Approximately 20 million people in the United States have gallstones. Most subjects with gallstones have no symptoms, but two percent to three percent of all patients with gallstones develop symptoms on a yearly basis. For years, the primary treatment of gallstones was traditional open cholecystectomy (removal of the gallbladder) which cures the disease permanently but is associated with a hospital stay of three to five days and an at-home recovery period of two to six weeks. Approximately 600,000 cholecystectomies are performed annually in the United States; the time lost from work in this group of patients was appreciable. In recent years, a number of alternative therapies for gallstones, ranging from dissolution to fragmentation with shockwaves, have been described. In all of these non-operative therapies, the gallbladder remains in place and the risk of recurrence of gallstones is estimated to be as high as 50 percent. Therefore it would be ideal to remove the gallbladder to cure the disease permanently while limiting the length of disability following the procedure.

Laparoscopy (the viewing of the interior of the abdomen using small; metal tubes after inflating the abdominal cavity with gas) has been used for many years for diagnosis and treatment of gynecologic diseases. Surgeons in Nashville and Paris reported performing laparoscopic cholecystectomy in humans in 1987. In recent years, the indications for surgical therapy administered through a laparoscope have expanded. Recent technological advances have made gallbladder removal by laparoscopy a safe procedure. Laparoscopic cholecystectomy is routinely performed at Zale Lipshy University Hospital at UT Southwestern, Parkland Memorial Hospital, Veterans Affairs of North Texas Health Care System, and Children's Medical Center of Dallas.

Patients with symptomatic gallstones undergo routine outpatient laboratory testing and are then admitted to the hospital the day of the operation. Standard general anesthesia is used during the procedure. The laparoscopic instruments (metal tubes through which one can view the internal organs as well as manipulate tissues) are inserted through small puncture wounds (5 to10 millimeters each) located in the navel and in the right upper abdomen. A total of four or five of these puncture wounds are used. The gallbladder is then removed. If indicated, cholangiograms (x-rays of the bile ducts) are obtained. Occasionally patients will have anatomy which is unusual, or excessive scar tissue in the region of the gallbladder, thereby making laparoscopic removal impossible. If this is the case, or if the surgeon is concerned that a complication may occur, then a standard open cholecystectomy with a larger incision will be performed.

The potential risks of this operation include the following: the small risk of general anesthesia; bleeding from the liver or from adhesions; perforation or injury of internal organs due to the laparoscopic instruments; injury to the bile ducts or liver arteries; inability to remove the gallbladder through the laparoscope necessitating open cholecystectomy; prolonged inability to take oral nourishment, and prolonged time away from work or school. The potential benefit to the patients is the avoidance of a large incision with its increased length of hospitalization. If the laparoscopic cholecystectomy is successful the patient should go home the same day or stay in the hospital overnight and may be able to return to work within one week.

In approximately 10 percent of patients with gallstones, one or more stones have escaped from the gallbladder and are lodged in the bile duct. If not removed, the stone could cause a backup of bile into the; system (jaundice) or, by passing through the bile duct into the intestine, could result in inflammation of the pancreas (pancreatitis). Prior to the institution of laparoscopic cholecystectomy, bile duct stones were easily managed during open cholecystectomy by making an incision in the bile duct, removing the stone(s) and closing the bile duct incision over a long rubber tube brought through the patient's abdominal wall. At the present time, it is more difficult to remove common bile duct stones during laparoscopic cholecystectomy. In patients with a high likelihood of stones within the bile duct (abnormal liver blood tests, a large bile duct on ultrasound or the demonstration of a bile duct stone on ultrasound), we generally recommend that the patient undergo an endoscopic procedure prior to the laparoscopic cholecystectomy. Because the bile duct enters the intestine in the duodenum (just downstream from the stomach), it is possible to place an endoscope through the mouth and stomach and into the duodenum. X-rays of the bile duct can then be performed to demonstrate whether stones are actually present. This procedure is called endoscopic retrograde cholangiopancreatography or ERCP. The procedure is done with administration of medicine by vein to minimize patient discomfort. If stones are present within the bile duct, it is usually possible to remove them during the performance of laparoscopic cholecystectomy, and we will try to remove them using laparoscopic techniques. The attempt sometimes fails. At that time a decision will be made whether to open the abdomen and do the standard operation of removing the bile duct stones or allow the stones to remain in place to be removed by postoperative ERCP. If you have a strong desire to pursue one of these options, you should notify your physician. Otherwise the decision will be made during the operation while you are asleep.

Should you decide to undergo laparoscopic cholecystectomy, it is important that you stop all medications containing aspirin or ibuprofen for one week peroperatively. If you are taking other medications, you must consult your physician regarding the advisability of continuing them pre- and postoperatively. While blood transfusions are rarely needed during the laparoscopic surgeries, we do require that you be typed and cross-matched for blood as a precaution. This will be included as part of your preoperative blood work.