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					                                                                                    Patient Education



                                                             Cholecystectomy
                                                                                              Partners in Your Surgical Care
AmERICAn COllEGE
  Of SuRGEOnS
DIvISIOn Of EDuCATIOn


                                                               Surgical Removal of the Gallbladder

                                                                                     Laparoscopic versus Open Cholecystectomy
                                                                                             Laparoscopic versus Open Cholecystectomy
                                                                              laparoscopic Cholecystectomy
                                                                              Laparoscopic Cholecystectomy             Open Cholecystectomy
                                                                                                                      Open Cholecystectomy



   Patient Education
   This educational information is
   to help you be better informed
   about your operation and
   empower you with the skills and
   knowledge needed to actively
   participate in your care.



   Keeping You
   Informed                                                Treatment Options                                                    Expectations
   Information that will help you
   further understand your operation.                      Surgery                                                              Before your operation—
                                                                                                                                Evaluation usually
   Education is provided on:                               Laparoscopic cholecystectomy—The                                     includes blood work, an
                                                           gallbladder is removed with instruments                              abdominal ultrasound,
   Cholecystectomy Overview ............. 1                placed into 4 small slits in the abdomen.                            and an evaluation by your
   Condition, Symptoms, Tests ............ 2               Open cholecystectomy—The gallbladder                                 surgeon and anesthesia
   Treatment Options ......................... 3           is removed through an incision on the                                provider to review your
                                                           right side under the rib cage.                                       health history and
   Risks and Possible Complications ..... 4                                                                                     medications and to discuss
   Preparation and Expectations ......... 5                Nonsurgical                                                          pain control options.
   Your Recovery and Discharge ........... 6                Stone retrieval                                                    The day of your operation—
                                                                                                                                You will not eat or drink
   Pain Control.................................. 7        For gallstones without symptoms
                                                                                                                                for at least 4 hours
   Glossary/References....................... 8             Watchful waiting                                                   before the operation.
                                                            Increased exercise                                                 Most often you will take
                                                            Diet changes                                                       your normal medication
                                                                                                                                with a sip of water.
  The Condition                                            Benefits and Risks                                                   Your recovery—If you
  Cholecystectomy is the surgical                                                                                               have no complications,
                                                           Benefits and Risk
  removal of the gallbladder. The                                                                                               you are often discharged
  operation is done to remove                              Gallbladder removal will relieve pain, treat                         home the same day after
  gallstones or to remove an infected                      infection, and in most cases stop gallstones from                    a laparoscopic procedure
  or inflamed gallbladder.                                 coming back. The risks of not having surgery                         and in 2 to 3 days after
                                                           are the possibility of worsening symptoms,                           an open procedure. Call
  Common symptoms                                          infection, or bursting of the gallbladder.                           your surgeon if you are in
   Sharp pain in the upper                                Possible complications include bleeding,                             severe pain, have stomach
    center or right abdomen                                bile duct injury, fever, liver injury,                               cramping, a high fever
                                                           infection, numbness, raised scars, hernia                            or chills, your skin turns
   Low fever
                                                           at the incision, anesthesia complications,                           yellow, or there is odor
   Nausea and feeling bloated                                                                                                  and increased drainage
                                                           puncture of the intestine, and death.
                                                                                                                                from your incision.

 This first page is an overview. For more detailed information, review the entire document.

 A mE R IC A n COl l EGE Of S uR GEO n S • 633 n. S A In T C l A IR S T. • C hIC AG O, Il 6 0 611 • w w w.fac s.org                                     1
The Condition, Signs and
                                                                                                                                Cholecystectomy




Symptoms, and Diagnostic Tests
                                                                                        Common hepatic duct

Keeping You                      Cystic duct
                                                                                     Common bile duct


