Cholecystectomy

Definition

Physiology of gallbladder

 

Definition Cholécystectomy

The cholecystectomy consists in withdrawing the gall bladder and calculations which it contains. It is about an operation requiring a short hospitalization.
It is carried out into ambulatory, if the ignition of the blister is not too important; In this case the patient is operated the morning and can return at his place the evening.
 
If the “bladder is very ignited –” cholécystitis   ” – or the patient is fragile – polypathologique-,   the surgical assumption of responsibility will be conventional (3 to 6 days of hospitalization).

 

  • The indications to carry out the cholecystectomy by laparoscopy (cholecystectomy by coelioscopy) are the following ones:
  • 1) Symptomatic bladder-like lithiasis (biliary colic).
  • 2) Complicated bladder-like lithiasis
  • 3) Cholécystite has acute
  • B) chronic Cholécystite
  • C) Pancréatite due to a lithiasic migration
  • D) Lithiasis of the bile duct :

 

Indications

Indications of Cholecystectomy

The indications to carry out the cholecystectomy by laparoscopy (cholecystectomy by coelioscopy) are the following ones:

  • IndicationsIndications
  • 1)Symptomatic bladder-like lithiasis (biliary colic).
  • 2)Complicated bladder-like lithiasis
  • A) Cholécystite has acute
  • B) chronic Cholécystite
  • C) Pancréatite due to a lithiasic migration
  • D) Lithiasis of the bile duct

Bladder-like lithiasis

The bladder-like lithiasis is defined as the presence of calculations within the gall bladder.

The women are more frequently touched.

Obesity and the diabetes support the formations of these calculations which are composed most of the time of cholesterol..
 

The bladder-like lithiasis can be symptomatic.

The patients can suffer from painful crises of biliary colic, secondaries with the distension of the blister upstream of a calculation located in the collet or the channel cystic.

  • The standard pain biliary colic
  • The pain is often the only symptom, but it can be accompanied by nauseas and vomiting.
  • This symptom is sometimes night and often of brutal beginning, typically after heavy meal (ingestion of greases or alcohol).
  • The pain is located below coasts on the right (hypochondre right) or in the middle of the upper part of the belly (epigastrium).
  • This pain can block breathing (inhibition inspiratory: sign of spontaneous Murphy) and to irradiate towards the right scapula or between the shoulders.
  • The pain increases during approximately 1 hour then it is calmed.

 

  • Any pain of biliary colic which lasts more than 5 hours must make fear a complication: cholécystite, angiocholite, pancréatite acute!

 

  • To note
  • The crises of biliary colics impose a doctor visit 
  • The clinical examination, a biological assessment and the realization of an echography make it possible to specify the diagnosis and to validate the indication with the cholecystectomy.
  • Echography is reliable to search bladder-like calculations and signs of complications: cholécystite, biliary lithiasic migration, pancréatite biliary e

 

Acute Cholecystitis

The cholécystite is an ignition (infection) of the wall of a blister containing of calculations.

One speaks then about cholécystite lithiasic.

We distinguish 3 phases:

1) Ignition and oedema of the blister: hydrocholecyste.
2) Infection of the bile (intestinal germs): cholécystite suppurated or pyocholécyste.
3) Necrose ischaemic bladder-like wall: cholécystite gangrenous.

  • symptomatology of a cholécystite is characterized by:

    Fever (> 38,5°).

    Pain of the abdomen higher right with posterior irradiation and in the area of the right shoulder.

    Nauseas and vomiting

Often a hospitalization is necessary with diet and antibiotics.

The biological assessment can show an inflammatory syndrome like an increase in the white globules and CRP.

 

Abdominal echography is the examination of reference

It finds a lithiasic blister with the thickened, duplicated and laminated walls. A perish-bladder-like liquid outpouring is frequent.

The gall bladder in the event of cholécystite can exceptionally be perforated and lead to a biliary peritonitis.

  • VOTRE TITRE
  • All cholécystite acute diagnosed must be operated!
  • if possible between 48-72 hours of the beginning of the painful crisis

Surgical operation can become more delicate in the presence of inflammatory phenomena of the hepatic pedicle and joinings with the close bodies like the duodenum or the right angle colic.

Chronic cholecistitis

The chronic cholécystite secondary with a succession of cholécystites with low noises untreated surgically, is cooled with antibiotics or of spontaneously favorable resolution.

  • Chronic inflammation consequences:
  • The chronic ignition can involve:
    Chronic Cholécystite scléro-atrophique= the blister is of reduced size, the wall is thickened and moulded on calculation
    Chronic Cholécystite with very fibrous walls, seat of deposits calcic-Blister to porcelain: at the risk of malignant transformation: bladder-like cancer
    Bilio-digestive dent cholecysto-duodenal fistula. fistula cholécysto-colic = This communication between the blister (or the bile duct) and the digestive tract complicates approximately 1 to 2% of the chronic cholécystites. The bilio-digestive dent is suspected in front of crises of cholécystites with repetition and the presence of air in the bile duct (aérobilie).
    The biliary ileus is an obstruction of the bowels related to the migration of a gallstone to the last intestinal handle (valvule iléo caecale blocked).

