Gallbladder Surgery: Overview

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Gallbladder surgery (cholecystectomy) entails the removal of the gallbladder, a pear-shaped organ located in the upper right side of the abdomen that stores bile. Gallbladder surgery is used to treat several gallbladder-related conditions, most commonly gallbladder inflammation (cholecystitis) from gallstones.

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What Is Gallbladder Surgery?

Gallbladder surgery is performed by a general surgeon in a hospital under general anesthesia. In select cases (e.g., an intolerance to general anesthesia), the operation may be performed under spinal anesthesia.

While the surgery can be scheduled in advance, in cases of severe inflammation, gallbladder surgery is performed emergently.

Various Surgical Approaches

There are a few surgical approaches that may be used to remove a patient's gallbladder.

  • Open: With this approach, the gallbladder is removed through a single large incision (about four to six inches in length) made in the upper right side of the abdomen.
  • Laparoscopic: With this minimally invasive approach, the surgeon makes four tiny incisions in the abdomen. A long, thin instrument that has a camera attached to it, called a laparoscope, is inserted into one of the incisions. This instrument allows the surgeon to visualize the abdominal organs through images projected onto a TV screen. Various surgical instruments are inserted through the other incisions to remove the gallbladder.
  • Robot-assisted: With this emerging and developing minimally invasive approach the surgeon views high-definition images of the abdomen while sitting at a computer console. The surgeon then uses controls to move robotic arms with attached surgical instruments to perform the surgery.

In terms of hospitalization after surgery, the open approach always requires a hospital stay. With the laparoscopic or robotic-assisted approach, select patients may be able to go home on the same day of surgery.

Overall, laparoscopic gallbladder surgery is the preferred approach for gallbladder surgery. When compared to open surgery, it is associated with less bleeding and a shorter recovery time.

There are patient scenarios, however, in which open surgery is the necessary approach. For example:

  • Patients who have or are strongly suspected of having gallbladder cancer
  • Patients who need gallbladder surgery as part of another operation (e.g., the Whipple procedure for pancreatic cancer)
  • Patients with a history of multiple upper abdominal surgeries with scar tissue

When comparing laparoscopic gallbladder surgery to robotic-assisted gallbladder surgery, the robotic-assisted approach is more costly and requires a slighter longer operation time. The robotic-assisted approach has also not been found to be more effective or safer than the laparoscopic gallbladder surgery for noncancerous gallbladder disease.

Contraindications

Absolute contraindications to undergoing gallbladder surgery include:

Relative contraindications include:

Potential Risks

While gallbladder surgery is generally low-risk, some potential surgical risks include:

  • Bleeding within the abdomen
  • Bile leakage from an injury to a bile duct
  • Wound infection or infection of the abdominal cavity (peritonitis)
  • Incisional hernia
  • Hematoma (blood collection) of the abdominal wall
  • Retained gallstones in the bile duct
  • Injury to the intestines or liver
  • Spilled gallstones in the abdominal cavity, potentially resulting in abscess formation

Purpose of Gallbladder Surgery

The purpose of gallbladder surgery is to treat medical conditions that affect your gallbladder, such as:

The gallbladder is what stores fluid produced by the liver and feeds it to your small intestine, helping your body break down the food you eat—in particular, fats. While the removal of any organ is considered with great care, the pros of removing the gallbladder when indicated invariably outweigh the cons.

You can live a healthy life without a gallbladder; bile that would normally be stored there will simply travel straight to the small intestine.

How to Prepare

If your surgery is scheduled, your surgeon will give you various preparatory instructions, such as:

  • Wearing loose-fitting, comfortable clothes on the day of your surgery.
  • Not eating prior to surgery (typically four to twelve hours)
  • Stopping certain medications for a period of time before your surgery—for example, nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Bringing personal items, like a toothbrush and hairbrush, for your hospital stay (if undergoing open surgery)
  • Arranging to have someone drive you home (if undergoing laparoscopic gallbladder surgery)

What to Expect on the Day of Surgery

What happens during your surgery depends on the approach the surgeon uses. Regardless of the approach used, the procedure should take about one to two hours.