Informed
most people with gallstones                                                                       Pancreas
                                  Liver
do not have symptoms.                                                                   Pancreatic duct
Eighty percent of people with
gallstones go 20 years or                 Gallbladder
                                                                                                  Small intestine
longer without symptoms.1,2
Gallstones are more                             Gallbladder
common in people who:
 are native American
 have a family history
   of gallstones                 The Condition                                              Symptoms
 are overweight                 The Gallbladder                                            The most common
 eat a lot of sugar                                                                        symptoms of cholecystitis are:
                                 The gallbladder is a small pear-shaped
 are pregnant                   organ under the liver.                                      Sharp pain
 do not exercise regularly                                                                   in right                  Upper
                                 The liver makes about 3 to 5 cups of
                                                                                                                Right          Left

 lose weight rapidly                                                                         abdomen
                                 bile every day. Bile is stored in the
 use estrogen to manage                                                                     Low fever
                                 gallbladder, and when food is eaten,
   menopause3,4                  especially fatty foods, the gallbladder                     Nausea and        Right          Left

Gallbladder pain or biliary      squeezes bile out through the cystic duct                    bloating
colic is usually temporary. It   and into the small intestine.                               Jaundice                 Lower

starts in the middle or right                                                                 (yellowing
side of the abdomen and can      Gallstones                                                   of the skin) may occur if gallstones
last from 30 minutes to 24       The medical term for gallstone                               are in the common bile duct
hours. The pain may occur        formation is cholelithiasis. A gallstone
                                 in the common bile duct is called
after eating a fatty meal.
                                 choledocholithiasis. Gallstones in the
                                                                                            Common
 Acute cholecystitis pain
   lasts longer than 6 hours,    ducts can block the flow of bile and cause
                                 swelling of the gallbladder.
                                                                                            Diagnostic Tests
   and there is abdominal
                                                                                            History and Physical
   tenderness and fever.         Cholecystitis is inflammation of the
 Pain on the right side of      gallbladder, which can happen suddenly                     Tests (see glossary)
   the abdomen can also          (acute) or over a longer period of time                    Abdominal ultrasound
   be from ulcers, liver         (chronic).
   problems, and heart pain.                                                                This is the most common test to check
                                 Perforated gallbladder is a condition when                 for gallstones. You may be asked not
Standard treatment               the gallbladder bursts or leaks, which
of acute cholecystitis                                                                      to eat for 8 hours before the test.
                                 happens only in rare cases but can be
is intravenous fluids,           life threatening.                                          Blood tests
antibiotics, pain medication,
and cholecystectomy.5            Cholecystectomy is the surgical removal                     Complete blood count
                                 of the gallbladder. The most common                         Liver function tests
                                 reason for a cholecystectomy is to remove                   Coagulation profile
                                 gallstones that cause biliary colic (acute
                                 pain in the abdomen caused by spasm or                     HIDA scan, cholescintigraphy
                                 blockage of the cystic or bile duct).                      Endoscopic retrograde cholangiogram
                                                                                            Magnetic resonance
                                                                                            cholangiopancreatography


2                                 A mE R IC A n COl l EGE Of S uR GEO n S • 633 n. S A In T C l A IR S T. • C hIC AG O, Il 6 0 611 • w w w.fac s.org
Surgical and
                                                                                                                                       Cholecystectomy




