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Patient care — surgical procedures

Cholecystectomy: (gall bladder removal) Surgery is done to remove the gallbladder if it is inflamed, blocked, filled with gallstones, or cancerous.

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The gallbladder is a muscular sac located under the liver. It stores and concentrates the bile produced in the liver that is not immediately needed for digestion. Bile is released from the gallbladder into the small intestine in response to food. The pancreatic duct joins the common bile duct at the small intestine adding enzymes to aid in digestion.

Gallbladder removal (cholecystectomy) is done while the patient is under general anesthesia (unconscious and pain-free). It can be done through an abdominal incision (open cholecystectomy) or through smaller incisions using a small video camera on a tube called a laparoscope (laparoscopic cholecystectomy).

In very complex or complicated cases, open cholecystectomy is usually recommended. An incision is made just below the ribs on the right side of the abdomen. The liver is moved to expose the gallbladder. The vessels and ducts to and from the gallbladder (cystic duct and artery) are cut and tied off, and the gallbladder is removed. The incision is closed.

The common bile duct, which drains the digestive fluid (bile) from the liver to the small intestine (duodenum), is examined for bile blockages or for the presence of stones. A small flat tube may be left in for several days to drain out fluids if there is any inflammation or infection.

In laparoscopic surgery, the abdomen is inflated with carbon dioxide to provide more room for the procedure. Through a small incision made at the navel, a laparoscope is inserted into the abdomen. Three small additional holes are made to allow the entry of surgical instruments. The gallbladder is located and the cystic duct and artery are cut and tied off. The gallbladder is removed. The incision is closed. Laparoscopic surgery has a lower rate of complications, a shorter hospital stay, and a better cosmetic results than the open procedure. However, in some cases the complexity of the situation requires use of the open technique.

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Cholecystectomy as seen through a laparoscope. (Wikipedia)

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