Gallbladder Surgery (Cholecystectomy)

Patient Education > Gallbladder > Gallbladder Surgery (Cholecystectomy)

HOW DOES BILE AID DIGESTION?

Your liver makes bile and transports it to other parts of your digestive system through a series of bile ducts connecting the liver to the duodenum (first part of the small intestine). Some bile is also sent to the gallbladder for storage until it is needed later for digestion. Bile passes in and out of the gallbladder through the cystic duct into the main or common bile duct emptying into the small bowel. Special hormones (chemicals made by the body released during digestion) signal the gallbladder to release bile after a large or fatty meal. Bile and food then mix in the duodenum along with pancreatic digestive juices. The digestive process then continues down the small bowel.

WHAT ARE SYMPTOMS OF GALLBLADDER DISEASE?

Many people who have gallstones or gallbladder disease without gallstones (called biliary dyskinesia) have symptoms develop after eating a large or fatty meal. This may include pain in the right upper quadrant or mid abdomen lasting for a few minutes to a few hours, pain in the back between the shoulder blades, pain under the right shoulder, nausea, vomiting, steady or severe pain in the upper abdomen increasing rapidly and lasting from 30 minutes to several hours, abdominal bloating, recurrent intolerance of fatty foods, belching, increased gas passage (flatus), indigestion, sweating, chills, low grade fever, yellow skin, clay colored stools. Often patients confuse gallbladder symptoms with reflux, peptic ulcer or heart disease. Symptoms often occur during or within half an hour of eating a large meal. Frequently they occur later in the evening. Weeks, months or even years may pass between episodes of gallbladder pain. Some patients describe this as colic (severe debilitating localized pain). Many people with gallstones have no symptoms. These patients are said to be asymptomatic and these stones are called “silent gallstones”. If they do not interfere in gallbladder, liver, or pancreas function and do not cause symptoms, they may not require treatment.

DO PEOPLE NEED THEIR GALLBLADDERS?

Fortunately, the gallbladder is an organ that people can live without. Losing it will not even require a change in diet. Once the gallbladder is removed, bile flows out of the liver through the biliary duct system directly into the small intestine instead of being stored in the gallbladder. However, because the bile is not stored in the gallbladder, it flows into the small intestine more frequently causing diarrhea in some people. Also, some studies suggest that removing the gallbladder may cause higher blood cholesterol levels, so occasional cholesterol tests may be necessary.

WHAT DOES THE NORMAL GALLBLADDER DO?

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The gallbladder is a small, pear-shaped, sac-like organ attached to the undersurface of the liver in the mid to right upper part of the abdomen. The liver produces bile, a fluid that breaks down fats in food and aids digestion. Some of this bile is stored in the gallbladder. The gallbladder concentrates the bile by removing water. Some of the chemicals may crystallize and form gallstones. After a fatty meal the gallbladder contracts squeezing bile through the ducts into the small intestine. If a diseased gallbladder is removed, the liver still makes bile to aid digestion. It is the gallbladder’s job to store and release bile, a fluid made by the liver to help digest fats in the foods eaten.

HOW DOES YOUR DOCTOR DETERMINE IF YOU HAVE A GALLBLADDER PROBLEM?

Your physician will thoroughly review your medical history and perform a physical examination. You may also have a series of tests to help find out if you have a problem with your gall-bladder. This may show you have gallstones and where these stones are located. These tests may also determine if you have a functional disorder of your gallbladder without gallstones (biliary dyskinesia). Your doctor will ask you about your symptoms, health problems or other factors that point to gallbladder disease. During an examination he may elicit tenderness in the middle or right upper portion of your abdomen. Various diagnostic tests may be suggested including an ultrasound. This uses painless sound waves to scan your abdomen for gallstones. Blood tests check your liver and pancreas functions and can suggest stones in your bile duct. Additional imaging studies such as a CT scan (computerized tomography) or a HIDA (hepatobiliary) scan also produce images of your gallbladder. A special scan called a CCK HIDA scan may determine if your gallbladder is functioning abnormally even in the absence of gallstones.

HOW DO I KNOW IF MY DOCTOR CAN PERFORM A LAPAROSCOPIC CHOLECYSTECTOMY INSTEAD OF AN OPEN GALLBLADDER SURGERY?

If you have had major surgery in the past with significant scarring (adhesions), you may not be a good candidate for a laparoscopic surgery. This is particularly true if your surgeries involved the upper abdomen. In addition, if you suffer from certain bleeding disorders, liver disease, or severe intra-abdominal infection, you may not be a good candidate for a laparoscopic surgery. If you are pregnant or near your due date or have another condition that may make it hard for your surgeon to view your gallbladder with a laparoscope, you may be advised to undergo open rather than laparoscopic surgery.

WHAT ARE THE RISKS AND COMPLICATIONS OF GALLBLADDER SURGERY?

Bleeding, infection, injury to surrounding organs (liver, blood vessels, nerves, pancreas, small bowel, colon, abdominal wall, etc), injury to common bile duct, blood clots, indigestion, nausea, vomiting, neuroma (painful spot), or numbness near the incision, incisional hernia, retained or continued formation of stones in the common bile duct.