Cholecystectomy

Laparoscopic Cholécystectomy in ambulatory

 

The cholecystectomy is practised under general anaesthesia, therefore you will not be conscious at the time of the procedure.
We make 3 even 4 small incisions in the abdomen for the laparoscopic cholecystectomy. A tube with a tiny video camera is inserted in the abdomen by one of the incisions. That allow us to look at the images on a screen in the operating room and to control our gestures.
The surgical instruments are introduced through the other incisions into your abdomen and your gall bladder is removed.

ablation vésicule dr Salsano Montpellier

Cholecystectomy by 30 minutes hard laparoscopic way to two hours.
In the event of laparoscopic cholecystectomy, the patient is often authorized to return at his place the very same day of the surgery, although sometimes a stay of one or two nights with the private clinic is necessary.
In general, you can expect to return on your premise once you are able to eat and to drink without pain and to go without assistance.
It takes approximately a week to recover completely.

La péri-operative cholangiography

We carry out a cholangiography with the X-rays to check the absence of wounds of the bile ducts.
If one finds gallstones or other problems in your principal bile duct, those could be corrected.

Conversion risk

The laparoscopic cholecystectomy is not adapted for everyone.
In certain cases, the surgeon can start with a laparoscopic approach and then to carry out a “conversion into laparotomy”.
The decision to convert into laparotomy (to make a broader incision) is made because of cicatricial tissue coming from previous operations or complications.

 

Cholécystectomy in open

During the open cholecystectomy your surgeon makes an incision of 10 cm in the abdomen, under the coasts, on your line. The muscles and the fabrics are drawn backwards to reveal your liver and the gall bladder. Your surgeon proceeds then to the intervention. The incision is then sutured. This cholecystectomy lasts from one to two hours.
After the cholecystectomy, you will be directed towards the recovery room until the drugs of the anaesthesia dissipate. Then, you will be transferred towards your room. The duration of recovery varies according to the technique used and from your health status.
In the event of opened cholecystectomy, you wait to pass two or three days to the hospital in convalescence. Once at the house, that can take from four to six weeks to be restored completely.

Complications

Complications of Cholecystectomy

Cholécystectomie involves a weak risk of complications, in particular :

  • Escape of bile.
  • Haemorrhage.
  • Iatrogenic wounds wound of the bodies in the vicinity, like the bile ducts, the liver and small intestine.
  • Pancréatitis.

 

The risk of complications depends on your general health status and the reason of your cholecystectomy.

Info

Useful Information for the preparation of a cholecystectomy

  • Speak to your doctor about all the medicines and supplements which you take.
  • Continue to take most drugs such as it were prescribed.
  • Cease taking certain medicines because they can increase your risk of bleeding.
  • You must remain with jeun the night before the intervention. You can drink a water mouthful with your drugs, but avoid eating and to drink at least 6 hours before the intervention.
  • It is necessary to take a shower with an antibacterial soap before the intervention..

Plan in advance the return to you and convalescence after an operation:

  • To find somebody to lead you to residence and to remain with you.
  • Ask a friend or a family member to accompany back you on your premise and to remain close to you the first night after the surgery.

Most people can return on their premises the very same day of their cholecystectomy, but of the complications can occur and require one or more nights with the private clinic.

If the surgeon must make a long incision in the abdomen to remove the gall bladder, you will have to perhaps remain with the private clinic longer.

It is not always possible to know in advance which procedure will be used.

Plan your stay if you must remain with the private clinic:
Do not forget to bring personal objects as your brush to teeth, comfortable clothing and books or magazines to pass the temp

Cœlioscopic Cholecystectomy = method of assumption of responsibility into ambulatory in Montpellier – Clementville Private clinic – Private clinic of the Park

After the operation

As waked up, the patient is led in his bed in the ambulatory surgery department. The nurse then proposes a little water or of herb tea to him: midday, the patient must be able to eat a light meal. Calming antalgic are managed by the perfusions which are left in place 2 to 3 a.m.
The nurse is attentive with the intensity of the pain of the patient and her capacity to find a satisfactory autonomy (displacements in the room, resumption of the micturitions and the transit, aspect of the wounds…).
After a few hours of recovery the perfusion is removed and analgesics (anti-pains) are taken by the mouth. The medical team and the anaesthetist ensure themselves whereas the pain does not reappear and that the abdominal comfort of the patient remains correct.
The exit of the patient can be considered.
The nurse makes sure that the patient is in possession of papers necessary: operational report, report of hospitalization, sick leave (15 days), ordinance of exit, return of consultation of control to 1 week in the attending physician, at 5 weeks in the surgeon

Exit from clinic

The exit will be decided only after one visit of the anaesthetist (and at the same time of the surgeon)   In practice, the patient leaves the service between 15:00 and 19:00, accompanied by a member of his family.
The evening meal must be light.
It is in general of a soup and a yoghourt L.

The following days

The wounds do not require any care because of their mode of fermeture.= intradermal overcasting (wire inside) and of the biological adhesive.
The patient has the possibility of taking a shower as of the shortly after the intervention.
The sick leave is 15 days safe for the labourers or it is 4 weeks.