What is Cholecystectomy?

Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is

performed most frequently through laparoscopic incisions using a laser. However,
traditional open cholecystectomy is the treatment of choice for many patients
with multiple/large gallstones (cholelithiasis) either because of acute
symptomatology or to prevent the recurrence of stones.

A cholecystectomy consists of excising the gallbladder from the posterior liver

wall and ligating the cystic duct, vein, and artery. The surgeon usually approaches
the gallbladder through a right upper paramedian or upper midline incision if
necessary, the common duct may be explored through this incision. When stones
are suspected in the common duct, operative cholangiography may be
performed (if it has not been ordered preoperatively). The surgeon may dilate the
common duct if it is already dilated as a result of a pathologic process. Dilation
facilitates stone removal. The surgeon passes a thin instrument into the duct to
collect the stones, either whole or after crushing them.

After exploring the common duct, the surgeon usually inserts a T-tube to ensure
adequate bile drainage during duct healing (choledochostomy). The T-tube also
provides a route for postoperative cholangiography or stone dissolution, when
appropriate.

A conventional open cholecystectomy is indicated when a laparoscopic

cholecystectomy does not allow for retrieval of a stone in the common bile duct
and when the client’s physique does not allow access to the gallbladder.
Occasionally, when a client is very obese, the gallbladder is not retrievable via
laparoscopic instruments. Further, a surgeon may have difficulty accessing the
gallbladder in an adult with a small frame and may need to perform the
conventional open cholecystectomy.