Question re: Lap. cholecystectomy

[ibbecca]

I am a 37 y.o. female in adequate health with a history of ITP blood disorder in remission post spleenectomy.  I have been having constant URQ pain for 2 months now.  All tests (blood work, CT scans of chest/abdomen, HIDA scan with & without ejection frature and u/s) have been normal.  My ejection fracture is 78%.  Physical exam consistent with gallbladder disease and HIDA scan showing sensitivity to CCK.  Doctor suspects gallbladder is going into spasms causing pain and is recommending a lap. choli.  I absolutely want my gallbladder removed however I'm not convince a lap. choli is better than an open procedure.  I have had 7 abdominal procedures and 5 lap procedures.  Everytime I have abdominal surgery I am told I have lots of adhesions and scarring.  Doctor said he would start with lap choli and switch to open if he couldn't visualize but I feel that would be like recovering from two surgeries.  Given my 12 abdominal procedures, history of blood disorder, history of adhesions/scarring and obesity, am I asking too much for an open procedure?  I have an appointment with another surgeon but it's only 3 days before my scheduled lap choli.  I'm wondering if I'm wasting my time trying to pursue an open cholecystectomy.  I know I'm in the minority for not wanting a laparoscopic procedure if offered, I just have a history of not doing well post-lap versus post-incision.  Thank you in advance.

[Jaybay]

Take it from one with a similar medical history as yours: do NOT go with an open procedure!  Your surgeon is absolutely correct in recommending the lap procedure.  Since you already have a history of developing abdominal adhesions, an open procedure is just asking for more.  I am currently on disability for this problem and have had to maintain a primarily liquid diet for years.  Adhesions following an open hysterectomy required a huge bowel resection, and now I'm just one big partial obstruction all over my bowels waiting for another total obstruction.  

Rule of thumb: more surgery causes more adhesions, causes more surgery to take down adhesions, causes more surgery... you get the idea.  With some patients it turns into a vicious circle.  Surgeons have been perfoming the lap chole procedure for many years now, and it is far superior to the open procedure.  The fewer tissues that are cut and disturbed, the less chance of developing post-op adhesions.  Simple as that.  I had the same thing done in 1998 and the recovery was amazingly fast.  Same thing with my appendix the following year.

The doc who did the hysterectomy talked me into the open procedure (in spite of my adhesions history) because he said he could better get to all the endometriosis that way.  Big fat liar.  I never should have listened to him against my better judgment.  Methinks it's just the way he's always done that surgery, and easier on him.  Oh well, live and learn.

Best wishes for a quick surgery and recovery.  :-)

[Felix'sMum]

Hi ...we are in a similar position; I'm awaiting a laparoscopic removal also and have had 3 laparotomies (hip to hip incisions for gynae operations (2 for the removal of large, twisted, adhered ovarian cysts). I think you should bear in mind the position of the incisions for the gall bladder procedure and that they may be well away from where you have had previous surgeries and thus where adhesions are likely to have formed. With cholecystectomy a laparoscope is inserted via the navel but the other incisions are generally in the upper part of the abdomen, around the leading edge of the rib. If your other surgeries have been for ob-gyn procedures or bowel for example, then any adhesions will not cause you a problem this time as the incisions will be much higher up. You should definitely let your surgeon give the laparoscopic approach a try...all he will do is increase the size of the incision if he is unhappy with how it's going....it won't be a whole new incision so you needn't feel you'll have to recover from 2 surgeries. A bigger op = more time spent in hospital, longer recovery generally, and an increased risk of infection and other complications, including damage to the bile duct. being overweight doesn't rule out successful keyhole surgery if the surgeon is skilled - I'm a big girl too and I'm not worried! I wish you good luck!

[Kevin Pho, MD]

Starting with a laparoscopic approach and then possibly switching to an open procedure is an common approach.

With any surgery, there will be an increased chance of adhesions.  Typically, the laparoscopic approach will decrease recovery time as opposed to an open procedure - it is recommended in most cases.

This question can be discussed with your surgeon - or in conjunction with another surgical procedure.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_