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The incidence of cholelithiasis in Taiwan is increasing year by year due to changes in dietary habits. Although percutaneous transhepatic cholangial drainage (PTCD), lithodialysis and extracorporeal shock wave lithotripsy (ESWL) are used for treatment, the recurrence rate is up to 61%, which are not in line with the principle of economic and effective treatment, and thus are not widely adopted. Generally speaking, cholecystectomy is the main treatment for cholelithiasis without special contraindications. The operative methods can be divided into open cholecystectomy and laparoscopic cholecystectomy.

Operations

• Open cholecystectomy: A 10-15 cm long incision must be made in the right upper quadrant of the abdomen or the middle of the upper abdomen for gallbladder removal. Postoperative complications include wound pain, indecent wounds, long hospitalization days and slow recovery. Unless you have special contraindications or severe abdominal adhesions, doctors will not consider traditional open cholecystectomy or other methods to deal with your problems.
• Laparoscopic cholecystectomy: Three to four 1-2 cm long small incisions are made in the abdomen, and then the gallbladder is carefully removed with special instruments with the aid of a laparoscopic camera. After the operation, due to slight wound pain, thin scars, shorter hospitalization days, and rapid recovery, social productivity can increase and the utilization rate of hospital beds can rise, so it is really the best way to treat gallstones economically, effectively and safely.
• After cholecystectomy, the body can still adapt normally without the gallbladder, including diet and lifestyle.

Surgery Preparation

• Please go to the anesthesiology clinic to complete the pre-anesthesia assessment and complete the consent form for surgery and anesthesia.
• A blood test, chest X-ray and electrocardiogram will be arranged during hospitalization.
• If you have any medical or food allergies, any medical history of hospitalization and surgery, or are pregnant, take any medication, etc., please inform your attending physician and nurse.
• For the safety of general anesthesia, please do not eat anything or drink water after 12am.
• If you have a history of chronic disease and need to take medication, please bring it with you when you are to be hospitalized. The nurse would ask the physician if the medication should be continued as usual.
• On the day of operation, you will be asked to change into a hospital gown, remove dentures and ornaments before administered with IV fluids.
• Please go to the washroom again to relieve yourself before the staff picks you up in the ward to the operating room.

Laparoscopic Surgery

• A special tube is inserted into the peritoneal cavity with injections of about 2-5 liters of carbon dioxide. After certain pressure is reached, three to four 1-2cm long small incisions are made in your abdomen. Then, the gallbladder is carefully removed under the laparoscope. The operation takes about 30 minutes to 1.5 hours, which is simple and safe. If the gallbladder adheres to surrounding tissues due to chronic inflammation, such as the stomach, duodenum, large intestine or omentum, it will take a longer time to operate on, or it will be replaced by traditional open cholecystectomy. Doctors will choose the most appropriate and safe treatment according to the actual situation of the operation.
• The success rate of laparoscopic cholecystectomy or traditional open cholecystectomy is up to 99.99%. About one in ten thousand patients dies of poor physical condition before operation, such as acute cholecystitis and sepsis or complications after operation, such as pneumonia, heart disease, and cerebral apoplexy.

Surgical Complications

• Common complications include 1) bile leakage; 2) bile duct obstruction; 3) residual choledocholithiasis; 4) wound infection; 5) shoulder pain; 6) costochondritis; and 7) bleeding. Generally speaking, the incidence is not high, about 0~3%, and most can be cured under the careful care of medical staff.

Postoperative Care Precautions

• After recovery from anesthesia, patients can rest in a semi-sitting position to relax the abdomen and improve wound pain, and turn over more and get out of bed as early as possible to pass wind. A few patients have mild shoulder pain and abdominal distension after operation, which are caused by carbon dioxide injected into the abdomen during the operation and the stimulation of the diaphragm. The symptoms will disappear in a short time. There is no cause for concern.
• Temporary fasting is required after the operation. When the medical staff tells you that you can eat, please drink a little boiled water first. If there is no abdominal distension or vomiting, you may consume low-fat soft food.
• The medical staff will help you assess your wound and change your dressing every day. Stitches will be removed about 6 to 7 days later. Before the removal, keep the dressing dry and do not get it wet to avoid infection of the wound.
• When you leave the hospital, the nurse will teach you how to change the dressing and take care of the wound in which there is a tube left, and you should return to the hospital as scheduled.
• If there is a drainage tube in the abdomen, please record the drainage volume and color every day. The normal color is light red or light yellow, and the volume is less than 50cc per day. If the color changes or the drainage volume increases, please immediately return to the hospital for treatment.
• In the first month or two after surgery, some patients may be intolerant of oily foods (leading to abdominal distension, diarrhea, etc.), so it is recommended that you take a low-fat, low-cholesterol diet, and then, with your body recovering, as long as there is no abdominal distension or fat leakage (diarrhea or a layer of oil floating on the toilet), you may gradually increase fat intake.
• In case of a fever, severe abdominal pain, slipping of the drainage tube, bright red drainage fluids, reduced drainage volume or redness, swelling, heat, pain at or purulent discharge from the wound, please return to the hospital for treatment as soon as possible (emergency treatment is available during non-outpatient hours).