right ribs. Subsequently, the supplying artery (Arteria cystica) and the branching bile duct (ductus cysticus) are ligated, cut and the gallbladder removed. The insertion of a wound drainage is usually not necessary. Before the operation, the administration of an antibiotic reduces the risk of infection. Thrombosis prevention (e.g., by heparin) may be required but not administered by default. Most patients can leave the hospital after three to five days.

Laparoscopic cholecystectomy

The gold standard in the treatment of gallbladder inflammation today is laparoscopic cholecystectomy. The gall bladder is minimally invasively removed by a so-called "keyhole surgery". Basic principle of all laparoscopic operations is the insertion of mostly three long instruments as well as a flexible camera optic into the abdomen through small incisions. The instruments can be controlled externally while the camera transmits a live image to a monitor.

The abdominal space is expanded by pumping in carbon dioxide, thereby ensuring better visibility and mobility of the operating physicians (so-called pneumoperitoneum). Then you can use the instruments under visual control to remove the gallbladder and transported through one of the cuts to the outside.

Advantages of laparoscopic gallbladder surgery compared to the conventional procedure are lower pain after surgery, smaller scars and thus a better cosmetic result as well as a shorter hospital stay. Complications are similar in both procedures. Recent methods use only a single access path through which all instruments in the abdominal cavity introduced ("single-site approach") or natural body orifices, such as the gastrointestinal tract or the vagina ("NOTES" = "natural orifice transluminal endoscopic surgery "). However, these surgical methods are still being tested.

Laparoscopic gallbladder removal should not be performed under the following circumstances:

• suspected gallbladder tumor, as the risk of seeding tumor cells into the abdomen is too great (for example, by accidental perforation of the gallbladder).
• in a severe cardiovascular disease, because the introduced air increases the pressure in the abdominal cavity and thus makes the blood return to the heart difficult.
• in patients who have a blood coagulation disorder because effective hemostasis is far more difficult in a laparoscopic cholecystectomy than in an open surgical technique.
• in pregnant women (especially in the last trimester of pregnancy), since the placement of the instruments and the gas can be spatially difficult.
• in patients who have already been operated on the abdomen and are therefore likely to have adhesions in the abdomen.

Change of the surgical technique (conversion)

Sometimes, during a laparoscopic operation, you have to switch to a conventional open surgery. This may be necessary, for example, if during laparoscopic surgery it turns out that the instruments pose an excessive risk of injury to adjacent organs or tissues (in about nine percent of cases).

What are the risks of cholecystectomy?

Cholecystectomy is a relatively safe procedure, but complications can not be completely ruled out, as with any procedure. These include bleeding, infection or injury to adjacent organs, however, are rare. Studies have shown an increased incidence of complications in patients undergoing conventional gall bladder surgery. However, this is the reason why it is primarily the seriously ill patients who need to undergo conventional surgery, who are at a higher risk of developing complications anyway. The risk of dying from gallbladder surgery is extremely low (less than 0.1 percent of cases).

What should I watch for after a cholecystectomy?

Basically, after a cholecystectomy no special diet must be followed. However, since the necessary for fat digestion bile still produced in the liver, but can no longer be cached in the gallbladder and delivered in larger quantities in the intestine, tolerate patients with the gallbladder, no fatty foods more. After consumption, diarrhea may increase.