Nonsurgical Treatment
                                                           The site is stapled or sutured
Surgical Treatment                                         closed, and a small drain may be
An operation is the recommended                            placed going from the inside to the                       Keeping You
treatment for gallbladder pain from
gallstones, and it is the only treatment
                                                           outside of the abdomen. The drain is
                                                           usually removed in the hospital. The
                                                                                                                     Informed
for acute cholecystitis.                                   procedure takes about 1 to 2 hours.                       Conversion rates from a
                                                                                                                     laparoscopic to an open
                                                                                                                     technique are less than 1%
      Laparoscopic versus Open Cholecystectomy
              Laparoscopic versus Open Cholecystectomy
laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy        Open Cholecystectomy
                                   Open Cholecystectomy    Procedure Options                                         for young healthy people.
                                                           Procedures may be done to remove                           The need to convert from
                                                           gallstones from the common bile duct.                       a laparoscopic to an open
                                                           Laparoscopic transcystic common bile                        procedure can increase
                                                           duct stone extraction is performed                          significantly if you are over
                                                           with insertion of instruments into                          65 years, are male, have a
                                                           the abdomen similar to laparoscopic                         history of acute cholecystitis,
                                                           cholecystectomy. The bile duct is                           past abdominal operations,
                                                           entered, and stones are removed                             high fever, high bilirubin,
                                                           directly or with a wire basket.                             repeated gallbladder
                                                                                                                       attacks, and diseases that
                                                           Endoscopic retrograde cholangio-                            limit your activity.5
Laparoscopic Cholecystectomy                               pancreatography is done by inserting
This technique is the most common for                      an endoscope into your mouth and
simple cholecystectomy. The surgeon                        continuing to pass it through your
will make 4 small slits in the abdomen.                    stomach and then into the common
                                                           bile duct. Gallstones are removed
                                                                                                                     Questions you should ask
A port (nozzle) is inserted into one of
the slits, and carbon dioxide gas inflates                 directly or with a balloon or basket.                      What type of procedure
the abdomen. This process allows the                                                                                   is right for me and why?
                                                           Complication rates range from 0
surgeon to see the gallbladder more                        to 9.1 per 1,000 procedures.6                              How much experience
easily. A laparoscope is inserted through                                                                              do you have with
another port. It looks like a telescope                                                                                this procedure?
with a light and video camera on the                       nonsurgical Treatment                                      Has the procedure been
end so the surgeon can see inside the                                                                                  done often at this center?
                                                           Watchful waiting
abdomen. Surgical instruments are                                                                                     Do you know the
placed into the other small openings                       If gallstones are seen on your ultrasound                   approximate cost of
and used to remove the gallbladder.                        but you do not have symptoms,                               the procedure?
                                                           watchful waiting is recommended.1,2
The surgeon removes the gallbladder
through the incision. The carbon                           Gallstones only, without cholecystitis
dioxide comes out through the small
slits and then the sites are closed with                    Increase your exercise. Exercising
sutures, metal clips called staples, or                      2 to 3 hours a week reduces
steri-strips. Your surgeon may start                         the risk of gallstones.7,8
with a laparoscopic technique and                           Eat more fruit and vegetables,
need to change to an open technique.                         and eat less foods high in sugars
                                                             and carbohydrates like donuts,
The procedure takes about 1 to 2 hours.                      pastry, and white bread.
Open Cholecystectomy                                        Alternative medicine options
                                                             are available.9
The surgeon makes an incision
approximately 6 inches long in the
upper right side of the abdomen and
cuts through the fat and muscle to the
gallbladder. The gallbladder is removed,
and any ducts are clamped off.

A mE R IC A n COl l EGE Of S uR GEO n S • 633 n. S A In T C l A IR S T. • C hIC AG O, Il 6 0 611 • w w w.fac s.org                                       3
Risks of This Procedure
                                                                                                                                     Cholecystectomy




    Your surgeon will do everything possible to minimize risks,
    but cholecystectomy, like all operations, has risks.

         The Risk                       What Happens                                                Keeping You Informed
     Infection          Infections occur in less than 1 per 1,000                  Your health care team should wash their
                        patients who have laparoscopic procedures.5,6,13,14        hands before examining you. Antibiotics
                                                                                   are given right before the operation.5

     Common bile        Injury to the bile duct is reported in 1 per 1,000         Your surgeon and nurse will watch for jaundice,
     duct injury        patients for open cholecystectomy and in 1 to 5            fever, and abnormal blood tests.5 further
                        per 1,000 for laparoscopic cholecystectomy.5,6,14          testing or surgery may be needed.

     Bleeding           Bleeding is rare. If you have chronic                      Your surgeon will check a coagulation profile to
                        biliary disease, your liver may not                        monitor for bleeding problems. A blood transfusion
                        form clotting factors.5,6,13                               usually is not required for cholecystectomy.

     Bile leakage       Bile leakage after surgery is very rare.                   Your surgeon will check for fever, monitor labs, and
                                                                                   may need to perform other tests such as sonography or
                                                                                   endoscopic retrograde cholangiopancreatography (ERCP).

     Retained common    A gallstone may pass after surgery                         Your surgeon will check blood tests
     bile duct stone    and block the bile from draining.5                         for your liver function.

