Gallbladder Removal Surgery (Cholecystectomy)

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Published: February 8, 2017
Last reviewed: November 3, 2017

Types of Gallbladder Surgery

There are two types of gallbladder removal surgery: laparoscopic and open surgery. The medical term for gallbladder removal surgery is cholecystectomy [2].

What is laparoscopic cholecystectomy?

The term laparoscopic refers to the examination of the loin (lapara) with an endoscope and cholecystectomy means the removal (ectomy) of the gallbladder (cholecystis) [1]. Other names for laparoscopic cholecystectomy are “lap chole” and “keyhole” gallbladder surgery.

Laparoscopic cholecystectomy is a minimally invasive procedure to remove the gallbladder, which involves the insertion of the laparoscope–a tube with a camera, light and instruments–through 4 small incisions in the abdominal wall (Video 1). The procedure is performed under general anesthesia, usually in an outpatient setting.

Whenever possible, a surgeon will recommend laparoscopic over open surgery, because it has a shorter recovery time and fewer complications and leaves less scarring.

You can be a candidate for laparoscopic gallbladder removal if you have [3]:

Laparoscopic gallbladder removal can be performed in children and adults, including pregnant women (preferably in the second trimester) [3].


Video 1. Laparoscopic gallbladder removal

According to New Choice Health, a laparoscopic gallbladder surgery in the United States can cost between 2,550 and 9,500 dollars.

What is open cholecystectomy?

Open cholecystectomy is gallbladder removal through a 4-6 inch long incision in the right upper abdomen. You can expect to have open instead of laparoscopic surgery in case of [4]:

  • Severe heart or lung disease
  • Trauma of the upper right abdomen
  • Gallbladder polyps greater than 18 mm [6]
  • A bleeding disorder
  • Severe liver cirrhosis

Reasons to convert laparoscopic into open surgery during the procedure include suspected gallbladder cancer, inability to control bleeding and excessive adhesions (internal scars) from previous gallbladder inflammation episodes or abdominal surgeries.


Video 2. Open gallbladder surgery

Chart 1. Laparoscopic vs Open Cholecystectomy

Laparoscopic Open
Indications Gallstones, gallbladder polyps, inflammation (cholecystitis), gallbladder dyskinesia Gallbladder cancer, abdominal injury, previous abdominal surgery, heart disease, severe liver cirrhosis
Anesthesia General General
Duration 1-2 hours 1-2 hours
Hospital stay <24 hours 2-5 days
Scars 4 scars: 3 x 5 mm in the upper abdomen and 1 x 10 mm below the belly button One 4-6 inch (10-15 cm) long scar below the right rib cage

What kind of doctor performs cholecystectomy?

It is a gastrointestinal surgeon who helps you prepare and who performs cholecystectomy. In complicated cases, a hepatobiliary surgeon who deals specifically with the liver and gallbladder can get involved.

How long does gallbladder removal surgery last?

Both laparoscopic and gallbladder removal surgery usually last for 1 to 2 hours [5,28]. After the procedure, you will be likely monitored in a room in a health facility for 4-6 hours for eventual complications, such as infection or bleeding [3]. If you can drink and walk and have no fever, you can expect to be discharged the same day after laparoscopic and the next day after open surgery.

What happens with a removed gallbladder?

After removal, a surgeon usually cuts the gallbladder open to check its content. If only gallstones are found and the walls of the gallbladder look normal from the inside, the gallbladder can be discarded. If abnormal growths (polyps) are found, the gallbladder is sent to a pathologist who checks it for cancer.

Chart 2. Gallbladder Removal Recovery Time

Laparoscopic Surgery

Open Surgery

Discharge from hospital <24 hours Within 2-5 days
Walking The day of the surgery Within 2-5 days
Showering (not bath) The day after surgery Within 2-5 days
Driving or flying The 2nd or 3rd day Ask a doctor
Eating As soon as you wake up As soon s you wake up
Usual diet Within a week Within a week
Returning to desk job Within a week Within 1-4 weeks
Returning to physical job Within 3 weeks Within 4-8 weeks
Returning to sports Ask a doctor Ask a doctor
Lifting >10 pounds After 2 weeks After 2 weeks
Scar healing 4-6 weeks 4-6 weeks

References: 19,20,21,22,23,24

NOTE:

  • Regular walking for few weeks after surgery helps to prevent complications, such as blood clots and pneumonia.
  • Smoking prolongs the healing time of surgical wounds [9].
  • If you experience any unusual symptoms shortly after surgery, such as severe pain, fever, jaundice, persistent cough or bleeding from the surgical wound, visit a doctor.
  • Persistent pain or pain that appears months after gallbladder removal can be due to sphincter of Oddi dysfunction.
  • Check for more side effects and complications of gallbladder surgery.

