Gallbladder Surgery: What to Expect on the Day of Surgery

To thoroughly understand what happens the day of gallbladder surgery, it’s important to know which type of surgery you will be having and why. In most circumstances, when the gallbladder is diseased, it is the result of gallstones. But there are other underlying conditions that may warrant gallbladder surgery, such as cancer of the gallbladder or inflammation of the gallbladder (cholecystitis).

Usually, the treatment of choice for various conditions of the gallbladder is a cholecystectomy (removal of the gallbladder). That’s because a person can function normally without a gallbladder. It may be done by a minimally-invasive or open surgery.

Before the Surgery

Before gallbladder surgery, it’s important to follow your surgeon’s instructions. Common preoperative orders include:

• No drinking or eating
• Take only medications that have been approved by the surgeon (with a small sip of water)
• Take a bath or shower before going to the hospital or outpatient center
• Do not apply lotion, deodorant, perfumes, or nail polish
• Do not shave the surgical site (abdomen)
• Remove all jewelry and/or contact lenses
• Bring a photo ID to the outpatient center or hospital
• Be prepared to answer a few questions before surgery (such as your full name, type of surgery you are expecting to have, which body part will be operated on).

As part of the admission procedure, an IV will be placed in your vein to administer fluids during the procedure and to administer medicines that help you to relax, before surgery. The combination of different medications given before and during surgery (including pain management medicine called anesthesia to put you to sleep) may result in a lack of memory after the procedure is over.

The surgeon usually discusses options for the type of anesthesia you will get (including the risks and side effects) before the day of the procedure. But, if you still have questions on the day of surgery, don’t hesitate to discuss them with your surgeon or another healthcare provider.

During the Surgery

There are categories that describe the different types of gallbladder surgery, including traditional open surgery and minimally invasive surgery. Be sure you confirm the technique to be used with your physician and ask questions so you understand what to expect.

• Minimally invasive surgery is performed via one or more small incisions in which a thin, tube-like instrument with a light and a lens for viewing is inserted through one opening to guide the surgery. Note, minimally invasive surgery can be used to describe traditional laparoscopic surgery (involving the surgeon guiding small instruments by hand) or it can be done with the assistance of robotic arms (called robotic-assisted surgery).
• Robotic-assisted surgery involves a computer console where the surgeon sits to control each move the robot arms make (in real time). The advantage of robotic-assisted surgery is that the surgeon gets a much better magnified 3D view of the surgical site, and it provides a greater range of motion and precision during the procedure.
• Open surgery is the traditional method of cutting the skin and making a large incision so that the surgeon has a full view of the gallbladder.

Tests

Although most of the preliminary tests will most likely be performed before the day of surgery, some tests are done immediately before or during the procedure.

Intraoperative Cholangiogram

In the case of gallbladder surgery, an X-ray called a cholangiogram may be done during your surgery. The test involves dye that is injected into the common bile duct. Next, an X-ray is taken so the surgeon can check to see if there are any gallstones in the bile duct. If stones are present, the surgeon will remove the stones with a special instrument, during the cholecystectomy.

Laparoscopic Ultrasound (LUS)

A laparoscopic ultrasound (LUS) may be performed as an alternative to an intraoperative cholangiography during a minimally invasive cholecystectomy procedure. The LUS has been described as a very simple and reliable way of viewing the common bile duct during laparoscopic gallbladder surgery.

According to the World Journal of Gastroenterology, "It is particularly useful for identifying the location of the common bile duct (CBD) and common hepatic duct (CHD) during difficult operative circumstances when the anatomy is obscured."

This procedure, like the intraoperative cholangiogram, allows the surgeon to detect any stones in the common bile duct. LUS also helps the surgeon see the anatomy of the bile ducts, which lowers the risk of accidental damage to the common bile duct (a common complication that can occur during the procedure).

Steps for Gallbladder Removal

Minimally invasive surgery may involve traditional laparoscopic or robotic-assisted surgery. Both types of minimally invasive surgery are performed to promote quicker recovery time, reduce bleeding, and lower the risk of infection and pain after surgery.

The steps involved in a laparoscopic cholecystectomy include:

1. You will be asked to remove your jewelry or other objects that could possibly interfere during surgery.
2. You will be asked to remove your clothing and put on a hospital gown.
3. You will be positioned on your back on the operating table.
4. If you have an excessive amount of body hair near the surgical site, it may be clipped off.
5. The skin over the surgical site will be cleaned with a sterile antiseptic solution.
6. An IV will be inserted and you will receive initial medication to induce relaxation.
7. General anesthesia will be administered.
8. A tube will be inserted into your trachea to help with breathing during the procedure.
9. The anesthesiologist (the doctor who administers the anesthesia) will continually monitor your vital signs (blood pressure, heart rate, and breathing) as well as checking your blood oxygen level during the surgery.
10. Once the anesthesia has induced sleep, the surgeon makes a small incision (close to the belly button) and inserts a port (a small device that creates an opening).
11. The abdomen is filled with gas via the port (to create space to perform the procedure).
12. A small camera is inserted through the port (showing the surgery on a screen in the operating room).
13. More ports (usually three to four total) are created once the surgeon can view the gallbladder area clearly.
14. Long, narrow instruments are placed in the additional ports (the instruments are used to perform the surgery).
15. The gallbladder is disconnected and taken out of the body through one of the incisions.
16. Once the surgery is complete, the surgeon closes the incisions with very small stitches, staples, surgical tape, or glue (these do not need to be removed, they will dissolve as the incision heals).

