Stones from the gallbladder and analyzed in the laboratory for identification with instruments which includes microscope. Gallbladder is a small pear shaped sac attached to the underside of the liver. It is in the upper right hand side of the belly, underneath the ribs. It is a storage area for a digestive fluid called bile. The gallbladder stores bile between meals, and releases it into the stomach after meals to help with digestion; particularly digestion of fats and oils. Problem occurs when the relative concentrations of chemicals in the bile become abnormal, and stones form. These stones may stay in the gallbladder and not cause any problems. However, often they do cause symptoms of pain, loss of appetite, bloating, heartburn, nausea or vomiting. When these symptoms occur we recommend removal of the gallbladder along with the stones. If this is not done there is a risk that the stones could cause jaundice or infection. At the present time there are two available procedures for removal of the gallbladder: These are the open cholecystectomy or the laparoscopic cholecystectomy. Open Cholecystectomy is the operation that consists of making an incision through the muscles of the abdominal wall, and directly removing the gallbladder. While in Laparoscopic Cholecystectomy, instead of an incision over the gallbladder area, there is a small incision by the belly button, and three smaller incisions near the gallbladder.

A viewing scope attached to a video monitor is inserted through the belly button incision. Various other instruments are inserted through the other incisions to remove the gallbladder. This operation has less postoperative discomfort, and is done with a very short hospital stay than the open cholecystectomy. This is sometimes done with a laser and called a Laser Cholecystectomy. However, instead of a laser most surgeons prefer to use an electrocautery unit which is a better instrument for this procedure. Preoperative prepations should be done. These include, not eat anything after midnight the night before the operation; your can have clear liquids up to three hours before the surgery. Right before surgery you will get a chance to talk to the anesthesiologist. He will be in charge of putting you to sleep. Feel free to ask the anesthesiologist any questions you may have about the anesthetic. The laparoscopic procedure begins with the insertion of a small hollow tube called a trocar into the abdomen just beneath the belly button. We insert this initial trocar using Open Technique, which means that a small incision is made, and a smooth, rounded, blunt tipped trocar is gently inserted into the abdomen under direct vision. This is in contrast to other techniques where a sharp needle and trocar are placed into the abdomen. The Open Technique almost completely eliminates the chance of injury to blood vessels or other organs. The abdominal cavity is then filled with carbon dioxide gas.

This inflates the abdomen to make space for the viewing scope and instruments. The laparoscope is then inserted in to the abdomen and the internal organs visualized on a color TV screen. Additional instruments are inserted into the upper abdomen through very small incisions. There are usually three incisions, but occasionally an additional one is needed. These instruments are used to find and divide the artery and duct to the gallbladder. Sometimes, an x-ray of the bile ducts called a cholangiogram is done during the operation to help define the anatomy and check for small stones in the bile ducts. An electrocautery machine is used to remove the gallbladder and cauterize the surface of the liver where the gallbladder was attached. The gallbladder is pulled out of one of the small incisions in the upper abdomen and removed. Once the gallbladder and stones have been removed the carbon dioxide is removed from the abdomen and the incisions are sutured closed. Occasionally, it is necessary to insert a small drain, to remove blood, serum or bile. If this was necessary it would stay in for a few days and be removed in the office.

After surgery, some patients notice nausea for the first 24 hours after the operation. This can usually be controlled with medication. The nausea is from the anesthetic medications as well as the procedure itself. In addition, some patients experience discomfort in the right upper abdomen and right shoulder. The right shoulder pain is a referred pain related to the carbon dioxide that has to be put into the belly during the operation. This stretches and irritates the diaphragm. The diaphragm has the same nerve supply as the shoulder-so you feel shoulder pain when the diaphragm is irritated. These symptoms usually resolve quickly over the first twenty four to forty eight hours. Once at home, most patients need to rest for the first few days, then slowly resume normal activity, and return to completely normal activity, including work, in one week. After the gallbladder has been removed, the bile will drain into the stomach continuously, rather than only after meals. This will not impair digestion. In fact, you may find that foods that disagreed with you before the surgery will be more acceptable after the gallbladder have been removed.