cholecystectomy

What is Cholecystectomy?

A cholecystectomy is a surgical procedure to remove your gallbladder — a pear-shaped organ that sits just below your liver on the upper right side of your abdomen. Your gallbladder collects and stores bile — a digestive fluid produced in your liver.

A cholecystectomy is a common surgery, and it carries only a small risk of complications. In most cases, you can go home the same day of your cholecystectomy.

A cholecystectomy is most commonly performed by inserting a tiny video camera and special surgical tools through four small incisions to see inside your abdomen and remove the gallbladder. Doctors call this a laparoscopic cholecystectomy.

In some cases, one large incision may be used to remove the gallbladder. This is called an open cholecystectomy.

What is the Gallbladder?

The gallbladder is an organ the shape and size of a small pear. It stores a substance called bile made by the liver. It keeps the bile until the body needs it to digest fatty foods.

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Before Cholecystectomy

Why it's done

A cholecystectomy is most commonly performed to treat gallstones and the complications they cause. Your doctor may recommend a cholecystectomy if you have:

. Gallstones in the gallbladder (cholelithiasis)

. Gallstones in the bile duct (choledocholithiasis)

. Gallbladder inflammation (cholecystitis)

. Large gallbladder polyps

. Pancreas inflammation (pancreatitis) due to gallstones

What are the symptoms of gallbladder problems?

Symptoms can include:

. Sharp pain in your abdomen,

. Nausea and vomiting,

. Indigestion,

. Fever, and

. Yellow skin – Jaundice is the medical term for skin and eyes that look yellow. You might get jaundice if gallstones block your bile duct.

Risks and Complications

A cholecystectomy carries a small risk of complications including:

. Bile leak

. Bleeding

. Infection

. Injury to nearby structures, such as the bile duct, liver and small intestine

. Risks of general anesthesia, such as blood clots and pneumonia

. Liver injury

. Scars and a numb feeling at the incision site

. A bulging of organ or tissue (a hernia) at the incision site

Your risk of complications depends on your overall health and the reason for your cholecystectomy.

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How you prepare

Food and medications

To prepare for a cholecystectomy, your surgeon may ask you to:

. Eat nothing the night before your surgery. You may drink a sip of water with your medications, but avoid eating and drinking at least four hours before your surgery.

. Stop taking certain medications and supplements. Tell your doctor about all the medications and supplements you take. Continue taking most medications as prescribed. Your doctor may ask you to stop taking certain medications and supplements because they may increase your risk of bleeding.

Clothing and personal items

Most people go home the same day of their cholecystectomy, but complications can occur that require one or more nights in the hospital. Plan ahead in case you need to stay in the hospital by bringing personal items, such as your toothbrush, comfortable clothing, and books or magazines to pass the time.

Other precautions

Find someone to drive you home and stay with you. Ask a friend or family member to drive you home and stay close the first night after surgery.

What you can expect

Before the procedure

A cholecystectomy is performed using general anesthesia, so you won't be aware during the procedure. Anesthesia drugs are given through a vein in your arm. Once the drugs take effect, your health care team will insert a tube down your throat to help you breathe. Your surgeon then performs the cholecystectomy using either a laparoscopic or open procedure.

During Cholecystectomy

Depending on your situation, your surgeon will recommend one of two surgical approaches:

Minimally invasive (laparoscopic) cholecystectomy

During a laparoscopic cholecystectomy, the surgeon makes four small incisions in your abdomen. A tube with a tiny video camera is inserted into your abdomen through one of the incisions. Your surgeon watches a video monitor in the operating room while using surgical tools inserted through the other incisions in your abdomen to remove your gallbladder.

Next you may undergo an imaging test, such as an X-ray or ultrasound, if your surgeon is concerned about possible gallstones or other problems in your bile duct. Then your incisions are sutured, and you're taken to a recovery area. A laparoscopic cholecystectomy takes one or two hours.

A laparoscopic cholecystectomy isn't appropriate for everyone. In some cases your surgeon may begin with a laparoscopic approach and find it necessary to make a larger incision because of scar tissue from previous operations or complications.

Traditional (open) cholecystectomy

During an open cholecystectomy, the surgeon makes a 6-inch (15-centimeter) incision in your abdomen below your ribs on your right side. The muscle and tissue are pulled back to reveal your liver and gallbladder. Your surgeon then removes the gallbladder.

The incision is sutured, and you're taken to a recovery area. An open cholecystectomy takes one or two hours.

After Cholecystectomy

After the procedure

You'll be taken to a recovery area as the anesthesia drugs wear off. Then you'll be taken to a hospital room to continue recovery. Recovery varies depending on your procedure:

. Laparoscopic cholecystectomy. People are often able to go home the same day as their surgery, though sometimes a one-night stay in the hospital is needed. In general, you can expect to go home once you're able to eat and drink without pain and are able to walk unaided. It takes about a week to fully recover.

You will get pain medicine as needed. A nurse may give it to you. Or you may give it to yourself through a device connected to your IV (intravenous) line.

You may have a thin plastic tube that goes through your nose into your stomach. This is to remove air that you swallow. The tube will be taken out when your bowels are working normally. You won’t be able to eat or drink until the tube is removed.

. Open cholecystectomy. Expect to spend two or three days in the hospital recovering. Once at home, it may take four to six weeks to fully recover.

You may have 1 or more drains in the incision if an open procedure was done. The drains will be removed in a day or so. You might be discharged with the drain still in and covered with a dressing. Follow your provider’s instructions for taking care of it.

You will be asked to get out of bed a few hours after a laparoscopic procedure or by the next day after an open procedure.

Depending on your situation, you may be given liquids to drink a few hours after surgery. You will slowly be able to eat more solid foods as tolerated.

Arrangements will be made for a follow-up visit with your provider. This is usually 2 to 3 weeks after surgery.

At home

Once you are home, it’s important to keep the incision clean and dry. Your provider will give you specific bathing instructions. If stitches or surgical staples are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and usually will fall off within a few days.

The incision and your abdominal muscles may ache, especially after long periods of standing. If you had a laparoscopic surgery, you may feel pain from any carbon dioxide gas still in your belly. This pain may last for a few days. It should feel a bit better each day.

Take a pain reliever as recommended by your provider. Aspirin or other pain medicines may raise your risk of bleeding. Be sure to take only medicines your healthcare provider has approved.

Walking and limited movement are generally fine. But you should avoid strenuous activity. Your provider will tell you when you can return to work and go back to normal activities.

Call your provider if you have any of the following:

. Fever or chills

. Redness, swelling, bleeding, or other drainage from the incision site

. More pain around the incision site

. Yellowing of your skin or the whites of your eyes (jaundice)

. Belly or abdominal pain, cramping, or swelling

. No bowel movement or gas for 3 days

. Pain behind your breastbone

Results

A cholecystectomy can relieve the pain and discomfort of gallstones. Conservative treatments, such as dietary modifications, usually can't stop gallstones from recurring. In most cases, a cholecystectomy will prevent gallstones from coming back.

Most people won't experience digestive problems after a cholecystectomy. Your gallbladder isn't essential to healthy digestion. Some people may experience occasional loose stool after the procedure, which generally resolves over time. Discuss with your doctor any changes in your bowel habits or new symptoms following your procedure.

How quickly you can return to normal activities after a cholecystectomy depends on which procedure your surgeon uses and your overall health. People undergoing a laparoscopic cholecystectomy may be able to go back to work in a matter of days. Those undergoing an open cholecystectomy may need a week or more to recover enough to return to work.