Cholecystectomy—Laparoscopic Surgery

(Gallbladder Removal; Lap Chole)

by Rosalyn Carson-DeWitt, MD

Click here to view an animated version of this procedure.

Definition

Cholecystectomy is the surgical removal of the gallbladder. This procedure is most often done laparoscopically. This is done through several small incisions in the abdomen. In some cases, the doctor may switch to open surgery. This involves a larger incision in the abdomen.

Laparoscopic Cholecystectomy vs. Open Cholecystectomy

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

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

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
  • EKG and chest x-ray —to make sure that the heart and lungs are healthy enough for surgery
  • MRI or CT scan to better view the gallbladder

Leading up to your procedure:

  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, like:
    • Anti-inflammatory drugs
    • Blood thinners
    • Antiplatelets
  • Arrange for a ride to and from the procedure. Also, have someone help you at home.
  • The night before, eat a light meal. Do not eat or drink anything after midnight.
  • You may be given:
    • Laxatives and/or an enema
    • Antibiotics
  • If instructed, shower before the procedure. You may be given special soap to use.

Anesthesia

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

Description of Procedure

Four small openings will be made in your abdomen. Carbon dioxide will be pumped into the abdomen to provide a better view.

The laparoscope will be inserted through one of the openings. It will provide images of the gallbladder and surrounding area. Instruments will be inserted through the other openings. They will be used to grasp the gallbladder and clip off the main artery and duct. The gallbladder will be removed through one of the openings. Dye may be injected into the duct to look for stones, which may be removed if found. The entire abdomen will be carefully examined. The incisions will be closed with sutures or staples. They will be covered with bandages.

A tiny, flexible tube may be placed into the area. This tube will exit from your abdomen into a little bulb. This is to drain fluid. The tube is usually removed within one week.

Immediately After Procedure

You will be taken to a recovery room.

How Long Will It Take?

About 30-60 minutes

How Much Will It Hurt?

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

Average Hospital Stay

If you do not have any problems, you may be able to go home the same day as the surgery or the next day.

Post-procedure Care

At the Hospital

After the procedure, the hospital staff will:

  • Monitor you for any problems
  • Give you medications for pain and nausea
  • Provide you with nutrition through an IV if you have a tube in your stomach to drain fluid
  • Help you to slowly progress from a liquid diet to soft foods

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 three weeks. When you return home, do the following to help ensure a smooth recovery:

  • Follow your doctor’s instructions.
  • Follow the recommended diet and activity plan.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.

Your liver will take over the functions of the gallbladder. You may notice that you have more trouble digesting fatty foods, especially during the first month of recovery.

Call Your Doctor    TOP

Call your doctor if any of these occur:

  • 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 persist 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:

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:

About cholecystectomy: surgical removal of the gallbladder. American College of Surgeons. Medem website. Available at:
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Accessed July 11, 2008.
Cholecystectomy. American College of Surgeons website. Available at:
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Accessed May 28, 2013.
Clayton ES, Connor S, Alexakis N, Leandros E. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ . Br J Surg. 2006;93:1185-91.
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, Toouli J. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. Apr 2006;19(2):CD003327.
Patient information for laparoscopic gallbladder removal (cholecystectomy) from SAGES. Society of American Gastrointestinal and Endoscopic Surgeons website. Available at:
...(Click grey area to select URL)
Accessed May 28, 2013.
Last reviewed February 2014 by Michael Woods, MD
Last Updated: 02/10/2014