     Pneumonia          General anesthesia, lack of deep breathing                 Deep breathing exercises can help expand your
                        and movement are possible causes.                          lungs and prevent complications after surgery.10

     Heart problems     heart problems are rare. Cardiac arrhythmias               Your surgeon may have you see a heart specialist
                        were reported in about 5 per 1,000 patients                before your operation. Your anesthesia provider is
                        and heart attack in 1 per 1,000.6,13                       always prepared in advanced cardiac life support.

     Kidney problems    Kidney or urinary problems have been reported              Your surgeon may give you extra fluids before your
                        in 5 per 1,000 patients. Dehydration and                   operation.5 let your nurse know when you urinate.
                        liver problems can increase this risk.6,13

     Deep vein          no movement during surgery can lead to                     Your surgeon or nurse will place support or
     thrombosis         blood clots forming in the legs. In rare                   compression (squeezing) stockings on your legs
     (blood clots)      cases the clot can travel to the lungs.                    and may give you blood thinning medication.
                                                                                   Your job is to get up and walk after surgery.

     Premature labor    fetal loss is reported as 40 per 1,000 patients            These risks increase with peritonitis
     and fetal loss     for uncomplicated cholecystectomy and as high              (infection of the abdominal cavity).
                        as 600 per 1,000 when pancreatitis is present.
                        The risk of preterm labor also increases.11,12

     Injury to the      Instrument insertion and use during laparoscopic           The surgeon will use extreme care and continuously
     intestines or      technique can injure the intestines.                       watch for any bleeding or bowel contents during the
     abdominal organs                                                              procedure. Patients who are obese or who have a history
                                                                                   of past abdominal operations or adhesions make it
                                                                                   more difficult to move and manipulate instruments.5

     Death              Death is extremely rare in healthy people                  Your entire surgical team will review for possible
                        and is reported as 0 to 1 per 1,000                        complications and be prepared to decrease all risks.
                        patients. The risk of death increases with
                        gangrene, a burst gallbladder or severe
                        diseases that limit your activity.1,6




4                                      A mE R IC A n COl l EGE Of S uR GEO n S • 633 n. S A In T C l A IR S T. • C hIC AG O, Il 6 0 611 • w w w.fac s.org
Expectations:
                                                                                                                                      Cholecystectomy




Preparation for Your Operation
Preparing                                                  What You Can Expect                                       Keeping You
for Your Operation                                         A bracelet with your name and
                                                           identification number will be placed on                   Informed
Tell your surgeon about other medical                      your wrist. Your wristband should be                      An effective way to do deep
problems that you have. Bring a list                       checked by all health care team members                   breathing is to breathe deeply
of all of the medications that you are                     before providing any procedures or                        and hold for 3 to 5 seconds.
taking, and show that list to your                         giving you medication. If you have                        Take 5 to 10 deep breaths every
surgeon and anesthesia provider.                           any allergies, an allergy bracelet                        hour while you are awake.
                                                           should also be placed on your wrist.                      Young children can do deep
Most often you will take your morning
                                                           An intravenous line (IV) will be started                  breathing by blowing bubbles.
medication with a sip of water. If you
are taking blood thinners (Plavix,                         to give your fluids and medication. The
coumadin, aspirin), your surgeon                           medication will make you feel sleepy.
may ask you to stop taking these.
                                                           A tube will be placed down your throat to
Home Preparation                                           help you breathe during the operation.                    Questions you should ask
You can often go home the same                             Your surgeon will perform your operation                   What medications
day after a laparoscopic procedure.                        and then close your incisions. If you have                  should I stop taking
Your hospital stay will be longer (2                       an open operation, a drain may be placed                    before my operation?
to 3 days) for an open procedure.                          from the inside of your incision out your                  When should I stop
                                                           abdomen.                                                    taking them?
Anesthesia
                                                           After your operation, you will be moved                    Should I take any
You will meet with your anesthesia                         to a recovery room.                                         medicines on the day
provider before the operation. Let                                                                                     of my operation?
him or her know if you have allergies,                     Preventing Pneumonia                                       What are the risks,
neurologic disease (epilepsy or stroke),                   Movement and deep breathing after                           problems, and side effects
heart disease, stomach problems, lung                      your operation can help prevent fluid                       of general anesthesia?
disease (asthma, emphysema), endocrine                     in your lungs and pneumonia.10                             Do I need antibiotics
disease (diabetes, thyroid conditions),
                                                                                                                       before surgery?
loose teeth, or if you smoke, abuse alcohol                Preventing blood clots
or drugs, or take any herbs or vitamins.                                                                              What will you do to
                                                           When you have surgery, you are at risk                      prevent blood clots?
                                                           of getting blood clots because of not                      If hair has to be removed
The Day                                                    moving during anesthesia. The longer
                                                           and more complicated your surgery, the
                                                                                                                       on my abdomen, how
                                                                                                                       will it be done?
of Your Operation                                          greater the risk. Your doctor will know
                                                                                                                      Did you wash your hands?
                                                           your risk for blood clots, and steps will be
Don’t eat or drink                                         taken to prevent them. This may include
Not eating or drinking for at least 4                      blood thinning medication and support
hours before the operation reduces your                    or compression (squeezing) stockings.
risk of complications from anesthesia.
                                                           Preventing Infection
What to bring                                               The risk of infection can be
 Insurance card and identification                          lowered if antibiotics are given
 Advance directive (see terms)                              right before surgery and hair
                                                             is removed at the surgical site
 List of medicines
                                                             with clippers versus shaving.
 Personal items such as
                                                            All health care providers should wash
  eyeglasses and dentures
                                                             their hands before examining you.
 Loose-fitting comfortable clothes
 Leave jewelry and valuables at home




