Che Miller, M.D.

Patient Education Literature
We recommend that you read this handout carefully in order to prepare yourself or family members for the proposed procedure.  In doing so, you will benefit both the outcome and safety of the procedure.  If you still have any questions or concerns, we strongly encourage you to contact our office prior to your procedure so that we may clarify any pertinent issues.

Laparoscopic Cholecystectomy
This procedure involves removal of the gallbladder from the liver bed using long instruments and cameras.  

Purpose of the procedure:
There are several reasons this procedure is performed.  Most commonly the gallbladder is removed when there are gallstones and symptoms of pain, nausea, or vomiting.  Occasionally, a gallbladder without stones needs to be removed if it is not functioning properly.  As with all organs, suspicion of cancer could be a reason for surgery.

As with any procedure in which anesthesia is administered, you will be asked not to eat or drink anything after midnight on the evening prior to your surgery.  You may brush your teeth in the morning, but do not swallow the water.  If you are on medications that must be taken you need to discuss these with the surgeon prior and/or anesthesiologist.  Certain medications can make this surgery more risky.  Blood thinners (i.e. Aspirin, Coumadin, Plavix, etc.), arthritis medications, and insulin are examples and should be discussed with your surgeon and anesthesiologist.

Description of Procedure:
After the anesthesiologist has you go to sleep, a tube will be placed in your trachea to help you breath.  Then four or five incisions will be made on your abdomen where ports will be placed to assist surgery.  A camera and several instruments will be used to remove the gallbladder.  Occasionally (<10% of the time) the gallbladder cannot be removed laparoscopically and the procedure must be done through a larger incision in an "open" technique.  If there are questions, an x-ray (cholangiogram) may be taken to help define your anatomy.

After the procedure:
Following the procedure, you will awaken in the OR and be taken to the recovery room.  Nurses and staff will help you wake further and control your pain.  It is not unusual to feel confused or out of place.  Fluid intake is important.  Most patients will go home the same day of surgery, but some need to be watched closely in the hospital.  You will be sent home with a prescription for pain medicine.  This is a narcotic and will effect your ability to drive or operate machinery.  It is ILLEGAL to drive while taking this medication.  Most of the pain resolves after the first 24-36 hours but may persist for 4 to 5 days.  Continue to drink plenty of fluids. A stool softener is usually given with narcotics to prevent constipation and should be taken as long as you are taking narcotic pain medications.  Early after surgery, a bland diet is best tolerated.  Over a couple of days, you may return to your regular diet.  There should be no restrictions to your activity. You may lift anything, exercise as you desire and have intercourse. You may drive if you have stopped the narcotic pain medications.  You may have a certain amount of diarrhea for the first 3 or 4 weeks after surgery and should not be alarmed.  After surgery, your incisions will be covered by dressings or band-aids.  Leave these in place for 24 hours, then you may remove them.  Underneath are striped pieces of tape.  Leave these until either they fall off or their edges curl.  Your sutures are on the inside and will dissolve after 4 wks.  You may shower after 24 hours but you should avoid bathing in a tub for 48 hours.  Do not swim for one week.
Conditions to Look For: 
Although cholecystectomy is a remarkably safe procedure, problems can arise. Should any of the following occur, please contact your physician as soon as possible:
1. Fever greater than 101 degrees.
2. Persistent vomiting after the third postoperative day.
3. Failure to have a bowel movement after four days.
4. Persistent abdominal distention and tenderness.
5. Increasing tenderness at the site of the skin incisions. Please note that the incisions will be red and uncomfortable for approximately 10 days. If pus develops or if areas of enlarging redness occur, please call your physician

The following is a list of emergencies.  Should any of these develop, proceed to your emergency department.  If you feel that you cannot make it to your emergency department or do not have someone to take you, call 911 immediately.

1)	Weakness or lightheadedness that prevent you from being able to walk.
2)	Chest pain or shortness of breath.
3)	Uncontrollable vomiting.
4)	Blood in your vomit or stool.
5)	Abdominal pain that cannot be controlled with your pain medications
6)	Swelling or rash after you take any medication for the first time.
Final Visit 
You should see your surgeon for a final office visit approximately one to three weeks after the surgery. Please do not hesitate to contact your doctor at anytime if things do not appear to be going smoothly.
Consent for Procedure:
I _______________________ have read the above description of my procedure.  I understand the indications, risks and benefits of surgery listed on this form and explained by my surgeon.  I agree to undergo a laparoscopic cholecystectomy and any other indicated procedures including a cholangiogram.  I agree to an open operation if necessary.  I have had an opportunity to ask questions and have received all the information I need to make this decision.
Surgical Risks
Minor risks of surgery include but are not limited to:  Bleeding, infection, diarrhea, constipation, abscess, pneumonia, and deep venous thrombosis.  These can occur in as many as 10 percent of patients.
Severe risks of surgery include but are not limited to: Anesthetic complications, drug reactions, injury to the ducts and arteries that supply the gallbladder and liver, injury to the bowel, wound dehiscence, pulmonary embolism, respiratory failure, cardiac failure, heart attack, kidney failure, and even death.  These can occur in less than 1 percent of patients.

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Patient Signature:				Surgeon Signature				Date