Cholecystitis Surgery

Cholecystitis surgery is known as cholecystectomy, which is the surgical removal of the gallbladder. The gall bladder is a small pear-shaped organ found on the right side of the abdomen just under the liver. This organ stores bile, a digestive fluid produced by the liver. Cholecystitis is caused when it becomes inflamed and typically occurs when the cystic duct is blocked by gallstones. Because gallstones obstruct the cystic duct (the tube that carries bile out of the gall bladder), bile will accumulate and thus inflame the organ and also cause pain.

Types Of Cholecystitis

Cholecystitis is generally classified into the following types:

• Acute Cholecystitis: Rapid inflammation of the gallbladder, usually caused by gallstones. Rarely, it can occur in the absence of stones, particularly among critically ill individuals. 

• Chronic Cholecystitis: long-standing inflammation of the gallbladder, frequently accompanying gallstones. It results from repeated episodes of acute cholecystitis, resulting in wall thickening and scarring.

• Calculous Cholecystitis: Gallstones cause cystic duct obstruction, hence a diagnosis of this type of cholecystitis. It is the commonest type of cholecystitis.   

• Acalculous Cholecystitis: This type may occur in the absence of gallstones, particularly in critically ill patients, following a major operation, or with a punctured abdomen or severe burns or infections.

Cholecystitis Symptoms:

The symptoms associated with cholecystitis are the inflammation of the gall bladder, are numerous and can range from mild to very severe. Below is a breakdown of some of these common symptoms:

• Severe Abdominal Pain: The most important feature is sharp, intense pain in the upper right abdomen radiating to the back or the right shoulder and varying in intensity.

• Tenderness: Will be tender on examination, particularly the upper right part of the abdomen. 

• Nausea and Vomiting: These may be additional accompanying symptoms. 

• Fever: A fever may indicate an infection. 

• Jaundice: Occasionally, yellowing of the skin and eyes may develop. This would mean that no bile duct obstruction exists.

• Sweating, loss of appetite, and bloating.

• Weakness and fatigue are especially common in older individuals.

Usually, these symptoms appear after eating, especially after foods that are high in fat. The pain can be quite severe and may worsen with deep breaths in Cholecystitis.

Cholecystitis Causes:

Cholecystitis refers to the inflammation of the gallbladder. Its main inflammatory process is due to a blockage of the gallbladder due to one reason or the other.  

1. Gallstones (Calculous Cholecystitis): This is the most common one. The gallstones are hardened deposits of digestive fluid that can form in the gallbladder. When these stones block the cystic duct (the tube that carries bile out of the gallbladder), there is a buildup of bile, resulting in inflammation, pain, and possible infection.  

2. Acalculous Cholecystitis: This type of cholecystitis occurs in the absence of gallstones. It is associated with major surgery, severe burns, or serious infections. It can impair blood flow to the gallbladder, prolonged fasting or total parenteral nutrition (TPN), or gallbladder "sludge" (thickened bile).  

3. Chronic cholecystitis: Chronic cholecystitis develops as a result of repetitive acute episodes, most commonly caused by gallstones. It may be asymptomatic, present as acute cholecystitis, or develop severe complications, including gangrene, perforation, or fistula formation.

4. Other Possible Contributing Factors:

• Tumors: Tumors developed inside the gallbladder or in the bile duct can obstruct bile flow.  

• Severe illness: It can cause ischemia of the gallbladder.  

• Bile duct problems: Bile ducts may also be obstructed by scarring or narrowing.  

• Infections: Very rare infections may induce gallbladder inflammation.  

In summary, anything that hinders proper drainage of bile from the gallbladder may lead to the onset of cholecystitis.

Risk Factors:

The risk factors for developing cholecystitis largely overlap with those of gallstone formation; gallstones are the most likely cause. A variety of factors can also be responsible for risk factors, such as:

• Sex (females at greater susceptibility).

• Age (greater risk after 40).

• Obesity (being overweight raises cholesterol levels in bile).

• Rapid weight loss (bile imbalance due to quick weight loss). 

• Pregnancy (hormonal changes lead to raised risk).

• Hormone treatment (estrogen medications increase risk).

• Diabetes mellitus (patients with diabetes are at an increased risk).  