A mE R IC A n COl l EGE Of S uR GEO n S • 633 n. S A In T C l A IR S T. • C hIC AG O, Il 6 0 611 • w w w.fac s.org                                     5
Your Recovery and Discharge
                                                                                                                                   Cholecystectomy




                                                                                                A small amount of drainage from
                                     Your Recovery



           x
                                                                                                 the incision is normal. If the
                                     and Discharge                                               drainage is thick and yellow or
                                                                                                 the site is red, you may have an
                                     Thinking Clearly                                            infection so call your surgeon.
                                     The anesthesia may cause you to feel                       If you have a drain in one of
                                     different for 2 or 3 days. Do not drive,                    your incisions, it will be taken
                                     drink alcohol, or make any big decisions                    out when the drainage stops.
                                     for at least 2 days.                                       Surgical staples, will be removed
           Avoid driving
                                                                                                 during your first office visit.
                                     Nutrition
                                                                                                Steri-strips will fall off in 7 to
                                      When you wake up, you will be                             10 days or they will be removed
                                       able to drink small amounts of                            during your first office visit.
                                       liquid. If you are not nauseous, you                     Avoid wearing tight or rough clothing.
                                       can begin eating regular foods.                           It may rub your incisions and
                                      Continue to drink lots of fluids,                         make it harder for them to heal.
                                       usually about 8 to 10 glasses per day.                   Protect the new skin, especially
                                                                                                 from the sun. The sun can burn
                                     Activity                                                    and cause darker scarring.
                                      You will be helped getting                               Your scar will heal in about 4 to
                                       out of bed and walking.                                   6 weeks and will become softer
                                      Slowly increase your activity.                            and continue to fade over the next
                                      Do not lift or participate in strenuous                   year. Keep the wound site out
     Steri-strips will fall off or                                                               of the sun or use sunscreen.
                                       activity for 3–5 days for laporoscopic
    they will be removed during
                                       and 10–14 days for open procedure.                       Sensation around your incision will
        your first office visit
                                      Avoid driving until your pain is                          return in a few weeks or months.
                                       under control without narcotics.
                                                                                               Bowel Movements
                                      You can have sex when you feel
                                       ready, usually after your sutures                        After intestinal surgery, you may
                                       or staples are removed.                                   have loose watery stools for several
                                      It is normal to feel tired. You may need                  days. If watery diarrhea lasts longer
                                       more sleep than usual.                                    than 3 days, contact your surgeon.
                                                                                                Pain medication (narcotics) can
                                     Work                                                        cause constipation. Increase the
                                     You can go back to work when you feel                       fiber in your diet with high-fiber
                                     well enough. Discuss the timing with                        foods if you are constipated. Your
                                     your surgeon.                                               surgeon may also give you a
                                                                                                 prescription for a stool softener.
                                     Wound Care
                                                                                               High-Fiber Foods
                                      Always wash your hands before and
Wash your hands before and                                                                     Food high in fiber include beans,
                                       after touching near your incision site.
 after touching near your                                                                      bran cereals and whole grain breads,
        incision site                 Do not soak in a bathtub until your
                                       stitches, steri-strips, or staples are                  peas, dried fruit (figs, apricots, and
                                       removed. You may take a shower                          dates), raspberries, blackberries,
                                       after the second postoperative                          strawberries, sweet corn, broccoli,
                                       day unless you are told not to.                         baked potatoes with skin, plums,
                                                                                               pears, apples, greens, and nuts.
                                      Follow your surgeon’s instructions
                                       on when to change your bandages.




