Panel Endorses New Gallbladder Removal Technique : Medicine: Federal experts call surgery using a laparoscope ‘safe and effective.’ The procedure lets patients recover more quickly and with less pain.

A federal advisory panel on Wednesday endorsed a relatively new and extremely popular technique involving use of a laparoscope for removing the gallbladder, saying it is “safe and effective” and offers “substantial advantages” over conventional, more invasive surgery.

But the committee of gastroenterology experts warned that only patients suffering symptoms from gallstones should undergo the procedure--technically known as a laparoscopic cholecystectomy--and that it should not be used to prevent future gallstone attacks.

The 14-member panel, convened by the National Institutes of Health, is believed to be the first such group to evaluate the procedure, which was first performed in France in 1987 and introduced into this country a year later.

“Shortly thereafter, it started to take off in a very exponential fashion, and rapidly became the most commonly performed operation for the removal of the gallbladder,” said Dr. John L. Gollan, director of the gastroenterology division at Brigham and Women’s Hospital in Boston, who served as chairman of the panel.

“Indeed, it appears to have become the treatment of choice for most patients with symptomatic gallstones,” he said, adding that an estimated 80% of all gallbladder removals are now performed using this technique.

The gallbladder is a small pear-shaped organ located beneath the liver on the right side of the abdomen. Its primary functions are to store, concentrate and secrete bile into the small intestine to help digest food.

But individuals can live without a gallbladder, and removing it has no effect on digestion.

Removal of the gallbladder is one of the most common surgical procedures performed in this country. An estimated 500,000 Americans undergo the operation annually.

Gallstones, which are pieces of solid material that form in the gallbladder, will be diagnosed in about 1 million Americans this year. An estimated 20 million people already have them. Gallstones are the most costly digestive disease, with an annual price tag for treatment of more than $5 billion.

Not everyone suffers symptoms, however, and many people can live with gallstones for years without experiencing discomfort. But the onset of gallstone attacks usually means subsequent attacks are much more likely.

A typical attack is marked by severe abdominal pain, and can include nausea and vomiting. Gallstones sometimes lead to more serious complications.

In the laparoscopic procedure, a surgeon inserts a fiber optic instrument attached to a miniature video camera and several specialized instruments through tiny incisions in the patient’s abdomen and, viewing the gallbladder on an external television monitor, uses the instruments to remove the organ. Like traditional surgery, it is conducted under general anesthesia.

Up until four years ago, most gallbladders were removed only through major surgery that involved opening up the abdomen.

The new procedure enables patients to recover much more quickly with less pain and disability. Most patients require a maximum of only two days in the hospital, followed by a one- to two-week recovery period, compared to a five-day hospital stay and three weeks to six weeks of convalescence.

The procedure also “can be performed at a cost equal to or slightly less than (conventional) open cholecystectomy, and with substantial cost savings to the patient and society due to reduced loss of time from work,” the panel said. The cost of both operations ranges roughly between $4,000 and $6,000.

While most patients with symptomatic gallstones are candidates for the procedure, some with certain medical conditions should not undergo it, the panel said. These include people with abdominal inflammation, acute pancreatitis, end-stage cirrhosis of the liver and gallbladder cancer. Women in the third trimester of pregnancy also should avoid the procedure because of the risk of damage to the fetus.

The committee also recommended that strict guidelines be developed for training and monitoring the competence of those who perform the procedure.

At least 15,000 surgeons in the United States have been instructed in the technique, the panel said.

A Less Painful Path

The laparascope allows surgeons to examine the gallbladder using only a tiny incision. The instrument itself is a rigid tube hooked to a video monitor:

1. Using a hollow needle, the doctor pumps carbon dioxide gas into the abdominal cavity to expand it.

2. With a second incision, just below the navel, the laparoscope is then inserted to reach the organ.

3. Instruments are inserted through other very small incisions to remove the gallbladder. The advantages are that it avoids more complicated surgery that involves cutting through stomach muscles, shortening recovery times.

Source: AMA Encyclopedia of Medicine