September 2020 – It’s one of the most common surgeries today.

Reminder: Afterhour Webinars

This month we continue our new interactive program: NIFA Afterhour Webinars, scheduled during evening and weekend daytime hours. Designed for current students, but open to all who would like to participate, ask questions and learn! Call 800-922-7747 to register.

• Thurs, Oct 1, 7:30pm EST – GARY HARGREAVES, President, NIFA Medical Billing, on what procedures RNFAs get reimbursed for, “Can I bill in my state?” “Is it worth becoming an APRN/RNFA versus an RNFA?” and other billing questions. 
• Sat, Oct 10, 11am EST – KIMBERLY JONES, MSN-Ed., RN, CNOR, RNFA, on navigating an online RNFA course, testing/remediation, case logs and documentation, and reviewing the grade report. 
• Sat, Oct 22, 11am EST – KIMBERLY JONES, MSN-Ed., RN, CNOR, RNFA, same topics as above.
• Tues, Oct 27, 7:30pm EST – DR. JOHN RUSSELL, DNP, APRN, FNP-BC, RN CCRN, RNFA – Introduction to the OR as an APRN, how your skill levels affect your employment, negotiating your RNFA training based on billing plans, and more.

Cholecystectomy Basics

The gallbladder is small, hollow, pear-shaped organ located under the liver. It receives and stores bile, then releases bile into the duodenum to help the body digest fat. Gallstones can develop when the bile becomes saturated with cholesterol, bile salts or bilirubin (bile pigment). Although some gallstones have no noticeable effects, some get larger and/or begin to obstruct bile ducts, causing significant pain.

Until the late 1800s, doctors worked to open the gallbladder and remove gallstones, but didn’t believe humans could survive without the organ. Then, in 1882, a 27-year-old German physician, after practicing on a cadaver, surgically removed the gallbladder of a man who had suffered from gallstones for 16 years, and cured his condition overnight.

These days, cholecystectomy, surgical removal of the gallbladder, is often performed on patients who experience recurring incidence of painful gallstones. It is also a treatment for acute inflammation of the gallbladder caused by an interruption in the bile flow; various complications from gallstone disease; and gallbladder cancer. It was formerly believed that porcelain gallbladder, a condition in which the gallbladder’s inner wall is encrusted with calcium, was associated with malignancy and that the gallbladder should be removed, but the current opinion is that the risk of malignancy is very small.

More than 1.2 million cholecystectomies are performed annually in the U.S., and 92% of them are done laparoscopically, according to a paper by Mark W. Jones and Jeffrey G. Deppen that was updated just last month in the National Center for Biotechnology Information.

“The anatomy of the biliary tree remains one of the most variant areas of the body,” Jones and Deppen write. “There are many anatomical variances such as choledulco cysts, fusiform gallbladders, accessory ducts, intrahepatic gallbladders, and duplications.”

Because of this variability, some cholecystectomies that begin laparoscopically are converted midway through to open procedures due to visibility problems and other challenges presented by the patient’s biliary anatomy, or excessive inflammation, uncontrolled bleeding or other factors.  “Conversion to open cholecystectomy should not be viewed as a complication or a failure but just the opposite,” Jones and Deppen say. “It is showing good judgment to complete the operation in the safest manner possible.”

Some cholecystectomies are planned in advance as open procedures, particularly when there are other comorbid conditions present.

Here’s a useful summary chart about Cholecystectomy from the American College of Surgeons, Education Division.