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JAMA Patient Page
May 1, 2018

Laparoscopic Cholecystectomy

JAMA. 2018;319(17):1834. doi:10.1001/jama.2018.3438

The gallbladder is a small organ underneath the liver that concentrates and stores bile.

Bile is fluid made by the liver and released into the small intestine to help digestion. Changes in bile concentration and composition caused by changes in diet, hormones, medications, or rapid weight loss or weight gain can result in formation of solid pieces of bile called gallstones. In the United States, more than 6 million men and 14 million women have had gallstone disease, with higher rates in Native and Hispanic Americans. A small portion of people with gallstones may experience occasional abdominal pain, nausea, and vomiting, often after meals.

Gallstones can sometimes migrate out of the gallbladder, block the normal flow of bile, and lead to inflammation and infection of the gallbladder. This is called cholecystitis and can cause sharp, constant abdominal pain, fever, nausea, and vomiting. These symptoms warrant a visit to a physician, who can arrange for an ultrasound and make a referral to a surgeon if appropriate.

Gallstones do not need to be treated if they are not causing problems. Patients who have cholecystitis or are bothered by symptoms of gallstones are treated with surgical removal of the gallbladder, known as cholecystectomy. Laparoscopic cholecystectomy, also known as minimally invasive cholecystectomy, is performed through 4 small incisions with use of a camera to visualize the inside of the abdomen and long tools to remove the gallbladder. Surgery is done under anesthesia, and patients are asleep throughout the entire procedure.

Most patients go home on the day of or the day after surgery. Patients can return to eating their usual meals at home. Mild to moderate pain is common for a few days and can be managed with pain medications as prescribed. Dressings on the incisions can typically be removed the day after surgery, at which time patients can resume regular showers, but some incisions may require special care as instructed by the surgeon. A few people may experience diarrhea after cholecystectomy, which goes away after a few weeks or months in most people.

Complications after laparoscopic cholecystectomy are rare but can be serious when structures near the gallbladder are damaged. One of these structures is the common bile duct, which is the main tube that drains bile from the liver and gallbladder to the small intestine. Damage to the common bile duct or other biliary ducts can cause leakage or obstruction of bile flow and has symptoms of abdominal pain, fever, and yellowing of skin, known as jaundice. These symptoms can also be caused by a gallstone that is left behind in the bile duct. Bleeding from a blood vessel near the gallbladder can sometimes occur. Most bleeding stops on its own, but rarely, persistent bleeding requires intervention. After cholecystectomy, patients who experience worsening pain, fever, chills, nausea, vomiting, or jaundice should see a doctor.

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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: Sheffield KM, Riall TS, Han Y. Association between cholecystectomy with vs without intraoperative cholangiography and risk of common duct injury. JAMA. 2013;310(8):812-820.

Topic: Abdominal Surgery