Gallbladder Removal Surgery (Cholecystectomy)

Published: February 8, 2017
Last reviewed: March 6, 2017

Types of Gallbladder Surgery

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

What is laparoscopic cholecystectomy?

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

Laparoscopic cholecystectomy is a minimally invasive procedure to remove the gallbladder using the laparoscope–a tube with a camera and light at the end–and instruments inserted through 4 small (5-10 mm) incisions in the abdominal wall. It is performed under general anesthesia, usually in an outpatient setting.

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

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

  • Gallstones causing recurrent pain
  • Gallbladder sludge causing complications, such as pancreatitis [16]
  • An acutely inflamed gallbladder (cholecystitis); surgery should be preferably performed within 48-72 hours after the onset of symptoms [18,19,20]
  • Gallbladder polyps smaller than 18 mm [21]
  • Calcified (porcelain) gallbladder
  • Biliary dyskinesiagallbladder-related pain in the absence of gallstones

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 [21]
  • A bleeding disorder
  • Severe liver cirrhosis

Some reasons to convert laparoscopic into open surgery include suspected gallbladder cancer, inability to control bleeding and excessive adhesions from previous gallbladder inflammation episodes or abdominal surgeries.

Video 2. Open gallbladder surgery

Chart 1. Laparoscopic vs Open Cholecystectomy

Laparoscopic Open
Indications Gallstones, polyps, cholecystitis, dyskinesia Gallbladder cancer, abdominal injury, previous abdominal surgery, heart disease, severe cirrhosis
Anesthesia General General
Hospital stay <24 hours ~1-4 days
Return to work ~7 days ~1 month
Scars 4 scars: 3 x 5 mm in the upper abdomen and 1 x 10 mm below the belly button A 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.

Is cholecystectomy a major surgery?

According to this discussion on ResearchGate and Emedicine [3], laparoscopic cholecystectomy is considered either an intermediate or major surgery. It is a serious surgery since it involves general anesthesia.

Is an emergency cholecystectomy required in acute gallbladder inflammation (cholecystitis)?

Some doctors want to wait for about 6 weeks for acute gallbladder inflammation to settle down before they remove the gallbladder because they want to avoid complications, such as bile duct injury. According to one Cochrane review of studies, there is no significant difference in the risk of complications between the emergency and postponed surgery, though [9].

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 can expect to be monitored for 4-6 hours for eventual complications, such as infection or bleeding [3]. If you are able to drink and walk and have no fever, you can leave the same day.

What happens with a removed gallbladder?

After removal, a doctor usually cuts the gallbladder to check for stones and abnormal growths (polyps) and send it to a pathologist to check it for cancer.

What is the recovery time after gallbladder surgery?

You can walk and go home the same day after laparoscopic gallbladder removal (cholecystectomy) and the next day you can remove the dressing and take a shower [6]. Unless you are taking strong narcotics and if a doctor agrees, you can drive or fly 2-3 days after surgery [7,17].

After laparoscopic surgery, you can expect to return to the desk job within a week and to a more physically demanding job within 3 weeks [7]. After open surgery, you can expect to go back to work within 4-6 weeks [6].

In the first few weeks after laparoscopic surgery, you can lift up to 10 pounds (5 kilograms) [28]. Do not do any heavy lifting or other heavy exercises within the first 2 weeks.

What to eat after a gallbladder surgery?

If you do not experience any gastrointestinal symptoms after gallbladder removal, you can eat whatever you want [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.

After gallbladder removal, the bile constantly flows into your intestine, so it may irritate it and trigger diarrhea. In this case, it may help if you have small and frequent meals and avoid foods high in fat and sugars.

Foods high in insoluble fiber, such as whole-grain bread, corn or brown rice, 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.

What are complications of gallbladder surgery?

Complications after a gallbladder surgery are rare and can include [28]:

  • Retained stones in the cystic or common bile duct
  • Microlithiasis–small bile crystals in the bile duct [27]
  • Infection of a surgical wound (fever, chills and discharge)
  • Urinary tract infection (cloudy urine)
  • Pneumonia (coughing up mucus)
  • Bile duct injury with bile leak
  • Bleeding
  • Heart problems: heart attack
  • Injury of the liver
  • Pancreatitis (pain in the upper abdomen and nausea)
  • Hernia (a soft lump at the site of the surgical wound)
  • A blood clot in the legs in individuals prone to deep vein thrombosis
  • Kidney failure
  • Death (in less than 1%)

Does cholecystectomy have any side effects?

Side effects after gallbladder removal are quite common and can include:

  • Nausea or vomiting, usually limited to few days after the procedure
  • Diarrhea, which usually resolves within 4-8 weeks but can become chronic
  • Bile reflux, which is similar to acid reflux, and can cause indigestion and heartburn
  • Recurrent pain in the right upper abdominal quadrant due to sphincter of Oddi dysfunction
  • Bloating, excessive gas (flatulence) or constipation
  • Weight loss due to diarrhea or avoiding eating
  • Fatty liver [22,23,24]
  • Metabolic syndrome (obesity, high LDL cholesterol and glucose levels, and hypertension) [26]

Cholecystectomy should not affect the digestion of nutrients or cause dumping syndrome [25].

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 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 skin [14]. By 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 skin, and the gallbladder is allowed to drain [11]. This method is used to treat an 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. Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES
      7. Gallbladder removal – laparoscopic – discharge  MedlinePlus
      8. de Menezes HL et al, 2013, Randomized study for assessment of hypolipidic diet in digestive symptoms immediately following laparoscopic cholecystectomy  PubMed
      9. Gurusamy K, Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis
      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. Gallstones — Approach to Medical Management  Medscape
      14. Contact Dissolution for Gallstones  Aetna
      15. Cholecystectomy risks  Mayo Clinic
      16. Evans WB et al, Is Empiric Cholecystectomy a Reasonable Treatment Option for Idiopathic Acute Pancreatitis?  Medscape
      17. When can I fly after surgery?
      18. Zafar SN et al, 2015, Optimal time for early laparoscopic cholecystectomy for acute cholecystitis  PubMed
      19. Sinha R et al, 2002, Acute Cholecystitis and Laparoscopic Cholecystectomy  PubMed Central
      20. Gul R et al, 2013, Comparison of Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: Experience from A Single Center  PubMed Central
      21. Sandberg AA, 2012, Diagnosis and Management of Gallbladder Polyps  PubMed Central
      22. Ruhl CE et al, 2013, Relationship of non-alcoholic fatty liver disease with cholecystectomy in the US population  PubMed
      23. Kwak M-S et al, 2015, Cholecystectomy is independently associated with nonalcoholic fatty liver disease in an Asian population  PubMed Central
      24. Nervi F et al, 2013, Cholecystectomy and NAFLD: does gallbladder removal have metabolic consequences?  PubMed
      25. Taylor TV, 1981, Postvagotomy and Cholecystectomy Syndrome PubMed Central
      26. Shen C et al, 2014, Association of Cholecystectomy with Metabolic Syndrome in a Chinese Population  PubMed Central
      27. Okoron N et al, 2008, Ursodeoxycholic acid treatment for patients with postcholecystectomy pain and bile microlithiasis  PubMed
      28. Cholecystectomy  American College of Surgeons

Leave a Reply

Your email address will not be published. Required fields are marked *