Click here [3] to view an animated version of this procedure.


Definition

Cholecystectomy is the surgical removal of the gallbladder, a muscular, pear-shaped organ that lies underneath the liver.


Parts of the Body Involved

  • Abdomen
  • Gallbladder
  • Bile ducts
  • Liver
  • Intestines

The purpose of the gallbladder is to store bile that is produced by the liver. Bile helps in the digestion [4] of fatty foods. When fatty foods are eaten, the gallbladder releases bile into a system of ducts that lead to the small intestine. Bile ducts (tubes) from the gallbladder and the liver join to allow bile to flow into the small intestine.


Reasons for Procedure

A cholecystectomy is done to remove a diseased or damaged gallbladder typically caused by infection or inflammation.

Various medical [5] conditions can cause infection or inflammation of the gallbladder. Sometimes, for example, hard gallstones form in the gallbladder. These stones can slip into the narrow bile ducts, obstructing them. Gallstones [6] (cholelithiasis) can cause inflammation and infection of the gallbladder (cholecystitis), pain [7], fever, nausea, jaundice [8] , and difficulty digesting fatty foods.


Risk Factors for Complications During the Procedure

  • Age: 60 or older
  • Pregnancy
  • Obesity [9]
  • Smoking
  • Excess stress [10]
  • Malnutrition
  • Recent or chronic illness
  • Diabetes [11]
  • Heart or lung problems
  • Bleeding disorders
  • Alcoholism [12]
  • Use of certain medications, including blood pressure pills, muscle [13] relaxants, tranquilizers, sleeping pills, insulin, steroids, sedatives, and hypnotic agents
  • Use of street drugs, including LSD, hallucinogens, marijuana, and cocaine

What to Expect

Prior to Procedure

Your doctor will probably do some or all of the following:

  • Blood tests to evaluate liver function
  • Ultrasound [14] to visualize the gallstones
  • HIDA or other radiological scans to better view the gallbladder
  • EKG [15] and chest x-ray [16] to make sure that your heart [17] and lungs are healthy enough to withstand the stresses of surgery

You may wish to ask your doctor:

  • Whether there are any alternatives to surgery, such as medication to dissolve gallstones
  • Whether you need to have traditional, open gallbladder surgery, or whether you are a candidate for laparoscopic (“keyhole”) surgery
  • Whether you should discontinue any medications prior to surgery, change your diet, self-administer an enema, takes antibiotics, or change any of your usual activities prior to surgery
  • How many laparoscopic procedures [18] he or she has performed

In the days leading up to your procedure:

  • Arrange for a ride to and from the procedure.
  • Arrange for help at home after returning from the hospital.
  • The night before, eat a light meal and do not eat or drink anything after midnight.
  • You may be given laxatives and/or an enema to clean out your intestines.
  • You may be given antibiotics to take.
  • You may be asked to shower the morning before surgery, using a special anti-bacterial soap.

During the Procedure

  • You will receive IV fluids throughout.
  • You will receive anesthesia, sedation medication, and antibiotics.
  • A breathing tube will be inserted.
  • You may require a tube through your nose and into your stomach to remove accumulated stomach acid and fluids.
  • You may require a catheter in your bladder until a few hours after the operation is completed.

Anesthesia

General-Sedative and anesthetic medications are usually given through an intravenous line; anesthetic gases may be given through an inhalation mask.

Description of the Procedure

There are two types of procedures used for gallbladder removal: classic, open surgery and laparoscopic or “keyhole” surgery.

Laparoscopic Cholecystectomy vs. Open Cholecystectomy


© 2008 Nucleus Medical Art, Inc.

Classic, open abdominal gallbladder surgery:

The surgeon will make a four to six inch incision in the upper right area of your abdomen. The incision may be oriented up-and-down or slanted diagonally beneath your ribs. The gallbladder is located beneath the liver and must be dissected away from the liver and the surrounding structures, including the bile ducts and arteries.

If your surgeon suspects that you may have a gallstone in one of your bile ducts, a procedure may be performed in which dye is squirted into the ducts to disclose the presence of a stone. If a stone is identified in the bile ducts, then the duct may be opened in order to remove the stone. While your abdomen is open, your surgeon will carefully examine the other organs and structures in the area to make sure that you do not have any other problems, complications, or bleeding. The incision is closed with either sutures or staples and then covered with a bandage.

Laparoscopic or “keyhole” gallbladder surgery:

Your surgeon will use sharp instruments called trocars to make four small 1/2-inch openings or ports in your abdomen. One port is near your navel, and the others are in your upper abdomen. A special needle is inserted into the umbilical port, and carbon dioxide is pumped in, puffing up your abdomen to allow the abdominal contents to be viewed more easily.

The laparoscope is inserted through the umbilical port. Images from its camera are magnified and projected onto a video monitor in the operating room. The surgeon will carefully examine the inside of your abdomen, locating your gallbladder and confirming that it needs to be removed. Surgical instruments will be inserted through the other three ports and used to move the abdominal organs out of the way, grasp the gallbladder, and clip off the gallbladder’s main artery and its duct.

