Cholecystectomy
all information

Cholecystectomy

(Gallbladder Removal)

En Español (Spanish Version)

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Definition

Cholecystectomy is the surgical removal of the gallbladder organ. This organ lies underneath the liver. It stores bile that is produced by the liver. Bile helps in the digestion of fatty foods. The gallbladder releases bile into a system of ducts that lead to the small intestine.

Parts of the Body Involved

  • Abdomen
  • Gallbladder
  • Bile ducts
  • Liver
  • Intestines

Reasons for Procedure

This surgery is done to remove a diseased or damaged gallbladder. The damage is typically caused by infection or inflammation.

Various medical conditions can cause the damage, including gallstones.

Risk Factors for Complications During the Procedure

  • Age: 60 or older
  • Pregnancy
  • Obesity
  • Smoking
  • Excess stress
  • Malnutrition
  • Recent or chronic illness
  • Diabetes
  • Heart or lung problems
  • Bleeding disorders
  • Alcoholism
  • Use of certain medications, including blood pressure pills, muscle 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 to visualize the gallstones
  • HIDA or other radiological scans to better view the gallbladder
  • EKG and chest x-ray to make sure that your heart and lungs are healthy enough to withstand the stresses of surgery

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

Anesthesia

General-sedative and anesthetic medications are usually given through an intravenous line. 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
  • Laparoscopic or “keyhole” surgery

Laparoscopic Cholecystectomy vs. Open Cholecystectomy

© 2008 Nucleus Medical Art, Inc.

Classic, Open Surgery

The surgeon will make an incision in the upper right area of your abdomen. It will be separated from the surrounding structures, including the liver, bile ducts, and arteries.

Your surgeon may squirt dye into the ducts to disclose the presence of a stone. The duct may then be opened in order to remove any stones. 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. The incision is closed with either sutures or staples and then covered with a bandage.

Laparoscopic or “Keyhole” Surgery

Your surgeon will use sharp instruments called trocars to make four small openings or ports in your abdomen. A special needle is inserted into the umbilical port, and carbon dioxide is pumped in. This will puff up your abdomen to allow the contents to be viewed more easily.

The laparoscope is inserted through a port. Images from its camera are magnified and projected onto a video monitor in the operating room. Surgical instruments will be inserted through the other three ports. They will be used to grasp the gallbladder and clip off the main artery and duct.

The gallbladder is then removed through one of the ports. The video images are watched carefully to identify any areas of bleeding. Dye may be injected into the duct to look for stones. Before removing the laparoscope, the entire abdomen is again carefully examined for any problems. The keyhole incisions are closed with just a few sutures or staples each and then covered with bandages.

During either 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 build 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?

The surgery 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 after the surgery. Most patients report less pain with the smaller keyhole incisions of laparoscopic surgery. Your surgeon will arrange for pain medications. 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. 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
  • Respiratory tract infection
  • Deep venous thrombosis and/or pulmonary embolism

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

You may have a nasogastric tube. The tube will help 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. You will 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. The diet will be progressed through soft, bland foods, to a regular diet.

You will receive instructions to care for the surgical incisions at home. You will also have diet and physical activity plan to help you through recovery.

Outcome

  • Recovery after open cholecystectomy takes about 4 to 6 weeks.
  • Recovery after laparoscopic cholecystectomy takes about 3 weeks.
  • Although you will have incisional pain after your surgery, you should no longer be experiencing pain from the gallbladder.
  • Your liver will take over the functions of the gallbladder. 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 doctor.

Call Your Doctor If Any of the Following Occurs

Monitor your recovery once you leave the hospital. As soon as you have a problem, alert your doctor. If any of the following occur, call your doctor:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
  • Cough, shortness of breath, chest pain
  • Increased abdominal pain
  • 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

RESOURCES:

American Gastroenterological Association
http://www.gastro.org/

National Digestive Diseases Information Clearinghouse, NIH
http://digestive.niddk.nih.gov/

CANADIAN RESOURCES:

The Canadian Association of Gastroenterology (CAG)
http://www.cag-acg.org/

Canadian Digestive Health Foundation
http://www.cdhf.ca/

References:

About cholecystectomy: surgical removal of the gallbladder. American College of Surgeons. Medem website. Available at: http://www.medem.com/search/article_display.cfm?path=\\TANQUERAY\M_ContentItem&mstr=/M_ContentItem/ZZZHZGB4IWC.html&soc=ACS&srch_typ=NAV_SERCH. Accessed July 11, 2008.

Clayton ES, Connor S, Alexakis N, Leandros E. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg. 2006;93:1185-91.

Gallbladder removal. Baylor College of Medicine Department of Surgery website. Available at: http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc_name=cholecystectomy&content_id=272. Accessed July 11, 2008.

Gallbladder surgery: laparoscopic cholecystectomy. University of California at Davis website. Available at: http://www.ucdmc.ucdavis.edu/surgery/specialties/gastro/gall.html. Accessed July 11, 2008.

Laparoscopic surgery: bile, duct, and gallbladder. New York University School of Medicine website. Available at: http://www.nyulaparoscopy.org/surgeries/gallbladder.html#stones. Accessed July 11, 2008.

Martin DJ, Wernon DR, Toouli J. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. Apr 2006;19(2):CD003327.

Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston Textbook of Surgery. 16th ed. Philadelphia, PA: WB Saunders; 2001;1076-1095.

What are the surgical procedures for gallstones and gallstone disease? University of California at Davis website. Available at: http://www.ucdmc.ucdavis.edu/. Accessed August 16, 2003.



Last reviewed November 2007 by Daus Mahnke, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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