Why open cholecystectomy

The technique has a low rate of complications, implies a shorter hospital stay, and offers the patient a more comfortable postoperative period than OC. This study describes a series of patients with AC who were treated with LC or OC and assesses the results of both techniques. Between June and December , we conducted a nonrandomized, prospective study of patients with AC: patients underwent LC, and underwent OC. The diagnosis of AC was established by 1 clinical and laboratory criteria, 2 an ultrasonographic indication of AC, 3 intraoperative findings of AC, or 4 pathological anatomical features revealing the presence of AC.

Patients in whom choledocholithiasis was diagnosed preoperatively were excluded from the study. Age, sex, and operative findings are shown in Table 1. An antibiotic and antithrombotic prophylaxis was performed during the preoperative period and continued until 24 to 48 hours postoperatively.

All the patients underwent surgery within 72 hours of the onset of symptoms. The patients underwent LC when the surgeon J. The surgical technique used for OCs in all patients was a subcostal incision with removal of adhesions plus cholecystectomy.

The surgical technique for LCs was performed according to the French school, as described previously. The following data were recorded: operating time; rate of conversion to OC in the LC group; postoperative complications, divided into 4 groups according to severity Table 2 9 ; and length of hospital stay.

When the expected frequency was less than 3, we used the Fisher exact test. A list of the type and number of complications in each group is provided the grade of the complication is given in parentheses :. In the LC group, these complications included 1 minor biliary fistula, which closed on the third postoperative day in a patient in whom the cystic duct was not identified during surgery; 1 case of choledochal stenosis caused by a burn from a coagulating crochet hook, which required reoperation a month after the cholecystectomy; 1 case of bleeding of the hepatic bed, which required a blood transfusion; 1 intra-abdominal abscess, drained by radiological puncture; and 2 cases of residual lithiasis 9 and 12 months after LC, which were resolved with endoscopic papillotomy.

In the OC group, these complications included 2 cases of bleeding of the hepatic bed; 1 foreign body, which required reoperation in the immediate postoperative period; and 1 ca se of residual lithiasis 14 months after the operation, which resolved with endoscopic papillotomy. The mean length of the hospital stay was 8. Laparoscopic cholecystectomy is a clear alternative in the management of uncomplicated biliary lithiasis.

The data published about patients with AC are usually multicentric studies or personal series reviewed retrospectively, and they are sometimes of little value because of the wide variation in the definition of AC and because they include cases with a histological rather than a clinical diagnosis. Our study included patients who were admitted to the emergency department for clinical, analytic, and ultrasonographic manifestations of AC; all the patients had signs of acute inflammation when LC was performed.

This is because the surgeon and the emergency department team must get used to managing the laparoscopic material and need time to master the laparoscopic technique; also, LC is more laborious than OC in patients with AC. The rate of conversion depends, on the one hand, on the surgeon's experience in fact, most conversions occurred in each surgeon's initial patients and, on the other hand, on the time when the patient undergoes surgery.

At a later stage, there is induration, hypervascularity, and the formation of abscesses and necrosis, factors that make dissection difficult. Tell your provider if you have a history of bleeding disorders. Let your provider know if you are taking any blood-thinning medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.

If this is an outpatient procedure, you will need to have someone drive you home afterward. You may have a cholecystectomy as an outpatient or as part of your stay in a hospital. The way the surgery is done may vary depending on your condition and your healthcare provider's practices. A cholecystectomy is generally done while you are given medicines to put you into a deep sleep under general anesthesia. A tube will be put down your throat to help you breathe.

The anesthesiologist will check your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. An incision will be made. The incision may slant under your ribs on the right side of your abdomen. Or it may be made in the upper part of your abdomen.

In some cases, 1 or more drains may be put into the incision. This allows drainage of fluids or pus. About 3 or 4 small incisions will be made in your abdomen. Carbon dioxide gas will be put into your abdomen so that it swells up. This lets the gallbladder and nearby organs be easily seen. The laparoscope will be put into an incision.

Surgical tools will be put through the other incisions to remove your gallbladder. When the surgery is done, the laparoscope and tools are removed. The carbon dioxide gas is let out through the incisions.

Most of it will be reabsorbed by your body. After the procedure, you will be taken to the recovery room to be watched. Your recovery process will depend on the type of surgery and the type of anesthesia you had.

Once your blood pressure, pulse, and breathing are stable and you are awake and alert, you will be taken to your hospital room. A laparoscopic cholecystectomy may be done on an outpatient basis. In this case, you may be discharged home from the recovery room.

You will get pain medicine as needed. A nurse may give it to you. Or you may give it to yourself through a device connected to your IV intravenous line.

You may have a thin plastic tube that goes through your nose into your stomach. This is to remove air that you swallow.

The tube will be taken out when your bowels are working normally. You may have 1 or more drains in the incision if an open procedure was done. The drains will be removed in a day or so. You might be discharged with the drain still in and covered with a dressing. You will be asked to get out of bed a few hours after a laparoscopic procedure or by the next day after an open procedure.

Depending on your situation, you may be given liquids to drink a few hours after surgery. You will slowly be able to eat more solid foods as tolerated. Arrangements will be made for a follow-up visit with your provider. You may need to stay in the hospital for 3 to 5 days after open gallbladder removal.

During that time:. If there were problems during your surgery, or if you have bleeding, a lot of pain, or a fever, you may need to stay in the hospital longer. Your doctor or nurses will tell you how to care for yourself after you leave the hospital.

Cholecystectomy - open; Gallbladder - open cholecystectomy; Cholecystitis - open cholecystectomy; Gallstones - open cholecystectomy. Biliary system. Sabiston Textbook of Surgery. Philadelphia, PA: Elsevier; chap Rocha FG, Clanton J. Technique of cholecystectomy: open and minimally invasive. In: Jarnagin WR, ed. Updated by: Debra G. Editorial team. Open gallbladder removal. To perform the surgery: The surgeon makes a 5 to 7 inch The area is opened up so the surgeon can view the gallbladder and separate it from the other organs.

The surgeon cuts the bile duct and blood vessels that lead to the gallbladder. The gallbladder is gently lifted out and removed from your body. To do this test, dye is injected into your common bile duct and an x-ray is taken. The dye helps find stones that may be outside your gallbladder.