Cholecystectomy - Gall Bladder Removal

About the Procedure

A Cholecystectomy (Gall Bladder Removal) is the surgical removal of the gall bladder due to an acute inflammation or a chronic condition. A gall bladder "attack" refers to the sudden onset of inflammation when gallstones (solid, crystallized bile) interfere with the function of the gall bladder. This usually requires emergency surgery. Patients with chronic symptoms which have increased in frequency and intensity may elect to have this operation. The standard procedure for removing the gall bladder is laparoscopic which is preferred over the older, invasive, abdominal surgery (open cholecystectomy) because it decreases the possibility of post-surgical infection, the incision sites are small, heal quicker, and have less noticeable scars. During an elective laparoscopic cholecystectomy the surgeon may encounter a situation where it becomes necessary to convert to an open procedure. This option requires a hospital stay from two to six days.

The procedure is performed under general anesthesia and completed in one to two hours. Discharge following laparoscopic surgery may be as early as the same day but a one-night stay should be planned. Several small punctures are made in the right upper quadrant of the abdomen where the surgeon will insert laparascopic devices such as a light, a camera, and a cutting tool. The gall bladder is located, surrounding tissue is isolated, and the organ is cut from its base. An examination of local vessels and organs is performed because an acute gall bladder attack can be symptomatic of stones in ducts leading from the gall bladder. The site is closed using a variety of material at the doctor's discretion.

What to Know Before the Procedure

The gall bladder is a small organ which aids in digestion by storing bile produced in the liver and is secreted into the small intestines to stimulate digestion of fats. Removal of this organ does not present digestion problems for the majority of patients. Once gallstones are present the only way to eliminate them is through surgery. Non-acute symptoms can be treated short-term with medication, dietary, and lifestyle changes if the patient wishes to avoid surgery.

Preparation for the procedure may include cleansing the intestines the day prior to surgery, adding or changing medications to avoid excess bleeding during the procedure, and/or showering with a special antibiotic soap. Pre-admission blood work, x-rays, and EKG are performed days prior to the operation, and restrictions on food and water intake will be required. Plan in advance for a ride at discharge as post-operative pain medications may cause drowsiness. Assistance for the first few days is recommended since pain and tiredness are the chief complaints during recovery.

What to Know After the Procedure

During the first three to five days post-op, strenuous activities and heavy lifting are to be avoided, bandages will need changing, and patients may take a shower but are not to take a bath. Patients need to rest and driving is discouraged until their energy returns. Most people are able to return to a sedentary job in a week but those with strenuous jobs should seek the advice of their physician. Open cholecystectomy is major abdominal surgery; recovery from this procedure may take four to six weeks.

For most patients the pain and discomfort of gallstones, or other conditions which initiated the surgery, will be relieved. Occasionally, patients complain of diarrhea, which can be controlled with medication, and difficulty digesting food has been reported.

If you Need to Travel Outside of your Local Hospital

While laparoscopic surgery is used extensively for gall bladder removal both domestically and internationally, it requires a skilled surgeon with the experience and skill to perform it. Choosing the doctor to conduct this procedure is a primary concern. A discussion about the risks and complications, including the potential for a laparoscopic procedure being switched to an open abdominal one, should be discussed with the physician before deciding on where it will be performed. In the event that international travel is chosen speak with your doctor in detail about pre and post-operative care, recovery times, and acceptable travel arrangements.