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Cholecystectomy (Gallbladder Removal)

The gallbladder is surgically removed in a cholecystectomy. Gallstones and other gallbladder problems are commonly treated by cholecystectomy.

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Gallbladder Disease

  • The gallbladder is a small organ under the liver
  • One of the functions of the liver is to make bile. Bile helps to digest your foods, particularly fat.
  • Bile is transferred from the liver into the bile ducts and into the intestine. Some bile is stored in the gallbladder.
  • Stones can be formed in the gallbladder and is a very common occurrence. 15% of the US population has gallstones.

  • These stones can cause symptoms, either in your gallbladder, or from entering the bile duct
  • Stones can cause blockage in the gallbladder, or ducts leading to inflammation or infection of the gallbladder, liver or pancreas. Some of these conditions can become life-threatening.
  • Generally, removal of the gallbladder is recommended once you have symptoms related to your gallstones, although each case is evaluated specifically.
  • Some people have abnormal function of their gallbladder, found with HIDA scan, also known as biliary dyskinesia. In some cases removal of your gallbladder may help these symptoms as well

Symptoms

  • Pain in the right upper side of your abdomen just beneath the ribs
  • Pain typically related to eating, especially fatty foods
  • Pain may be in the middle or radiate to the right shoulder or back
  • Nausea/bloating, decreased appetite • Previous choledocholithiasis or pancreatitis from gallstones (stones blocking or passing through the main bile duct)

Common tests

  • Blood tests (CBC, CMP, lipase, coagulation studies). These evaluate for infection or blockage of the liver or pancreatic ducts by stones that have fallen out of the gallbladder
  • Ultrasound – this is the best test to evaluate for gallstones
  • CT, MRI/MRCP or HIDA – may be used in addition for specific indications

Treatment Options

  • Laparoscopic Cholecystectomy
  • Watchful waiting (likely recommended if you do not have symptoms related to your gallstones)
    • Healthy diet and regular exercise may help decrease risk of symptoms

Surgery (Laparoscopic Cholecystectomy)

  • Very common operation with low risk
  • 4 small incisions with hollow tubes placed to use instruments and a lighted camera
  • Carbon dioxide is used to make space between your organs to work with small instruments
  • The small artery and duct that lead to your gallbladder are clipped and cut
  • The attachments between the gallbladder and liver are divided
  • Gallbladder (and stones inside) are placed into a bag and removed from your abdomen
  • The gallbladder is sent to the pathologist to examine under a microscope

Risks

  • Bleeding, infection, damage to surrounding structures
  • Bile leak
  • Retained stone
  • Common bile duct injury
  • Conversion to open procedure (large incision) <1%.
  • Anesthesia-related risks (heart, lung complications and blood clots)
  • Your risk of complications depends on your overall health and the reason for your cholecystectomy.

Results

  • After surgery you will not have the symptoms you were having from your gallstones
  • Dietary changes usually do not prevent stones from recurring, or dissolve stones. Removal of your gallbladder nearly always prevents future stones.
  • Your gallbladder is not essential for healthy digestion.
  • It is common to notice change in bowels for the first few weeks after gallbladder removal, but for most this will return to normal
  • Some people may continue to have changes with bowel movements (loose, or urgency related to certain foods). If this occurs please call to discuss treatment options.

What to expect

Preparing for your surgery

  • Nothing to eat or drink after midnight the night before your surgery
  • You may take am meds (you will be told which ones to take/hold) with a sip of water in the am
  • If you smoke; quitting smoking before surgery can decrease your risk of respiratory complications and infections after surgery.

Day of Surgery

  • You will receive general anesthesia and have breathing tube (endotracheal tube) put down during surgery. You will be completely asleep for this and the tube is removed before you wake up. The anesthesia provider will meet with you the morning of surgery
  • Most people go home within a few hours after surgery
  • You will need someone to drive you home and be close for the first night following your surgery

Postoperatively

  • Eat normal diet, start with bland foods. Ensure you are drinking 8-10 glasses of water a day after surgery. Eat high-fiber foods or take fiber supplement (ex. Metamucil) to help with your bowel movements after surgery.
  • It is normal to have pain, especially in your shoulder/neck and with deep breathing. This is from the gas used during surgery and will resolve within a couple days. Changing positions can help.
  • You will be sent home with pain medications which most people will take for a few days after surgery then are able to wean to non-narcotic mediations
  • Take ibuprofen (unless you have a medical reason not to) in addition to help decrease the amount of narcotic you are taking.
  • Norco (the narcotic most commonly prescribed) has Tylenol in it. Either take norco OR Tylenol in addition to the ibuprofen.
  • Take stool softeners and/or laxatives as needed (docusate, miralax) to help your bowels stay regular following surgery. Anesthesia and pain medications can contribute to constipation postoperatively.
  • Walk around as able. Take deep breaths to fully expand your lungs. This can help prevent pneumonia and blood clots
  • Slowly increase your activity. You are typically ready for normal activity by 1-3 weeks after your surgery.
  • Most people will be able to return to work or school about 5-7 days after surgery.
  • Wound care
    • All sutures used will be buried under the skin and absorbable. o If you have steri strips over your incisions. Remove bandaids in 24-48hrs after surgery. Leave white strips (steri strips) in place and shower. Let soapy water run over these and pat dry. They will begin to peel off in about 7-10 days then you may remove.
    • If you have skin glue (dermabond) over the incisions you may shower immediately. When this begins to flake off you may peel off, typically in a week.
    • Do not bathe, soak incisions, go in hot tube, pool or lake/ocean for 2 weeks.
    • Your scar with heal over the next 4-6 weeks and continue to fade and soften over the next year. Use sunscreen over incisions when exposed to sun for the next year.

When to Call

  • Severe or worsening uncontrolled pain
  • A fever >101.3
  • Continuous vomiting
  • Foul smelling drainage, redness or continued bleeding from an incision site
  • Chest pain or trouble breathing (call 911 or go to the ER)
  • Any questions or concerns

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