6                                    A mE R IC A n COl l EGE Of S uR GEO n S • 633 n. S A In T C l A IR S T. • C hIC AG O, Il 6 0 611 • w w w.fac s.org
                                                                                                                                       Cholecystectomy




Pain                                                       Pain Control
The amount of pain is different for each                   Everyone reacts to pain in a different                    Keeping You
person. Some people need only 2 to 3                       way. A scale from 0 to 10 is often
doses of pain control medication, while                    used to measure pain. At a “0,” you
                                                                                                                     Informed
others use narcotics for a full week.                      do not feel any pain. A “10” is the                       Extreme pain puts extra stress
Home Medications                                           worst pain you have ever felt.                            on your body at a time when
                                                                                                                     your body needs to focus on
The medicine you need after                                Common Medicines to Control Pain                          healing. Do not wait until your
your operation is usually                                  Narcotics or opioids are used for severe                  pain has reached a level “10”
related to pain control.                                   pain. Some side effects of narcotics                      or is unbearable before telling
                                                           are sleepiness; lowered blood pressure,                   your doctor or nurse. It is much
                                                                                                                     easier to control pain before it
When to Contact                                            heart rate, and breathing rate;
                                                           skin rash and itching; constipation;                      becomes severe.
Your Surgeon                                               nausea; and difficulty urinating. Some
                                                           examples of narcotics include morphine,
If you have:
                                                           oxycodone, and hydromorphone.
   Pain that will not go away                             Medications are available to control
   Pain that gets worse                                   many of the side effects of narcotics.
   A fever of more than 101°F (38.3ºC)                    Non-narcotic Pain Medication
   Vomiting
                                                           Most nonopioid pain medications
   Swelling, redness, bleeding,                           are nonsteroidal anti-inflammatory
    or bad-smelling drainage                               drugs (NSAIDs). They are used to
    from your wound site                                   treat mild pain or combined with a
   Strong abdominal pain                                  narcotic to treat severe pain. They
   Jaundice or yellow skin                                also can reduce inflammation. Some
   No bowel movement or unable                            side effects of NSAIDs are stomach                            Splinting your stomach
    to pass gas for 3 days                                 upset, bleeding in the stomach or
   Watery diarrhea lasting                                intestines, and fluid retention. These
    longer than 3 days                                     side effects usually are not seen with
                                                           short-term use. Examples of NSAIDs
                                                           include ibuprofen and naproxen.
    Other Instructions:
                                                           Non-medicine Pain Control
                                                           Distraction helps you focus on other
                                                           activities instead of your pain. Music,
                                                           games, and other engaging activities are
                                                           especially helpful with children in mild
                                                           pain.
                                                                                                                             Guided imagery
                                                           Splinting your stomach by placing a
    Follow-up Appointments                                 pillow over your abdomen with firm
                                                           pressure before coughing or movement
       Who             Date            Phone               can help reduce the pain.

                                                           Guided imagery helps you direct and
                                                           control your emotions. Close your eyes
                                                           and gently inhale and exhale. Picture
                                                           yourself in the center of somewhere beau-
                                                           tiful. Feel the beauty surrounding you
                                                           and your emotions coming back to your
                                                           control. You should feel calmer.