The gallbladder is then dissected from its position near the liver and removed through one of the ports. The video images are watched carefully to identify any areas of bleeding. As in open cholecystectomy, if your surgeon suspects you may have a stone blocking the main bile duct, dye may be injected into the duct system, and the duct may be opened to remove any stones located. Before removing the laparoscope, the entire abdomen is again carefully examined for any areas of bleeding or other damage. When the laparoscope is removed, a special gas valve is left in place briefly to allow all the carbon dioxide to escape from the abdomen. The keyhole incisions are closed with just a few sutures or staples each and then covered with bandages.

During either open or laparoscopic gallbladder surgery, your surgeon may choose to place a tiny, flexible tube into the area where the gallbladder was removed. This tube will exit from your abdomen into a little bulb; this is to drain any fluids that may accumulate during the first few days after surgery. The tube is usually removed within one week after your operation.

After Procedure

The gallbladder will be examined by a pathologist.

How Long Will It Take?

Uncomplicated cholecystectomy usually takes about 30 to 60 minutes; the open procedure is often a bit shorter than the laparoscopic procedure.

Will It Hurt?

You will most likely feel some pain [7] after cholecystectomy, although most patients report less pain [7] with the smaller keyhole incisions of laparoscopic surgery. Your surgeon will arrange for you to have access to effective pain [7] medications, initially through your intravenous line and then by mouth. You will probably also need medications for nausea.

Possible Complications

During laparoscopic surgery, the surgeon may need to switch to a classic open abdominal adrenalectomy [19] . This may occur if the surgeon:

  • Encounters excess scarring from previous surgeries
  • Encounters a very severely diseased or inflamed gallbladder
  • Is unable to remove stones blocking the bile duct
  • Is unable to appropriately visualize the structures in the abdomen

Other possible surgical complications include:

  • Missed gallstones in the bile ducts
  • Gallstones that are accidentally spilled into the abdominal cavity, potentially causing future problems
  • Bleeding
  • Wound infection
  • Injury to the bile duct or other nearby structures or organs
  • Adverse reactions to general anesthesia
  • Urinary tract infection [20]
  • Respiratory tract infection
  • Deep venous thrombosis [21] and/or pulmonary embolism [22]

Average Hospital Stay

Open cholecystectomy: Hospital discharge within 2 to 6 days.

Laparoscopic cholecystectomy: Hospital discharge within 1 to 2 days of surgery.

Postoperative Care

At the Hospital

While you are recovering in the hospital, you will receive the following care:

  • You may be nauseated after surgery. Depending on various factors, your surgeon may have placed a nasogastric tube through your nose and into your stomach to drain fluids and stomach acid. You won't be able to eat or drink until this is removed and you're no longer nauseated, so you'll continue to receive fluids and sugar through an IV.
  • Once you are able to take things by mouth, you will be started on a liquid diet, progressing through soft, bland foods, to a regular diet.
  • You will probably require anti-nausea and pain [7] medications first through your IV and then by mouth. Patients who have had a classic open abdominal cholecystectomy require stronger pain [7] medications for a longer period of time than those who undergo the laparoscopic procedure.
  • You may be given special compression stockings to wear after surgery to decrease the possibility of blood clots forming in your legs.
  • In order to improve lung function after general anesthesia, you may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently.

At Home

When you return home after the procedure, do the following to ensure a smooth recovery:

  • You need to keep the bandages covering your incision clean and dry. Change your bandages according to the schedule provided by your healthcare team, replacing them with sterile bandages provided by the hospital.
  • Ask your healthcare team about how to gradually and appropriately increase your exercise [23] so that you can increase your stamina without stressing yourself.
  • Follow your healthcare team’s recommendations about a healthy diet when you leave the hospital.
  • Be sure to get plenty of rest and sleep [24] to help your body heal faster.

Outcome

  • Recovery after open cholecystectomy takes about 4 to 6 weeks; depending on your occupation, you may be able to return to work [25] after about a month.
  • Recovery after laparoscopic cholecystectomy takes about 3 weeks; depending on your occupation, you may be able to return to work [25] after about 2 weeks.
  • Although you will have incisional pain [7] after your surgery, you should no longer be experiencing pain [7] from your gallstones or gallbladder disease.
  • Your liver will take over the functions of the gallbladder, although some people notice that they have a little more trouble digesting fatty foods, particularly for the first month after surgery.
  • You may notice increased gas or changes in your bowel habits during the first month after surgery. If these persist, inform your healthcare provider.

Call Your Doctor If Any of the Following Occurs

It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. If any of the following occur, call your doctor:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain [7], excessive bleeding, or discharge at the incision site
  • Cough, shortness of breath, chest pain [7]
  • Increased abdominal pain [7]
  • Blood in the stool
  • Nausea and/or vomiting that you can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Pain, burning, urgency or frequency of urination, or blood in the urine
  • Pain and/or swelling in your feet, calves, or legs