Open Cholecystectomy

Cholecystectomy
• “CHOLECYST” Gallbladder “ECTOMY” surgical
removal
• Kocher or right subcostal incision is the most
often used incision and allows excellent
exposure of the gallbladder bed and cystic duct.
Alternatively, an upper midline incision can be
used when other concomitant operations are
planned and a wider exposure is needed.
 Gallbladder
• Sac-like organ that sits beneath the liver
• It stores bile produced by the liver
• BILE travels down the bile ducts from the
liver into the gallbladder where it is
stored.
• This BILE helps break down and absorb
fatty foods
• DUODENUM is where the fats absorb
 Risk Factors for Gallbladder
Diseases
• Female
• Pregnant
• Age 40 and above
• Obese
• High fat and cholesterol diet
• Low fiber diet
• Heredity
• Liver Disease
 Reasons for Gallbladder Removal
• Cholelithiasis
– too much cholesterol, too much bilirubin, or not enough bile salts
– Cholesterol Stones
• These are usually yellow-green. They're the most common, making up 80% of
gallstones
– Pigment Stones
• These are smaller and darker. They're made of bilirubin

• Cholecystitis
– inflammation of the cystic duct and gallbladder

• Choledocholithiasis
– presence of a gallstone in the common bile duct
– lead to jaundice on the physical exam from hepatic outflow obstruction of bilirubin
– abnormal liver function

• Cholangitis
– inflammation of the bile ducts which can also lead to infection
– cancer of the pancreatic head can also lead to obstruction of
the common bile duct
 Signs and Symptoms
• Right Upper Quadrant Pain
• Nausea/Vomiting,
Indigestion
• + Murphy’s Sign
• Fever
• Jaundice
 Diagnostic Test
• Blood tests
– to look for signs of an infection or signs of gallbladder problems.

• Abdominal ultrasound, endoscopic ultrasound, or

computerized tomography (CT) scan 
– used to create pictures of your gallbladder that may reveal signs of cholecystitis or stones
in the bile ducts and gallbladder.

• A hepatobiliary iminodiacetic acid (HIDA) scan

– involves injecting a radioactive dye into your body, which attaches to bile-producing cells
so that it can be seen as it travels with the bile through the bile ducts.
– tracks the production and flow of bile from your liver to your small intestine and shows
blockage.
 Treatment
• Ursodeoxycholic Acid (UDCA) and
Chenodeoxycholic acid (CDCA)
– Used to dissolve Cholesterol gallstone
• Symptomatic drug
– Analgesics (Ibufropen) (pain)
– Antacid (Maalox)/ H2-Blockers (Famotidine)
– Antiemetic (Plasil) (nausea & vomiting)
 Surgical Management
• Cholecystectomy
– Open Cholecystectomy
– Close (Laparoscopic) Cholecystectomy
• Cholelithotomy
– Removal of Gallstone
 Complications
• Bleeding.
• Infection.
• Injury to the tube (the bile duct) that carries bile
from the gallbladder to the small intestine.
• Liver injury.
• Scars and a numb feeling at the incision site.
• A bulging of organ or tissue (a hernia) at the
incision site.