To give you a sense of what's involved, here is a brief walk-through of how laparoscopic gallbladder surgery (the most common procedure) is done:

  • Vital signs are taken, an IV catheter and a urinary catheter are placed, and anesthesia medication is delivered to put you to sleep. The skin of your abdomen is prepared with an antibacterial solution.
  • The surgeon will begin by making four small incisions, approximately half an inch long, in the upper-right side of the abdomen—two for access for surgical instruments, one to allow the laparoscope to be inserted, and one for a port that releases carbon dioxide gas to inflating the abdomen.
  • The surgeon will then separate the gallbladder from the healthy tissue and place it in a sterile bag to allow it to pass through one of the small incisions. A drain may be placed in the abdomen to prevent fluid (bile and blood) from collecting.
  • The surgeon will then inspect the area where the gallbladder was removed and close the ducts that were connected to it.
  • If there are no signs of leaking, the port will be removed. The remaining gas will leak out of the incisions as the instruments are taken out.
  • The incisions will then be closed with stitches or surgical staples. A sterile bandage or adhesive strips will be placed over them.
  • Anesthesia will be stopped and you will be taken to a recovery area.

Recovery

In the recovery area, a nurse will monitor your vital signs (e.g., blood pressure and heart rate) and help control common post-surgical symptoms, like pain and nausea.

If you underwent a laparoscopic or robotic-assisted cholecystectomy, you may stay in the hospital for one or two nights or be discharged from the recovery room after around six hours. In this case, you will need to have a family member or friend drive you home where you will finish recovering.

If you underwent open surgery, you will be taken to a hospital room where you will stay for approximately two to four days.

As you recover in the hospital, you can expect the following:

  • You will be given pain medication (an opioid) through your IV. When ready, you will be transitioned to an oral pain medication.
  • If you had a nasogastric tube placed in the operating room and it was not removed in the recovery room, it may be taken out. At that time, you will be able to drink liquids and slowly advance to solid foods, as tolerated.
  • You may be given a blood thinner or compression boots to prevent blood clots.
  • You will be asked to use an incentive spirometer to strengthen your lungs after surgery.
  • Your urinary catheter and any abdominal drain(s) placed will typically be removed within a few days of being in the hospital.

Once discharged from the recovery room or hospital, you will have various post-operative instructions to follow at home.

These may include:

  • Keeping your incision site(s) clean and dry.
  • Taking your pain medication as directed.
  • Restricting certain activities, like heavy lifting, swimming, or sports for one to four weeks.

Full recovery from open gallbladder surgery takes about six weeks; recovery from a laparoscopic surgery takes about four weeks.

When to Seek Medical Attention:

When recovering from gallbladder surgery, be sure to contact your doctor if you experience any of the following symptoms:

  • Persistent or severe abdominal pain, cramping, or swelling
  • Fever or chills
  • Redness, swelling, bleeding, or abnormal drainage at the incision site(s)
  • Signs of jaundice (yellowing of your skin and the whites of your eyes)
  • No bowel movement or gas for three days
  • Nausea or vomiting

Long-Term Care

To ensure that you are healing and recovering well after surgery and to monitor for complications, it's important to attend all follow-up appointments with your surgeon. These appointments are usually scheduled at two weeks and then four or six weeks after surgery.

While the goal of gallbladder surgery is to alleviate symptoms of gallstones (in most cases), a small subset of patients continues to have symptoms after surgery, including nausea, vomiting, bloating, jaundice, diarrhea, or abdominal pain.

This phenomenon is termed post-cholecystectomy syndrome (PCS), and it may occur early (hours to days) or later (weeks to months) after the gallbladder is removed. Since there are multiple potential etiologies that may cause this syndrome, your surgeon may need to perform imaging of your abdomen as well as blood tests at your follow-up appointments.

A Word From Verywell

While gallbladder surgery is a common operation, it nevertheless poses risks. If you (or a loved one) are undergoing this surgery, be sure to adhere to your post-operative instructions, and reach out to your surgical team with any questions or concerns.

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