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[cholecyst- + -ectomy]
Removal of the gallbladder by laparoscopic or abdominal surgery. The procedure is performed for symptomatic gallbladder and bile duct disease.
LAPAROSCOPIC CHOLECYSTECTOMY SCARS
Acute, chronic, or acalculous cholecystitis (biliary inflammation that is not caused by gallstones), repeated episodes of biliary colic, biliary dyskinesia, gallstone pancreatitis, and occasionally cholangitis are indications for the procedure. The gallbladder does not usually need to be removed for asymptomatic gallstone disease, except in patients with diabetes mellitus.
In the U.S. alone, about 750,000 cholecystectomies are performed annually.
Risk factors for gallstone disease include advancing age, diabetes mellitus, female gender, obesity and overweight, and parity.
Surgical complications, including wound infections, adverse reactions to anesthetics, and injury to the liver, gallbladder, bile ducts, or neighboring organs, occur about 5% of the time.
Preoperative: The patient is informed about the procedure, including the need for drains, catheter, and nasogastric tubes and is taught about incentive spirometry, leg exercises, incision splinting, analgesia use, and other postoperative concerns.
Postoperative: General patient care concerns apply. Vital signs are monitored and dressings are inspected. The patient is assessed for pain and for gastrointestinal and urinary function; analgesics and antiemetics are provided as needed. Fluid and electrolyte balance is monitored, and prescribed fluid replacement therapy is administered until the patient is permitted oral intake. The patient is encouraged to breathe deeply and to perform incentive spirometry to prevent atelectasis and impaired gas exchange. The patient is assisted with early ambulation and with splinting the abdomen when moving about or coughing. Peripheral circulation is evaluated, and venous return is promoted with leg exercises and elastic stockings or pneumatic hose as prescribed.
If a laparoscopic approach is used, the patient will typically be discharged on the day of or the day after surgery. Clear liquids are offered after recovery from general anesthesia, and the patient can resume a normal diet within a few days. If an open incision is used, the patient is placed in a position of comfort; a nasogastric (NG) tube is frequently required to prevent abdominal distention and ileus, and is attached to low intermittent suction. The volume and characteristics of drainage from the NG tube and any abdominal drains or T-tubes are documented. Skin care and appropriate dressings are provided around any drain site.
When peristalsis returns, the NG tube is removed as directed. Oral intake, beginning with clear liquids, is initiated. The T-tube may be clamped before and after each meal to allow additional bile to enter the intestine. Signs and symptoms of postcholecystectomy syndrome (fever, abdominal pain, and jaundice) and other complications involving obstructed bile drainage are reported; urine and stool samples are collected for analysis of bile content in the event that any such complications occur.
Discharge teaching for the patient and family includes wound care and T-tube care if appropriate (the T-tube may remain in place up to 2 weeks); the need to report any signs of biliary obstruction (fever, jaundice, pruritus, pain, dark urine, and clay-colored stools); the importance of daily exercise such as walking; avoidance of heavy lifting or straining for the prescribed period; and any restrictions on motor vehicle operation. Although diet is not restricted, the patient may be more comfortable avoiding excessive intake of fats and gas-forming foods for 4 to 6 weeks. Arrangements for home health follow-up or care may be necessary. The patient should return to the surgeon for a post-operative evaluation visit as scheduled. If gallstones were present, the patient is taught to reduce the risk of recurrence by maintaining normal body weight, exercising regularly, and eating three well-balanced meals daily, including fiber and calcium and avoiding alcohol and foods high in saturated fat. Weight loss, if needed, should be carried out gradually, and crash dieting discouraged.
SEE: Nursing Diagnoses Appendix
LAPAROSCOPIC CHOLECYSTECTOMY SCARS