Cost of laparoscopic cholecystectomy by state

What is a laparoscopic cholecystectomy?

Endoscopic gallbladder removal, also known as laparoscopic cholecystectomy, is the surgical removal of the gallbladder through a minimally invasive process called laparoscopy. In the past, gallbladder removal required a large incision into the abdominal cavity through which the surgeon removed the gallbladder under direct visualization. Since 1989 when it was invented, the laparoscope enables the gallbladder to be removed with only a small incision in the abdomen, with the gallbladder being removed via a handheld device while the surgeon visualizes the gallbladder on a screen, using the video camera and light source on the laparoscope. The smaller incision size and less involved surgery enable faster healing time and less pain than the prior method.  

The gallbladder is a small pouch-like structure located next to the liver, on the right side of the abdominal cavity. Its function is to store bile that is produced by the liver. Bile is a substance that helps in the digestion of fatty foods. Sometimes, the bile can build up and form crystals, or gallstones. This can block the exit of the bile from the gallbladder, leading to inflammation and infection of the gallbladder, which can cause abdominal pain and bloating on the right side of the belly area. At times, fever, nausea, and jaundice (yellow-tinged skin or eyes) can develop as well.  

If you are having some of the symptoms listed above, your physician may order bloodwork and an abdominal ultrasound, which is a test that helps visualize the liver and gallbladder to check for gallstones or inflammation. Based on these results, your symptoms, and your physical exam, your physician may recommend that you have a laparoscopic cholecystectomy. For more information, see www.my.clevelandclinic.org.

Why would you get a liver biopsy with a laparoscopic cholecystectomy?

A liver biopsy may be recommended if you have abnormal liver blood work, have symptoms that are suspicious for liver disease, or have abnormal liver imaging tests such as an abnormal abdominal ultrasound. The liver biopsy can be performed during a laparoscopic cholecystectomy because the liver and the gallbladder are located near each other. During this procedure, a small piece of liver tissue is taken out through a thin tube inserted into the abdomen. This piece of liver sample is sent to the pathology lab and analyzed microscopically to assess for any abnormalities and give a diagnosis for your symptoms. Liver problems that can be discovered include liver tumors, hepatitis, fatty liver, inflammation, or infection. The results of the liver biopsy help your physician to treat the condition. For more information, see www.mayoclinic.org.

Is laparoscopic cholecystectomy a major surgery?

Any surgical procedure carries some risk, including infection, bleeding, and damage to nearby body organs. Laparoscopic cholecystectomy is a major surgery in the sense that a body organ, the gallbladder, is being removed. However, it is now considered routine surgery, with over 600,000 such surgeries being performed yearly in the United States. The complication rate is approximately 0.5%.

How long does laparoscopic cholecystectomy take?

A laparoscopic cholecystectomy usually lasts 1 to 2 hours if everything goes smoothly. If you have scar tissue buildup from prior abdominal surgeries or other complications, it could take longer. 

How painful is laparoscopic gallbladder surgery?

During the surgery itself, you will be under general anesthesia and will not feel any pain. Upon completion of the surgery, while in the recovery room, you will receive pain medication and a prescription for narcotic pain medication to help control your pain as you heal. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen also help with the pain. You will likely experience mild to moderate abdominal pain for the first 24-48 hours after surgery. Pain at the shoulder is also common due to the irritation of the body tissues from the extra air that is inserted into the abdominal cavity during the procedure, which helps to visualize the body organs better. Patients who undergo laparoscopic gallbladder removal usually have a faster recovery time and less pain than those undergoing the regular open type of gallbladder removal, which requires a larger incision.

How long does it take to recover from laparoscopic gallbladder surgery with liver biopsy?

After laparoscopic gallbladder surgery, you will likely go home from the hospital the same day. You may experience mild to moderate pain in the belly and shoulders for up to 48 hours on average. You should be back to your regular activity within two weeks, sometimes as early as 3-5 days after surgery. You may experience intermittent and mild abdominal discomfort or low energy levels for up to 6 weeks after the procedure. Your surgeon will guide you on what activities can be undertaken and in what time frame based on your specific response to the surgery.

What are the side effects of having your gallbladder removed?

Side effects of having your gallbladder remove include nausea and vomiting from the anesthesia, which usually last for a very short time after the surgery. Fatigue and constipation can also occur for up to 2 weeks as you heal from the surgery. Narcotic pain medicine can cause constipation, so as your pain resolves and you wean off of the narcotics, your bowel pattern should return to normal. 

Longer-term effects of gallbladder removal include digestion problems and chronic diarrhea. Some patients have problems digesting fatty foods. Digestion of fat requires bile, which is usually stored in the gallbladder. Once your gallbladder is removed, only smaller amounts of bile are available for digestion and can make it harder for you to digest a large fatty meal.

Chronic diarrhea is common within the first week of having your gallbladder removed, and usually lessens over the next few weeks. Males under age 50 years old are more likely to develop chronic diarrhea. You should contact your doctor for guidance on how to manage this condition.

What food should you avoid if you have no gallbladder?

The gallbladder acts as storage for large amounts of bile, which helps you digest fats. If you have had your gallbladder removed, you have less bile available for use during digestion. The smaller amounts of bile make it harder, but not impossible, for your body to digest fatty foods. It is recommended that you eat a low-fat diet to ensure that the food will be digested properly and not give you indigestion. Smaller, more frequent meals also put less stress on your digestive system. High fiber foods help to keep your bowels regular. For more information, visit www.hopkinsmedicine.org.

How long does it take to get the results of a liver biopsy?

The liver tissue taken during a biopsy is sent to a pathology lab, where it is examined under a microscope and is analyzed for various medical conditions depending on your specific symptoms. The analysis of the liver tissue can take up to 2 weeks. Your physician should arrange for an office or phone meeting to discuss the results with you. Based on the results, a treatment plan will be discussed.