Cholecystectomy

A cholecystectomy removes the gallbladder, usually through several small laparoscopic incisions. The gallbladder stores and concentrates bile made by the liver. After surgery, the liver continues to make bile, but bile flows continuously through the common bile duct into the duodenum rather than being stored for release with a fatty meal. The most common reason for urgent removal is acute calculous cholecystitis. A gallstone blocks the cystic duct, trapping bile inside the gallbladder. Pressure rises, the wall becomes inflamed and edematous, and impaired blood flow can lead to ischemia, gangrene, or perforation. Antibiotics and IV fluids can reduce infection and stabilize the patient, but they do not remove the obstructing stone or the diseased organ. Surgery provides source control. Elective cholecystectomy may also be performed for recurrent biliary colic from symptomatic gallstones. Biliary colic causes episodic right upper-quadrant or epigastric pain, often after a fatty meal, but usually does not produce fever or marked inflammatory laboratory changes. Fever, persistent tenderness, and leukocytosis shift concern toward acute cholecystitis.