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Cholecystectomy -- Open Surgery

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(Gallbladder Removal—Open Surgery)

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Definition

Cholecystectomy is the surgical removal of the gallbladder. This organ is near the liver. It stores bile that is made 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.
The open version of this surgery is done when the surgeon may not be able to perform a less invasive version called laparoscopic surgery.
Laparoscopic Cholecystectomy vs. Open Cholecystectomy
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Reasons for Procedure

This surgery is used to remove a diseased or damaged gallbladder. The damage is typically caused by infection or inflammation. The damage is often due to gallstones, which are crystals of bile that can form in the gall bladder. Sometimes these get stuck in the ducts that bile normally flows through. This blockage in the ducts can damage the gallbladder and the liver.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a cholecystectomy, your doctor will review a list of possible complications, which may include:
  • Gallstones that have entered the abdominal cavity
  • Bleeding
  • Infection
  • Injury to other nearby structures or organs
  • Reactions to general anesthesia
  • Blood clots
Some factors that may increase the risk of complications include:
  • Age: 60 or older
  • Pregnancy
  • Obesity
  • Smoking
  • Malnutrition
  • Recent or chronic illness
  • Diabetes
  • Heart or lung problems
  • Bleeding disorders
  • Alcoholism and illegal drugs
  • Use of certain medicines

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 gallstones
  • HIDA scan (hepatobiliary iminodiacetic acid scan)—an x-ray test that uses a chemical injected into the gall bladder to create pictures of your liver, gallbladder, ducts, and small intestines
  • Other scans to better view the gallbladder
  • EKG and chest x-ray to make sure that your heart and lungs are healthy enough before surgery
Leading up to your procedure:
  • Talk to your doctor about your current medicines. Certain medicines may need to be stopped before the procedure, such as:
    • Anti-inflammatory drugs
    • Blood-thinning drugs
  • Arrange for a ride to and from the procedure. Also arrange for help at home when you return from the hospital.
  • The night before, eat a light meal. 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.
  • You may be asked to shower the morning before surgery. You may be given a special soap to use.

Anesthesia

General anesthesia will be used. You will be asleep for the procedure.

Description of Procedure

The doctor will make an incision in the upper right area of your abdomen. The gallbladder will be separated from the structures around it, including the liver, bile ducts, and arteries.
After the gallbladder is gone, your doctor may squirt dye into the bile ducts. This will help show if there is a gallstone in the ducts. The duct may be opened to remove any stones. While your abdomen is open, your doctor will examine the other organs and structures. This will be done to make sure that you do not have any other problems. The incision will be closed with sutures or staples. It will then be covered with a bandage.
Your doctor may 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 of your operation.

Immediately After Procedure

The gallbladder will be examined by a specialist. You will be taken to a room to recover. You will be monitored closely.

How Long Will It Take?

About 30-60 minutes

How Much Will It Hurt?

You will most likely feel some pain after the surgery. Your doctor will arrange for pain medicines.

Average Hospital Stay

2-6 days

Post-procedure Care

At the Hospital
  • You will be monitored for problems.
  • You may need medicines for nausea.
  • You may have a nasogastric tube, which is a tube that will go from your nose, down your throat, and into your stomach. The tube will help to drain fluids and stomach acid. You will not be able to eat or drink until this is removed and you are no longer nauseated. You will continue to receive fluids and sugar through an IV.
  • When you are able to take things by mouth, you will be started on a liquid diet. Your diet will be progressed through soft foods to a regular diet.
At Home
Recovery takes about 4-6 weeks.
When you return home, do the following to help ensure a smooth recovery:
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Be sure to follow your doctor’s instructions.
  • You will get a diet and physical activity plan to help you through recovery. Following the plan will help your recovery.
  • 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.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occur:
  • 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
  • Pain that you cannot control with the medicines you have been given
  • Blood in the stool
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which last for more than two days after you leave the hospital
  • Bloating and gas that last for more than a month
  • Pain, burning, urgency or frequency of urination, or blood in the urine
  • Pain and/or swelling in your feet, calves, or legs
  • Dark urine, light stools, or yellowing of the skin or eyes
In case of an emergency, call for medical help right away.

RESOURCES

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

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

CANADIAN RESOURCES

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

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

References

Bile, duct, and gall bladder. New York University School of Medicine website. Available at: http://www.nyulaparoscopy.org/surgeries/gallbladder.html. Accessed July 11, 2008.

Cholecystectomy. American College of Surgeons website. Available at: http://www.facs.org/public%5Finfo/operation/cholesys.pdf. Accessed January 31, 2013.

Cholecystectomy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 31, 2012. Accessed January 31, 2013.

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 surgery: laparoscopic cholecystectomy. University of California at Davis website. Available at: http://www.ucdmc.ucdavis.edu/surgery/specialties/gastro/gall.html. Accessed January 31, 2013.

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

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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