A mE R IC A n COl l EGE Of S uR GEO n S • 633 n. S A In T C l A IR S T. • C hIC AG O, Il 6 0 611 • w w w.fac s.org                                      7
Glossary of Terms
                                                                                                                                                   Cholecystectomy




and for More Information
Glossary of Terms                                                           for more Information
Abdominal ultrasound This test uses sound                                   for more information, please go to the American
waves to determine the location of deep                                     College of Surgeons Patient Education Web site at
structures in the body. A hand roller is placed on                          www.facs.org/patienteducation/.
top of clear gel and rolled across the abdomen.
                                                                            The information provided in this brochure is chosen from recent
Advance directives Documents signed by                                      clinical research. The research listed below does not represent
a competent person giving direction to                                      all of the information that is available about your operation.
health care providers about treatment                                       1. Society for Surgery of the Alimentary Tract. Treatment
choices. They give you the chance to tell                                       of gallstones and gallbladder disease. (2003)
your feelings about health care decisions.                                  2. National Institutes of Health. Gallstones and laparscopic
Adhesions A fibrous band or scar                                                cholecystectomy. NIH Consensus Statement (1992)12:1–28
tissue that causes internal organs                                          3. Nakeeb A, Cumuzzie AG, Martin L, et al. Gallstone: genetics
to adhere or stick together.                                                    versus environment. Annals of Surgery (2002)235:842–849
                                                                            4. Weinsier RL, Wilson LJ, Lee J. Medically safe rate of weight loss
Bilirubin A blood test used to determine                                        for the treatment of obesity: a guideline based on risk of gallstone
liver and gallbladder dysfunction.                                              formation. American Journal of Medicine (1995)98:115–117
Complete blood count (CBC) A blood test                                     5. Souba W, Fink M, Jurkovich G, et al. ACS Surgery:
that measures red blood cells (RBCs)                                            Principles and Practice. New York, NY: WebMD, 2004
and white blood cells (WBCs). WBCs                                          6. Petelin J. Laparoscopic common bile duct exploration.
increase with inflammation. The normal                                          Surgical Endoscopy (2003)17: 1705–1715
range for WBCs is 8,000 to 12,000.                                          7. Leitzmann MF, Giovannucci EL, Rimm EB, et al. The relation
                                                                                of physical activity to risk for symptomatic gallstone disease
Endoscopic retrograde cholangiogram An                                          in men. Annals of Internal Medicine (1998)128:417–425
endoscope with a camera on the end is                                       8. Leitzmann MF, Rimm EB, Willet WC, et al. Recreational
passed through your mouth, stomach,                                             physical activity and the risk of cholecystectomy in women.
and intestines into the bile duct to                                            New England Journal of Medicine (1999)341:777–784
check for and remove gallstones.                                            9. Moga MM. Alternative treatment of gallbladder disease.
                                                                                Medical Hypothesis (2003)60:143–147
HIDA (hepatobiliary iminodiacetic acid scan)
                                                                            10. Overend TJ, Anderson CM, Lucy SD, et al. The effect of
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This information is published to educate you about your
specific surgical procedure. It is not intended to take the                     analysis of 22,953 consecutive cases from the Swiss Association
place of a discussion with a qualified surgeon who is familiar                  of Laparoscopic and Thoracoscopic Surgery database. Journal
with your situation. It is important to remember that each                      of the American College of Surgeons (2006)203:723–728
individual is different, and the reasons and outcomes of any
operation depend on the patient’s individual condition.                     Reviewed by:     Patricia L. Turner, MD, FACS
The American College of Surgeons (ACS) is a scientific and                                   Mark Malangoni, MD, FACS
educational organization that is dedicated to the ethical and
competent practice of surgery. It was founded to raise the
standards of surgical practice and to improve the quality
of care for the surgical patient. The ACS has endeavored to
present information for prospective surgical patients based
on current scientific information; there is no warranty on                  We are grateful to Ethicon Endo-Surgery for their support
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