What to eat after a gallbladder surgery?

If you do not experience any gastrointestinal symptoms after gallbladder removal, you can eat whatever you want as soon as you can sit comfortably [8]. Usually, there is no need for food restrictions or special diets, such as a liquid or low-fat diet. You also do not need any dietary supplements because gallbladder removal does not affect the digestion or absorption of nutrients.

Foods high in insoluble fiber, such as whole-grain bread and non-starchy vegetables, can help you maintain soft bowel movements, so you do not need to strain and thus allow a surgical wound to heal properly.

Few days after surgery, you can start to drink alcohol, unless your doctor has told you otherwise. Be aware that alcohol can increase the side effects of narcotics or other medications or trigger diarrhea.

If you experience diarrhea after gallbladder removal, it may help if you have small meals and avoid foods high in fat and sugars and spicy foods.

Is there any alternative for gallbladder removal?

Nonsurgical methods are now rarely used to treat gallstones because of the high rate of recurrence.

Oral dissolution of gallstones by ursodeoxycholic acid (UDCA) can be used to treat cholesterol gallstones smaller than 20 mm in the absence of gallbladder inflammation [12]. With this therapy, gallstones can decrease by 1 mm per month [13].

Contact dissolution with methyl tert-butyl ether (MTBE) involves the instillation of chemicals into the gallbladder through a catheter, which is placed into gallbladder through the abdominal wall [14]. With this method, the gallstones can dissolve within several hours to days [14].

Extracorporeal shock wave lithotripsy (ESWL) breaks down gallstones into small pieces, which are then naturally eliminated through the bile ducts into the intestine [10].

In percutaneous cholecystostomy, a doctor inserts a catheter into the gallbladder through a small incision in the abdominal wall, which allows the gallbladder to drain [11]. This method is used to treat acute gallbladder inflammation in critically ill patients who are not able to undergo surgery.

  • References

      1. Laparoscopic cholecystectomy  Online Etymology Dictionary
      2. Cholecystectomy  Merriam-Webster
      3. Sherwinter DA, Laparoscopic cholecystectomy  Emedicine
      4. Hope WW, Open cholecystectomy  Emedicine
      5. Cholecystectomy (gallbladder removal)  Mayo Clinic
      6. Sandberg AA, 2012, Diagnosis and Management of Gallbladder Polyps  PubMed Central
      7. Gul R et al, 2013, Comparison of Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: Experience from A Single Center  PubMed Central
      8. de Menezes HL et al, 2013, Randomized study for assessment of hypolipidic diet in digestive symptoms immediately following laparoscopic cholecystectomy  PubMed
      9. Silverstein P, 1992, Smoking and wound healing  PubMed
      10. Dissolution therapy for the treatment of gallstones  UpToDate
      11. Fahrbach TM, Percutaneous Cholecystostomy Technique  Emedicine
      12. Schoenfield LJ et al, 1993, Oral and contact dissolution of gallstones  PubMed
      13. Guarino MPL et al, 2013, Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed PubMed Central
      14. Contact Dissolution for Gallstones  Aetna
      15. Cholecystectomy risks  Mayo Clinic
      16. Shaffer EA, 2001, Gallbladder sludge: what is its clinical significance?  PubMed
      17. Sinha R et al, 2002, Acute Cholecystitis and Laparoscopic Cholecystectomy  PubMed Central
      18. Zafar SN et al, 2015, Optimal time for early laparoscopic cholecystectomy for acute cholecystitis  PubMed
      19. Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES  Sages.org
      20. Gallbladder removal – laparoscopic – discharge  MedlinePlus
      21. When can I fly after surgery? NHS.uk
      22. Cholecystectomy  American College of Surgeons
      23. Gallbladder removal – open – discharge  MedlinePlus
      24. Gallbladder removal – open  University of Maryland Medical Center

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