What gas is used for gallbladder surgery?

Review question

Índice Show

Symptoms of gallstones
Types of gallstones
Causes and risk factors for gallstones
Diagnosis of gallstones
Complications of gallstones
Treatment for gallstones
Surgical removal of the gallbladder or gallstones
Laparoscopic cholecystectomy
Open gallbladder surgery
Complications after gallbladder surgery
Self-care after gallbladder surgery
Long-term outlook after gall bladder surgery
Where to get help
Things to remember

What are the benefits and harms of various gases for insufflation (inflation with gas) of the abdominal (tummy) cavity to allow easier access to organs during laparoscopic (key-hole) abdominal surgery?

Background

Laparoscopic surgery is now widely performed to treat various abdominal diseases. An ideal gas for insufflation of the abdominal cavity, increasing working, and viewing space, should be cheap, colourless, not flammable, inexplosive, easily removed by the body, and completely non-toxic to participants. Currently, carbon dioxide is the most frequently used gas for this purpose. However, use of carbon dioxide may cause heart or lung complications. So, other gases have been suggested as alternatives to carbon dioxide.

Study characteristics

We searched for all relevant studies up to October 2021.

We identified 10 clinical trials with 583 participants, of which three trials (260 participants) compared nitrous oxide (laughing gas) with carbon dioxide, five trials (177 participants) compared helium with carbon dioxide, and one trial (146 participants) compared room air with carbon dioxide. Studies were conducted in the USA, Australia, China, Finland, Iran, and the Netherlands. The mean age of the participants in the trials ranged from 19 to 62 years.

Study funding sources

Two of 10 included studies were sponsored by non-commercial grants. The other eight studies did not report funding sources.

Key results

We do not know whether nitrous oxide, helium, and room air are superior, equivalent, or inferior to carbon dioxide in the number of people with heart or lung complications, surgical complications, or serious unwanted events.

Because of the few participants included in the review, the safety of using nitrous oxide, helium, or room air is unknown.

Quality of the evidence

Overall, the quality of the evidence for the results is very low. Thus, future well-designed trials examining complications, harms, quality of life, and pain are urgently needed.

Post-Operative Instructions for Laparoscopic Gallbladder Removal

Foris Surgical Group, LLP

GENERAL CONSIDERATIONS:

You will find yourself feeling weak and tired for 1-2 weeks after going home (and maybe longer). This will eventually resolve.
Listen to your body and rest when you feel you need to.
You might experience soreness like a sprain in the right shoulder or back. This is due to the gas that is put into your abdomen during the surgery- it will go away in 2-3 days. Apply heat to shoulder and back and take your pain medication as prescribed.
Try not to lie flat. Elevate your head on several pillows and place a pillow under your knees to promote comfort and decrease risk of developing shoulder soreness.
Your belly will feel bloated for about one week; you may not be able to close your pants. This will pass as the gas in the abdomen is absorbed.
In the meantime, you might be more comfortable in loose fitting clothing.
The belly button incision site and upper midline incisions are usually the most sore.
You will probably develop mild bruising around one or more of your incisions.

DIET:

You may return to normal food after you get home from your surgery. You may wish to avoid heavy foods following your surgery and perhaps just take liquids that day.
The day after your surgery you may eat anything you wish. You should avoid fatty foods for two weeks following your surgery. You may want to avoid carbonated beverages for several days.

ACTIVITIES:

You will feel easily fatigued for at least one week after discharge; this is normal.
Rest as much as you need to.
You may take short trips in a car as desired.
You should not drive until you have stopped taking your pain medications.
You are encouraged to take short walks two to three times daily.
Do NOT lift anything over 20 lbs.
Refrain from sports and exercise during the first week home.
You may go up and down stairs as desired.
After one week, you may return to all normal activities, as you desire (avoid very heavy, sudden lifting that causes increased discomfort).
Depending on the physical activity requirements of your job you will probably be out of work a minimum of one week but this should be discussed with your surgeon.

INCISIONS:

Remove the band aids or gauze 2 days after you get home.
On the 2nd day after surgery, you may remove your dressings and shower. Please keep the dressings and incision sites dry until then. If you have small brown strips of tape across the incisions, you may gently wash over them and pat the strips of tape dry after the shower. Let these fall off by themselves.

MEDICATIONS:

Use your pain pills (narcotics) as prescribed.
You should switch to plain Tylenol (acetaminophen) or Advil (ibuprofen) as soon as possible to reduce complications or side effects from the narcotics.
The pain pills (especially Tylox, Percocet, Vicodin, Oxycodone, Oxy IR, etc.) are prone to cause constipation. Increase fluids, fruits, and fiber in your diet to help prevent constipation.
If you have not had a bowel movement by the 3rd day after surgery, you may take a gentle laxative such as Milk of Magnesia.

