What Is It?
Cholecystectomy is the surgical removal of the gallbladder, the small saclike organ located near the liver in the upper right-hand side of the abdomen. The gallbladder stores bile from the liver. Bile helps your body to break down and absorb fats. There are two ways to remove the gallbladder:
- Traditional surgery — The surgeon cuts open the abdomen and removes the gallbladder through an incision that is about 6 inches long.
- Laparoscopic surgery — The surgeon makes four small (less than an inch) incisions, and uses a laparoscope (a tubelike instrument with a camera for viewing inside the abdomen) to guide surgical instruments to the gallbladder, where the gallbladder is cut away from the liver and removed through one of the small incisions.
Currently, surgeons remove about 500,000 gallbladders in the United States each year. In about 90 percent of patients, laparoscopic surgery is used because it requires a shorter hospital stay, is less painful and has a shorter recovery period than traditional surgery. In the remaining 10 percent, traditional surgery may be necessary because the patient has significant abdominal scarring from prior surgery or has a higher risk for complications during surgery.
Most people have no side effects from living without a gallbladder. Bile can pass directly from the liver to the intestines, so the gallbladder usually is not missed.
What It’s Used For
Surgeons remove gallbladders to prevent complications from gallstones, which are rocklike nuisances that can form inside the gallbladder. Gallstones can produce symptoms as simple as pain after eating, but also can lead to cholecystitis or pancreatitis. Cholecystitis is an inflammation or infection of the gallbladder that develops when a gallstone blocks a bile duct (or tube) that leads from the gallbladder to the intestine. Cholecystitis produces fever, nausea or vomiting, and pain in the upper right-hand side of the abdomen. Pancreatitis is an inflammation of the pancreas that can be caused by a gallstone blocking the duct coming from the pancreas. This leads to pancreatic enzymes irritating and inflaming the pancreas. Pancreatitis is dangerous and can be life threatening. Symptoms of pancreatitis include pain in the upper-middle part of the abdomen, nausea or vomiting.
There are no specific preparations for gallbladder surgery. About one week before surgery, you will need to stop taking aspirin and other blood-thinning medications. Beginning at midnight on the night before your surgery, you must not eat or drink anything. This reduces the risk of vomiting during surgery.
Your doctor will review your allergies and your medical and surgical history. If there is a possibility that you could be sent home from the hospital the same day as your surgery, you will need to have someone drive you home. If you are a woman and there is any chance that you might be pregnant or you are trying to get pregnant, tell your doctor before your surgery.
How It’s Done
No matter which type of surgery you have, you will be put under general anesthesia, making you unconscious during your surgery. An intravenous (IV) line inserted into one of your veins will deliver fluids and medications.
- Traditional surgery — The surgeon cuts a 4-inch by 6-inch incision in the upper right-hand side of your abdomen and removes your gallbladder. Often, a test called cholangiography is done (an X-ray study of dye injected into the ducts) during the operation to look for any stones that have already passed into one of the ducts. In cholangiography, dye is injected into the ducts and X-rays are taken. If stones are seen, they will be drained and a tube may stay in place until after the surgery to allow for further drainage. After the gallbladder is removed, the incision is closed with stitches. After surgery, you are monitored for several hours in a recovery room. Later you return to your hospital room. While in the hospital, you gradually will resume eating a normal diet and get out of bed. Usually, you remain in the hospital for three to six days.
- Laparoscopic surgery — The surgeon first makes a small incision at the navel and puts air into the abdomen to make it easier to see and avoid damaging any of the organs with the incisions or instruments. Next, a laparoscope, which has a tiny camera on the end, is inserted through the small incision at your navel. Once the laparoscope is inside your abdomen, the camera on the laparoscope transmits images to a viewing screen. These images help to guide the surgeon. Using the laparoscope, the surgeon can get an inside view while making three smaller incisions. The surgical instruments are inserted through these other incisions. After the surgeon cuts the gallbladder duct and artery, the surgeon removes the gallbladder through one of the small incisions, usually the one at your bellybutton. All of the instruments are removed, and the surgeon closes all the incisions with stitches or surgical tape. After you wake up from anesthesia, the IV line remains in place until you can drink fluids on your own, usually within a few hours after surgery. If you are having a same-day procedure, you can leave the hospital when you feel well enough to go home safely. You may be able to eat a light meal later that day (in the evening).
If there are any problems or complications during a laparoscopic surgery, the surgeon will switch to a traditional cholecystectomy. This might happen is there is too much bleeding, the gallbladder is difficult to remove or there are signs of infection.
You will visit your doctor for follow-up within seven to 10 days after you return home from the hospital. Your doctor will check the healing of your incisions and remove any stitches. After laparoscopic surgery, you usually can return to work within three to seven days. After traditional surgery, you may need to wait four to six weeks before going back to work. Check with your doctor before resuming specific activities, such as sports, heavy labor and lifting.
Possible complications of a cholecystectomy include infection, excessive bleeding, blood clots or injury to surrounding organs. Occasionally, people have diarrhea after cholecystectomy. A medication called cholestyramine (Questran) can help to bind the additional bile passing into the intestine that can lead to diarrhea.
When To Call A Professional
Once you return home from the hospital, call your doctor immediately if you develop a fever or if your incision becomes red, tender or swollen.
Diseases and Conditions Center
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.