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 .
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) . 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 :
- Gallstones causing recurrent pain
- Gallbladder sludge causing complications, such as pancreatitis 
- Acute cholecystitis [7,17,18]
- Gallbladder polyps smaller than 18 mm 
- Chronic inflammation with calcified (porcelain) gallbladder
- Gallbladder dyskinesia, which refers to gallbladder pain in the absence of gallstones
Laparoscopic gallbladder removal can be performed in children and adults, including pregnant women (preferably in the second trimester) .
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 :
- Severe heart or lung disease
- Trauma of the upper right abdomen
- Gallbladder polyps greater than 18 mm 
- 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
|Indications||Gallstones, gallbladder polyps, inflammation (cholecystitis), gallbladder dyskinesia||Gallbladder cancer, abdominal injury, previous abdominal surgery, heart disease, severe liver cirrhosis|
|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 . 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
|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|
- 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 .
- 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 . 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 . With this therapy, gallstones can decrease by 1 mm per month .
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 . With this method, the gallstones can dissolve within several hours to days .
Extracorporeal shock wave lithotripsy (ESWL) breaks down gallstones into small pieces, which are then naturally eliminated through the bile ducts into the intestine .
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 . This method is used to treat acute gallbladder inflammation in critically ill patients who are not able to undergo surgery.
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