Cholecystectomy

What Is It?

Cholecystectomy is the surgical removal of the gallbladder, the small saclike organ located near the liver in the upper right 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 tube-like instrument with a camera for viewing) to guide surgical instruments to the gallbladder. The gallbladder is cut away from the liver and removed through one of the small incisions.

Surgeons remove about 500,000 gallbladders in the United States each year. About 90% of the time, 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%, traditional surgery is used because the person has significant abdominal scarring from prior surgery, severe inflammation or other factors associated with a higher risk of 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 lumps that form inside the gallbladder. Gallstones can cause symptoms as simple as intermittent pain after eating, but they also can lead to cholecystitis cholangitis 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 causes fever, nausea or vomiting, and pain in the upper right side of the abdomen. Cholangitis is an infection of the bile ducts that may occur when a gallstone blocks the main bile duct between the liver and intestine. 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.

Preparation

Your doctor will review your allergies and your medical and surgical history. If there is any chance that you may be pregnant or you are trying to get pregnant, tell your doctor before your 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.

You will need to have someone drive you home after 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 6-inch incision in the upper right side of your abdomen and removes your gallbladder. Often, a test called cholangiography is done during the operation to look for any stones that have already passed into one of the ducts. (In this test, a dye is injected into the bile ducts and X-rays are taken.) If stones are seen on the X-rays, they may be removed, and a tube may be placed in the common bile duct until after the surgery for 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 stay in the hospital for three to six days.
• Laparoscopic surgery The surgeon makes a small incision at the navel and puts air into the abdomen to make it easier to see. This help to avoid damaging any organs with the incisions or instruments. Next, a laparoscope, a device with a tiny camera on the end, is inserted through the small incision at your navel. Once the laparoscope is inside your abdomen, a camera on the laparoscope transmits images to a viewing screen. Three smaller incisions are made, and the surgical instruments are inserted through these incisions. The surgeon cuts out the gallbladder, and removes the gallbladder through one of the incisions, usually the one at your bellybutton. All of the instruments are removed, and the surgeon closes 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 may happen if there is too much bleeding, the gallbladder is difficult to remove or there are signs of severe infection.

Follow-Up

You will need to visit your doctor for follow-up sometime after you leave the hospital. This may be within a few days to a few weeks 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.

Risks

Possible complications of a cholecystectomy include infection, bleeding, blood clots, damage to bile ducts, and injury to surrounding organs. Occasionally, people have diarrhea after cholecystectomy. A medication called cholestyramine (Questran) can help to treat the 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.

Additional Info

American College of Surgeons (ACS)

633 North Saint Clair St.

Chicago, IL 60611-3211

Phone: 312-202-5000

Toll-Free: 1-800-621-4111

Fax: 312-202-5001

Email: postmaster@facs.org

http://www.facs.org/

American Liver Foundation

75 Maiden Lane

Suite 603

New York, NY 10038

Phone: 212-668-1000

Toll-Free: 1-800-465-4837

Fax: 212-483-8179

Email: info@liverfoundation.org

http://www.liverfoundation.org/