During Robotic Surgery

Robotic surgery is replacing traditional laparoscopic surgery more and more. It’s important to note that robotic surgery is a type of minimally invasive surgery. In fact, it’s very similar to laparoscopic surgery and the steps are the same. The difference is that during robotic-assisted surgery, the surgeon guides the robot, instead of directly guiding the instruments by hand.

During Traditional (Open) Cholecystectomy

Your surgeon may have scheduled a planned open cholecystectomy, or a minimally invasive cholecystectomy procedure may need to be switched (during the surgery) to an open method, to ensure your optimal safety. Common reasons for a planned open procedure may include:

• Scars or inflammation (possibly from an earlier surgery)
• Obesity (which causes problems seeing organs clearly through a scope)
• Bleeding problems that occur during surgery

Sometimes, during the planned minimally invasive surgery, the procedure is switched to an open method when it is decided that an open method is safer. This could be because of the particular anatomy of a person’s gallbladder (making it difficult to view through the scope) or due to other reasons.

The steps up to and including administration of general anesthesia are the same regardless of which type of gallbladder surgery you are having. The remaining steps performed during an open cholecystectomy include:

1. After the anesthesia has induced sleep, a 6-inch incision is made in the right side of the abdomen, just below the ribs, or the incision may be made in the upper part of your abdomen.
2. The muscle and tissue is pulled back to expose the gallbladder and liver.
3. The surgeon removes the gallbladder (using traditional large-sized instruments).
4. In some instances, a drain (or more than one drain) may be placed into the incision to help allow fluids or pus to drain away from the incision.
5. The incision is sutured, a dressing is placed over the incision, and you are taken to the recovery room

After the Surgery

When you wake up from surgery, you will be in the recovery room. This is a place where people who have had surgery can be closely watched for any post-op (after surgery) complications that could occur.

The nurse will frequently check your vital signs (including your pulse, blood pressure, breathing and temperature) and other signs and symptoms. It’s vital to let the nurse know if you have any questions, are concerned about symptoms you are experiencing or are wondering what to expect next.

Under most circumstances, patients recovering from an uncomplicated cholecystectomy will stay in the recovery room for at least an hour or more.

Pain

After gallbladder surgery, you will feel some pain at the incision site/s of your abdomen. If you had a minimally invasive procedure, you may also feel some pain in the shoulder area (this is the result of the carbon dioxide gas that was inserted during the procedure). The shoulder pain will usually subside within 24 to 48 hours after surgery.

Follow your surgeon’s post-operative (after surgery) instructions regarding pain medications. In addition to taking pain relievers, putting ice on the incision site can help alleviate pain; but, always discuss the safe use of ice with your nurse or other healthcare provider, and don’t use ice unless you have your surgeon’s approval.

Your surgeon or the nurse should provide you with information about how long to expect pain, and what to do/take for it. Generally, over-the-counter, anti-inflammatory pain medications such as ibuprofen (Motrin, Advil) can be taken; sometimes narcotics are prescribed. Only take pain medication that is prescribed by your healthcare provider.

Nausea

Another symptom that is common after gallbladder surgery is nausea, you may also experience vomiting; these symptoms should subside within a day or two after the procedure. If you continue to have vomiting or nausea, be sure to consult with your healthcare provider.

Be sure to follow your surgeon’s instructions for after the surgery, including pain management, wound care, and activity.

Discharge

Discharge criteria include standards a person must meet before being discharged from a hospital or outpatient center. Facilities may differ regarding which standards, exactly, constitute a patient’s discharge, but common criteria include:

• Being able to walk and move about safely
• Tolerating an oral diet (which may consist of liquids and bland, low-fat solids)
• Having stable vital signs (including blood pressure, pulse, temperature, and breathing rate)
• Exhibiting an absence of excessive pain, nausea, vomiting, or bleeding

Open Surgery Discharge

If you had a minimally invasive cholecystectomy, you will most likely be going home the same day you have your surgery. But those undergoing an open procedure will need to stay in the hospital (usually for two to four days after the procedure).

Either way, it’s important to have a reliable friend or family member drive you home after the procedure. The nurse will go over your discharge instructions right before you leave the hospital. It may be helpful to have someone help take notes about your aftercare orders, due to the fact that the medications (given before and during surgery) can impact your memory.

Resuming Normal Activity

You should expect to feel better each day after the procedure. If your job does not require physical exertion, you may be able to return to work (and your normal activity) in one to two weeks. But, if you lift heavy objects, or are very active in your job, it could take up to a month.

If you had an open cholecystectomy it may take four to six weeks before getting back to your normal daily routine.  Be sure to consult with your healthcare provider before driving, resuming normal activity, or going back to work after your surgery.