WHAT ARE SOME WAYS THAT A PATIENT CAN PREPARE FOR SURGERY?

Stop eating fatty or fried foods. Follow the surgeons instructions for blood tests or other imaging studies as directed. Discuss any prior anesthesia problems with the anesthesiologist. Do not drink or eat anything (even water) after midnight the night before surgery. Tell your doctor about all prescription and over the counter medication you take, especially aspirin, blood thinners or herbal remedies. Ask if you should stop taking any medications before surgery and clarify which medicines (heart, blood pressure, diabetes) you should take prior to surgery. Arrange to have someone drive you home after surgery. Check with your doctor for any special instructions.

WHAT CAN I EXPECT FROM MY GALLBLADDER SURGERY EXPERIENCE?

With laparoscopic cholecystectomy you may be discharged the day of or the day after surgery. In either event, only a short hospital stay is usually needed. Your surgery is performed through several small incisions. The laparoscope is inserted through one incision to place a light and camera inside your abdominal cavity. The camera lets your surgeon view your abdominal contents and gallbladder. Your surgeon inserts special instruments through the other small incisions to cut, clip, tie and remove the gallbladder. The surgery generally takes between 1-2 hours.

WHAT HAPPENS DURING MY LAPAROSCOPIC SURGERY?

The anesthesiologist will give you an IV medication to deeply sedate you and then place you under a general anesthetic. A breathing tube will be placed in your windpipe to ensure oxygen delivery and allow close monitoring by the anesthesiologist during your operation. Your abdomen will be inflated with carbon dioxide (C02) gas to help your surgeon see and move instruments inside your abdominal cavity. This gas will be removed, with any residual gas dissolving (without symptoms) at the end of your surgery. During surgery a cholangiogram (x-ray of the bile duct system) may be performed. The x-ray may reveal stones in your bile duct which may need to be removed at the time of surgery or during a subsequent procedure called an Endoscopic Retrograde Cholangeo Pancreatography (ERCP). In rare cases your surgeon may feel it is not safe to continue a laparoscopic cholecystectomy once it has begun. If so, your gallbladder is removed through a standard/larger incision in the right upper part of your abdomen, beneath your ribcage. Tiny clips are used to close off the ducts and blood vessels at the base of the gallbladder before it is removed. These clips stay in your body and are harmless. They do not interfere with future CT scans, MRI’s or airport metal detectors. Your gallbladder is then detached from your liver using an electric current (cautery) device.

WHAT CAN I EXPECT FROM MY RECOVERY?

Most patients having laparoscopic surgery go home the same day or the day after surgery. Normal full recovery is 7-10 days. Incisions are small, therefore, there is less pain and faster healing. Within weeks your digestive system will adjust and you will be able to eat normally. Patients with administrative or desk jobs (primarily sitting without walking or lifting) can return to work within a few days to 1 week. Those patients requiring more physical activity (heavy lifting, bending, twisting or being on their feet for 8 hours or more) may require a week or two longer to recover.

WHAT HAPPENS TO ME IN THE HOSPITAL BEFORE I GO HOME?

When you wake up after surgery you will be in a recovery room. Small bandages will cover your incisions. An IV with tubing will be in place until you can drink fluids. You may have discomfort or nausea requiring medications which can be delivered through your IV. You may experience some discomfort in your right shoulder for a short time due to the gas inflation of your abdomen. This will go away within a day or two. Within hours after surgery you may be drinking liquids and walking. You may be able to eat a light meal later that day if you desire and then go home or wait until the following morning to go home. The nurses will ask you to take deep breaths and cough to keep your lungs clear. You will be asked to take short walks to improve circulation in your legs and prevent blood clots from forming. You will need to continue your regular medications.

WHAT CAN I EXPECT AT HOME FOLLOWING MY GALLBLADDER SURGERY?

When you return home you must continue to follow instructions to speed your recovery. Have a thermometer available during the first few days to ensure you do not have a fever. Avoid heavy lifting or vigorous exercise. We request patients do not drive for the first few days until they are off all pain medications and have resumed normal strength and reflexes. You may shower over most dressings (clear plastic called opsite) but should check with your doctor. Gradually over the next 3-5 days you can increase and resume more normal activities. Be aware that pain medications can cause short-term changes in bowel habits such as constipation. You may experience some bruising and discomfort at your incision sites. For the first day at home, application of ice will be helpful. Thereafter, the application of warm, moist heat utilizing a heating pad or hot tub bath will provide relief. Be careful not to burn yourself. Expect to have some gas pains or other discomfort while your digestion returns to normal and your body adjusts to the loss of your gallbladder. During this short time, eat whatever was easy for you to digest before your surgery. Within the first 7-10 days after surgery you will usually be seen for a postoperative visit by your surgeon to check your progress and answer your questions. Additional appointments will be scheduled as needed. Call your doctor immediately if you develop a fever over 101F ° (38.5C ° ), chills, shakes, or sweats. You should also notify your physician if your incision drains large amounts of fluid or blood, enlarges, becomes red, swollen, tender, or exudes a pus-like material. Finally, call your physician with any increasing pain, abdominal distention, nausea, vomiting, or any other acute change in your condition.