Understanding Gallbladder Removal Scars
Gallbladder removal surgery, also known as cholecystectomy, is one of the most common operations performed today. Over half a million gallbladders are removed annually in the United States. While the surgery is generally considered low risk, complications can happen and patients are often left with visible scarring.
What Causes Gallbladder Removal Scars
There are two main techniques for removing the gallbladder - the open procedure and laparoscopic method:
- Open Cholecystectomy - This technique requires a 5 to 7 inch incision under the right rib cage to access and remove the gallbladder. It leaves significant noticeable scarring where the larger abdominal incision was made.
- Laparoscopic Cholecystectomy - Currently the most common technique, it only requires several small incisions to insert cameras and instruments to view the gallbladder internally and remove it. There are typically 3 to 4 smaller 1/4 to 1 inch incisions that minimizes scars.
For laparoscopic surgery, despite the small camera entry points, the abdominal distention and manipulation still causes tissue inflammation and healing that contributes to scar formation.
Where Gallbladder Removal Scars Occur
The location of gallbladder removal scars depends which surgical technique is utilized:
- Open Method - A 5-7 inch long curved scar is located under the right lower ribs. The curved incision wraps around the tip of the rib cage.
- Laparoscopic Approach:
- Umbilical Scar - Umbilicus/belly button where initial abdominal entry port is placed.
- Right Upper Quadrant Scars - Two 0.5 inch scars in the right upper abdomen, usually below edge of ribs.
- Right Mid Abdominal Scar - A 0.5 inch scar midway down from ribs to hip bone on right side of abdomen.
Healing Stages of Gallbladder Removal Scars
Incisions from gallbladder surgery will form scars via normal wound healing in various progressive phases:
- Inflammatory Phase - Starts immediately after surgery. The area is swollen and tender while the immune system begins repairing damage.
- Proliferative Phase - Body produces collagen fibers and new blood vessels are formed for structure and nourishment.
- Maturation Phase - Collagen continues strengthening while surrounding tissues contract. Fades from dark pink to a lighter, flatter scar over 1+ years.
Factors Affecting Appearance of Scars
Several factors impact the final appearance of gallbladder removal scarring such as:
- African, Asian, and Hispanic ethnicities prone to more obvious, raised scarring called hypertrophic or keloid scars.
- Elderly patients have thinner skin that scars worse than younger patients.
- Diabetics often experience delayed wound healing.
- Obesity related health issues lead to poor incision healing.
- Genetics can determine one's natural collagen production and scarring tendencies.
- Proper aftercare reduces scarring by minimizing wound site infections.
Gallbladder Removal Scar Treatment Options
If problematic raised, colored, painful or itchy scars develop after gallbladder removal surgery, several options exist to improve their appearance and feel:
Steroid Injections
Injection of corticosteroid medications like triamcinolone or Kenalog flatten and soften thickened scars. The injections can be effective but may require repeat treatments.
5-Fluorouracil
5-FU solution used in problems scars reduces excessive fibroblast activity and collagen production. Multiple treatments are typically given.
Cryotherapy
Applying liquid nitrogen by cotton swab or spray probe freezes and destroys scar tissue, allowing new, flatter tissue regrowth.
Laser Skin Resurfacing
Ablative and non-ablative lasers remove scarred epidermal tissue layers so normalized skin cells can replace it.
Silicone Gel Sheeting
Silicone sheets worn over scars flatten and fade raised scars through hydration and compression methods.
Surgical Scar Revision
Severely problematic, painful or restricting scars may necessitate formal surgical excision and resuturing techniques for improved cosmetic outcomes.
Preventing Gallbladder Scar Formation
While some scarring is inevitable after any gallbladder removal surgery, proper preparation and aftercare can help minimize long term scarring:
- Quit smoking prior to surgery which impairs wound healing.
- Control blood glucose levels in diabetics to avoid poor incision healing.
- Follow surgeon's directions on suture care and activity restrictions.
- Clean incisions daily and watch for signs of infection like pus or redness.
- Use topical silicone gel on closed incisions to hydrate and flatten scars.
Even following optimal healing protocols, some degree of permanent scar tissue will occur after gallbladder removal surgery. But understanding the causes, timeline, risk factors and latest scar treatment options helps patients understand what to expect and address significant scarring issues if they arise during recovery.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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