CALL YOUR DOCTOR IF:

You develop a fever above 101.5F. Having a slight temperature elevation for first couple days is normal.
You have a fever that persists greater than one week.
You develop enough drainage from any of the incisions to saturate a piece of gauze after the first dressing change.
You develop yellow or green drainage or rings/streaks of redness around the incision site(s).
Generally, you will feel stronger and less sore with each passing day. If, after a few days, you begin to feel worse rather than better, you should call the office.
If you notice very dark urine or the white part of your eyes (sclera) turns yellow.

FOLLOW UP:

Call the office after you get home to schedule a checkup in 10-14 days or as instructed by your surgeon.

Finally, if you have any questions or concerns regarding your surgery or recuperation please DO NOT HESITATE to call our office –we are here to help in any way we can.

Foris Surgical Group, LLP
45 Thomas Johnson Drive, Suite 211
Frederick, MD 21702
(301)-694-3200

Print Page – Laparoscopic Gallbladder Removal

Gallstones are small stones made from cholesterol, bile pigment and calcium salts, which form in a person’s gall bladder.
Medical treatment isn’t necessary unless the gallstones cause symptoms.
Treatment options include surgery and shattering the stones with soundwaves.

The gallbladder is a small sac that holds bile, a digestive juice produced by the liver that is used in the breakdown of dietary fats. The gallbladder extracts water from its store of bile until the liquid becomes highly concentrated. The presence of fatty foods triggers the gallbladder to squeeze its bile concentrate into the small intestine. Gallstones (biliary calculi) are small stones made from cholesterol, bile pigment and calcium salts, usually in a mixture that forms in the gallbladder. They are a common disorder of the digestive system, and affect around 15 per cent of people aged 50 years and over. Some things that may cause gallstones to form include the crystallisation of excess cholesterol in bile and the failure of the gallbladder to empty completely. In most cases, gallstones don’t cause any problems. However, you might need prompt treatment if stones block ducts and cause complications such as infections or inflammation of the pancreas (pancreatitis). Surgeons may remove your gallbladder (called a cholecystectomy) if gallstones (or other types of gallbladder disease) are causing problems. Techniques include laparoscopic (‘keyhole’) cholecystectomy or open surgery. The gallbladder is not a vital organ, so your body can cope quite well without it.

Symptoms of gallstones

In approximately 70 per cent of cases, gallstones cause no symptoms. The symptoms of gallstones may include:

pain in the abdomen and back. Pain is generally infrequent, but severe
increase in abdominal pain after eating a fatty meal
jaundice
fever and pain, if the gallbladder or bile duct becomes infected.

Types of gallstones

There are three main types of gallstones being:

mixed stones – the most common type. They are made up of cholesterol and salts. Mixed stones tend to develop in batches
cholesterol stones – made up mainly of cholesterol, a fat-like substance that is crucial to many metabolic processes. Cholesterol stones can grow large enough to block bile ducts
pigment stones – bile is greenish-brown in colour, due to particular pigments. Gallstones made from bile pigment are usually small, but numerous.

Causes and risk factors for gallstones

Gallstones are more common in women than in men. They are also more common in overweight people and people with a family history of gallstones.

There is no single cause of gallstones. In some people, the liver produces too much cholesterol. This can result in the formation of cholesterol crystals in bile that grow into stones. In other people, gallstones form because of changes in other components of bile or because the gallbladder does not empty normally.

Diagnosis of gallstones

Doctors diagnose gallstones by using a number of tests, including:

general tests – such as physical examination and x-rays
ultrasound – soundwaves form a picture that shows the presence of gallstones
endoscope test – endoscopic retrograde cholangiopancreatography (ERCP). A thin tube is passed through the oesophagus and injects dye into the bowel to improve the quality of x-ray pictures
hepatobiliary iminodiacetic acid (HIDA) scan – a special type of nuclear scan that assesses how well the gallbladder functions
magnetic resonance cholangiopancreatography (MRCP) – a form of the body-imaging technique magnetic resonance imaging (MRI). The person’s liver, biliary and pancreatic system is imaged using an MRI unit. The image is similar to an ERCP test.

Complications of gallstones

If gallstones cause no symptoms, you rarely need any treatment.

Complications that may require prompt medical treatment include:

biliary colic – a gallstone can move from the body of the gallbladder into its neck (cystic duct), leading to obstruction. Symptoms include severe pain and fever
inflammation of the gallbladder (cholecystitis) – a gallstone blocks the gallbladder duct, leading to infection and inflammation of the gallbladder. Symptoms include severe abdominal pain, nausea and vomiting
jaundice – if a gallstone blocks a bile duct leading to the bowel, trapped bile enters the person’s bloodstream instead of the digestive system. The bile pigments cause a yellowing of the person’s skin and eyes. Their urine may also turn orange or brown
pancreatitis – inflammation of the pancreas, caused by a blocked bile duct low down near the pancreas. Pancreatic enzymes irritate and burn the pancreas and leak out into the abdominal cavity
cholangitis – inflammation of the bile ducts, which occurs when a bile duct becomes blocked by a gallstone and the bile becomes infected. This causes pain, fever, jaundice and rigors (shaking)
infection of the liver
cancer of the gallbladder (occurs rarely).

