Cholecystectomy—Open Surgery

(Gallbladder Removal—Open Surgery)

by Rosalyn Carson-DeWitt, MD

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Definition    TOP

Cholecystectomy is the surgical removal of the gallbladder. The gallbladder is near the liver. It stores bile that is made by the liver. Bile helps in the digestion of fatty foods. The gallbladder releases bile into a system of ducts that lead to the small intestine.

The open version of this surgery is done when a less invasive version called laparoscopic surgery cannot be done.

Laparoscopic Cholecystectomy vs. Open Cholecystectomy

Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure    TOP

This surgery is used to remove a diseased or damaged gallbladder. The damage is typically caused by infection or inflammation. This is often due to gallstones, which are crystals of bile that can form in the gallbladder. Sometimes, these get stuck in the ducts that bile normally flows through. This blockage in the ducts can damage the gallbladder and the liver.

Possible Complications    TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Gallstones that have entered the abdominal cavity
  • Bleeding
  • Infection
  • Injury to other nearby structures or organs
  • Reactions to general anesthesia
  • Blood clots

Some factors that may increase the risk of complications include:

  • Increased age
  • Pregnancy
  • Obesity
  • Smoking
  • Malnutrition
  • Recent or chronic illness
  • Diabetes
  • Heart or lung problems
  • Bleeding disorders
  • Alcoholism and illegal drugs
  • Use of certain medications

What to Expect    TOP

Prior to Procedure

Your doctor will probably do some or all of the following:

  • Blood tests to evaluate liver function
  • Ultrasound to view gallstones
  • Hepatobiliary iminodiacetic acid (HIDA) scan—an x-ray test that uses a chemical injected into the gall bladder to create pictures of your liver, gallbladder, ducts, and small intestines
  • MRI or CT scan to better view the gallbladder
  • Electrocardiogram (EKG) and chest x-ray to make sure that your heart and lungs are healthy enough before surgery

Leading up to your procedure:

  • Talk to your doctor about your current medications. Certain medications may need to be stopped before the procedure, such as:
  • Arrange for a ride to and from the procedure. Also arrange for help at home when you return from the hospital.
  • The night before, eat a light meal. Do not eat or drink anything after midnight.
  • You may be given laxatives and/or an enema to clean out your intestines.
  • You may be given antibiotics.
  • You may be asked to shower the morning before surgery. You may be given a special soap to use.

Anesthesia

General anesthesia will be used. You will be asleep for the procedure.

Description of Procedure    TOP

An incision will be made in the upper right area of your abdomen. The gallbladder will be separated from the structures around it, including the liver, bile ducts, and arteries.

After the gallbladder is gone, dye may be squirted into the bile ducts. This will help show if there are gallstones in the ducts. The duct may be opened to remove any stones. While your abdomen is open, the other organs and structures will be examined. This will be done to make sure that you do not have any other problems. The incision will be closed with sutures or staples. It will then be covered with a bandage.

A tiny, flexible tube may be placed into the area where the gallbladder was removed. This tube will exit from your abdomen into a little bulb. This is to drain any fluids that may build during the first few days after surgery. The tube is usually removed within one week of your operation.

Immediately After Procedure    TOP

The gallbladder will be examined by a specialist. You will be taken to a room to recover. You will be monitored closely.

How Long Will It Take?    TOP

About 30-60 minutes

How Much Will It Hurt?    TOP

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay    TOP

2-6 days

Post-procedure Care    TOP

At the Hospital

In the recovery room, the staff will monitor you for problems. In addition:

  • You may have a nasogastric tube, which is a tube that will go from your nose, down your throat, and into your stomach. The tube will help to drain fluids and stomach acid. You will not be able to eat or drink until this is removed and you are no longer nauseated. You will continue to receive fluids and sugar through an IV.
  • When you are able to take things by mouth, you will be started on a liquid diet. Your diet will be progressed through soft foods to a regular diet.
Preventing Infection

During your stay, the hospital staff will take steps to reduce your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chance of infection, such as:

  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home

Recovery takes about 4-6 weeks. You will have a special diet and physical activity plan to help with your recovery. Follow instructions on wound care to prevent infection. Your doctor may advise pain medications for discomfort. Your liver will take over the functions of the gallbladder. Some people notice that they have a little more trouble digesting fatty foods, particularly for the first month after surgery.

Call Your Doctor    TOP

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
  • Cough, shortness of breath, chest pain
  • Increased abdominal pain
  • Pain that you cannot control with the medications you have been given
  • Blood in the stool
  • Persistent nausea and/or vomiting
  • Bloating and gas that last for more than a month
  • Pain and/or swelling in your feet, calves, or legs
  • Dark urine, light stools, or yellowing of the skin or eyes

If you think you have an emergency, call for medical help right away.

RESOURCES:

Gastro—American Gastroenterological Association
http://www.gastro.org
National Digestive Diseases Information Clearinghouse
http://digestive.niddk.nih.gov

CANADIAN RESOURCES:

The Canadian Association of Gastroenterology
http://www.cag-acg.org
Canadian Digestive Health Foundation
http://www.cdhf.ca

References:

Cholecystectomy. American College of Surgeons website. Available at: https://www.facs.org/~/media/files/education/patient%20ed/cholesys.ashx. Accessed May 28, 2013.
Cholecystectomy. EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated May 17, 2013. Accessed May 28, 2013.
Clayton ES, Connor S, et al. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg. 2006;93:1185-1191.
Gallbladder surgery: laparoscopic cholecystectomy. University of California at Davis website. Available at:
...(Click grey area to select URL)
Accessed May 28, 2013.
Martin DJ, Wernon DR, et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. Apr 2006;19(2):CD003327.
Last reviewed February 2015 by Michael Woods, MD
Last Updated: 3/18/2013