• Family history (increases risk). 

• Ethnic group (Native Americans and Hispanics at a much higher risk). 

• High cholesterol (promotes gallstone formation). 

• Severe illness (in particular, sepsis). 

• Extended fasting or TPN (result in bile stasis). 

• Compromised blood flow and immunosuppressive conditions to the gallbladder.

Gaining an insight into the risk factors would assist in risk reduction.

Complications of cholecystitis

Untreated or unmanaged severe cholecystitis can lead to the following serious complications: 

• Empyema of the gallbladder: If the bile gets obstructed in the gall bladder, it may then be infected by bacteria and get abscess formation called empyema. 

• Gallbladder Gangrene: Severe inflammation may compromise blood supply to the organ, leading to necrosis (death of tissues or cells, called gangrene), which is a serious infection and may even cause death. 

• Gallbladder Perforation (Rupture): A ruptured gallbladder might pour infected bile into the peritoneal cavity, resulting in peritonitis, a very serious condition because it can be fatal for humans. 

• Choledocholithiases: The Transfer of gallstones from the gallbladder to occlude the bile duct results in a jaundiced appearance, cholangitis, and pancreatitis. 

• Fistulization: It becomes possible with time to create an abnormal direct passage between the gallbladder and small intestine. 

Prevention:

Preventing the formation of gallstones is a core preventive effort for cholecystitis since gallstones are the most common underlying cause. Here’s a breakdown of prevention practices: 

• Maintain a Healthy Weight. 
• Healthy Diet. 
• Healthy Cholesterol Levels. 
• Exercise Regularly. 
• Healthy Weight Loss Pace. 
• No Prolonged Fasting. 

Cholecystitis Remedies: 

Surgical removal of the gallbladder (cholecystectomy) is the most common treatment for cholecystitis, especially for recurrent or severe cases. In less severe cases, treatment may involve pain management, dietary changes to reduce fat intake, antibiotics for infections, and anti-inflammatory medications. However, surgery is often necessary to prevent recurrent attacks and complications associated with cholecystitis.

Major surgery for cholecystitis would involve laparoscopic or open cholecystectomy. Open cholecystectomy is described as a procedure where the patient had a larger incision, manual retraction of tissues, and in some cases would require placement of a drainage tube; in turn, this would take a longer recovery duration and more pain with bigger scar compared to laparoscopic cholecystectomy, though the latter technique is not used for complex cases. The surgeon guides this choice based on your condition. 

Diagnosis: The diagnosis of cholecystitis includes medical history, physical examination, and tests. An overview of the evaluation follows: 

• History and Physical Examination: The patient may be asked through symptoms such as abdominal pain, nausea, and vomiting and by the physician, physical examination checking for tenderness while using Murphy's sign. 
• Blood: CBC and liver function tests can tell whether there is an infection and other non-normalities that can indicate bile duct problems. 
• Imaging tests: Tests for identification and assessment of gallstones and gallbladder function include ultrasound (abdominal and endoscopic), HIDA scan, CT scan, MRCP, and ERCP.

Preparation: To make sure the patient is ready for surgery, a pre-operative evaluation is performed, involving a review of their medical records and tests for diagnosis. Options for anaesthesia are discussed.

Anesthesia: During the surgery, a general anesthesia is used to produce consciousness and pain relief.

Incision: The lower abdomen is separated into multiple tiny incisions during a laparoscopic cholecystectomy. An open procedure for cholecystectomy involves making a single, bigger incision.

Access and Visualization: Laparoscopy devices, including a digital camera, are inserted through the cuts to access and visualize the gallbladder. During an open procedure, the gallbladder is directly accessed by the surgeon via the incision.

Gallbladder Removal: The surgeon effectively separates the gallbladder from the liver and the bile ducts using specialized instruments. The gallbladder is subsequently removed either through the bigger incision during the open procedure or through one of the two laparoscopic incisions.

Closure: Surgical staples or sutures are utilized to close incisions.

After Surgery: In the recovery area, the patient is kept an eye out for any potential problems right away. Antibiotics and painkillers might be recommended. Within a day or two, patients are usually released from the hospital and given instructions on post-operative care, which may include food and exercise limitations. Appointments for follow-up are planned in order to track recovery.