Treatment for gallstones

Gallstones that cause no symptoms, generally don’t need any medical treatment. In certain cases (such as abdominal surgery for other conditions), doctors may remove your gallbladder if you are at high risk of complications of gallstones.

Treatment depends on the size and location of the gallstones, but may include:

dietary modifications – such as limiting or eliminating fatty foods and dairy products
lithotripsy – a special machine generates soundwaves to shatter the gallstones. This treatment is used in certain centres only, for the minority of people with small and soft stones
medications – some medications can dissolve gallstones, but this treatment is only rarely given, due to side effects and a variable success rate
surgery.

Surgical removal of the gallbladder or gallstones

Around 80 per cent of people with gallstone symptoms will need surgery. Surgeons may remove your entire gallbladder (cholecystectomy), or just the stones from bile ducts.

Techniques to remove the gallbladder include:

laparoscopic cholecystectomy – ‘keyhole’ surgery. The surgeon makes a number of small incisions (cuts) through the skin, allowing access for a range of instruments. The surgeon removes the gallbladder through one of the incisions
open surgery (laparotomy) – the surgeon reaches the gallbladder through a wider abdominal incision. You might need open surgery if you have scarring from prior operations or a bleeding disorder.

Before the operation, you need to discuss some things with your doctor or surgeon, including:

your medical history, since some pre-existing conditions may influence decisions on surgery and anaesthetic
any medications you take on a regular basis, including over-the-counter preparations
any bad reactions or side effects from any medications.

Laparoscopic cholecystectomy

The general procedure includes:

The surgeon makes a number of small incisions into your abdomen, so that slender instruments can reach into the abdominal cavity.
A tube blowing a gentle stream of carbon dioxide gas is inserted. This separates the abdominal wall from the underlying organs.
The surgeon views the gallbladder on a TV monitor by using a tiny camera attached to the laparoscope.
Special x-rays (cholangiograms) during the operation can check for gallstones wedged in the bile ducts.
The ducts and artery that service the gallbladder are clipped shut. These clips are permanent.
The gallbladder is cut free using either laser or electrocautery
The gallbladder, along with its load of gallstones, is pulled out of the body through one of the abdominal incisions.
The instruments and the carbon dioxide gas are removed from the abdominal cavity. The incisions are sutured (closed up) and covered with dressings.

Open gallbladder surgery

The general procedure is the same as for laparoscopic surgery, except that the surgeon reaches the gallbladder through a large, single incision in the abdominal wall. Sometimes, an operation that starts out as a laparoscopic cholecystectomy turns into open surgery if the surgeon encounters unexpected difficulties, such as not being able to see the gallbladder properly.

After a gallbladder operation, you can expect to:

feel mild pain in your shoulder from the carbon dioxide gas
receive pain-relieving medications
be encouraged to cough regularly to clear your lungs from the general anaesthetic
be encouraged to walk around as soon as you feel able
stay overnight in hospital, if you had a laparoscopic cholecystectomy
stay up to eight days in hospital, if you had open surgery.

Complications after gallbladder surgery

All surgery carries some degree of risk. Possible complications of cholecystectomy include:

internal bleeding
infection
injury to nearby digestive organs
injury to the bile duct
leakage of bile into the abdominal cavity
injury to blood vessels.

Self-care after gallbladder surgery

Be guided by your doctor, but general self-care suggestions include:

Rest as much as you can for around three to five days.
Avoid heavy lifting and physical exertion.
Expect your digestive system to take a few days to settle down. Common short-term problems include bloating, abdominal pains and changes to toilet habits.

Most people recover within one week of laparoscopic surgery.

Long-term outlook after gall bladder surgery

You will need to see your doctor between seven and 10 days after surgery to make sure all is well. Some rare complications may have to be followed up with another operation.

Where to get help

Things to remember

Gallstones are small stones made from cholesterol, bile pigment and calcium salts, which form in a person’s gall bladder.
Medical treatment isn’t necessary unless the gallstones cause symptoms.
Treatment options include surgery and shattering the stones with soundwaves.

Gallstones, Gastroenterological Society of Australia (GESA), NSW, Australia. More information here .
'Cholelithiasis', The Merck Manual of Diagnosis and Therapy, eds R. Berkow, M. Beers, A. Fletcher & R. Bogin. Merck & Co, Whitehouse Station, NJ, USA. More information here .
Zakko, SF, 2010, Patient information: Gallstones, UpToDate Inc, More information here .
Afdhal, NH, 2008, Natural history of asymptomatic gallstones, UpToDate Inc, More information here .

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