Cholecystotomy or cholecystostomy, open, with exploration, drainage, or removal of calculus (separate procedure)
CPT4 code
Name of the Procedure:
Cholecystotomy or Cholecystostomy, open, with exploration, drainage, or removal of calculus. Commonly referred to as an "open cholecystostomy."
Summary
An open cholecystostomy is a surgical procedure where an incision is made to access the gallbladder, allowing for exploration, drainage, or removal of gallstones (calculi). This procedure is often performed when other less invasive methods are not suitable.
Purpose
This procedure addresses conditions of the gallbladder such as severe gallstone disease, cholecystitis (inflammation of the gallbladder), or biliary obstruction. The goal is to relieve symptoms, prevent complications, and restore normal gallbladder function.
Indications
- Severe or complicated gallstone disease
- Acute or chronic cholecystitis
- Biliary obstruction
- Inability to perform laparoscopic cholecystectomy due to patient factors
Preparation
- Fasting for at least 8 hours prior to surgery.
- Adjustment or temporary discontinuation of certain medications.
- Preoperative imaging studies such as an ultrasound or CT scan.
- Blood tests to evaluate overall health and readiness for surgery.
Procedure Description
- The patient is given general anesthesia.
- A surgical incision is made in the upper right part of the abdomen to access the gallbladder.
- The surgeon explores the gallbladder and surrounding tissues.
- If present, gallstones are carefully removed.
- The gallbladder may be drained of bile and other fluids.
- The incision is closed with sutures or staples. Tools used include scalpels, retractors, and possibly laparoscopic instruments.
Duration
The procedure typically takes between 1 to 2 hours, depending on complexity.
Setting
Performed in a hospital operating room.
Personnel
- General surgeon
- Anesthesiologist
- Surgical nurses
- Surgical technologist
Risks and Complications
- Infection
- Bleeding
- Injury to nearby organs (e.g., liver, intestines)
- Bile leakage
- Blood clots
- Adverse reactions to anesthesia
Benefits
- Relief from pain and other symptoms caused by gallstones or cholecystitis.
- Prevention of further complications such as biliary sepsis.
- Improved overall quality of life.
Recovery
- Hospital stay for a few days post-surgery.
- Pain management with medication.
- Restricted activity for several weeks.
- Follow-up appointments to monitor healing.
- Instructions on wound care, diet, and activity.
Alternatives
- Laparoscopic cholecystectomy: Less invasive but may not be suitable for all patients.
- Percutaneous cholecystostomy: A needle or catheter-based drainage technique, typically for high-risk patients.
- Endoscopic retrograde cholangiopancreatography (ERCP) with stone removal.
Patient Experience
- Expect to feel soreness and some pain at the incision site post-surgery.
- Pain management will be provided through medications.
- May experience bloating or discomfort as the digestive system adjusts.
- Gradual return to normal activities as per medical advice.