Gallbladder Removal

Gallbladder Removal (Open or Laparoscopic)

The surgery to remove the gallbladder is called a cholecystectomy (say "co-lee-sist-eck-toe-mee"). With traditional surgery, the gallbladder is removed through a 5- to 8-inch long incision (cut) in your abdomen. The cut is made just below your ribs on the right side and goes to just below your waist. This is called open cholecystectomy.

A newer way to remove the gallbladder is called laparoscopic (say "lap-are-oh-skop-ick") cholecystectomy. With this surgery, a laparoscope (a small, thin tube with a scope on the tip of it that is used to see the inside of your body) is used to remove the gallbladder. Several small incisions are used rather than one large incision.

How is a Laparoscope used to Remove the Gallbladder?

The laparoscope is put into your body through a tiny cut made just below your navel. Your doctor can then see your gallbladder on a TV screen and do the surgery with tools inserted in 3 other small cuts made in the right upper part of your abdomen. Your gallbladder is then taken out through one of the incisions.

What are the Benefits of this Type of Surgery?

With laparoscopic cholecystectomy, you may return to work more quickly, have less pain after surgery, have a shorter hospital stay, and have a shorter recovery time. Unlike traditional surgery, laparoscopic surgery to remove the gallbladder can be done without cutting the muscles of your abdomen. The incision is also much smaller.

With laparoscopic cholecystectomy, you probably will only have to stay in the hospital overnight. With open cholecystectomy, you would need to stay in the hospital for about 5 days. Because the incisions are smaller with laparoscopic cholecystectomy, there isn't as much pain after this operation as after open cholecystectomy.

Who shouldn't have this Type of Surgery?

If you had surgery around your gallbladder before, if you tend to bleed a lot, or if you have any problem that would make it hard for your doctor to see your gallbladder, an open surgery may be better for you. Your doctor will decide which type of surgery is appropriate for you.

What are the Complications?

Complications are rare but may include bleeding, infection and injury to the duct (tube) that carries bile from your gallbladder to your stomach. Also, during laparoscopic cholecystectomy, the intestines or major blood vessels may be injured when the instruments are inserted into the abdomen. Remember, all of these complications are rare.

Open Gallbladder Surgery Overview

In open gallbladder surgery (cholecystectomy), the surgeon removes the gallbladder through a single, large incision in the abdomen. You will need general anesthesia, and the surgery lasts 1 to 2 hours. The surgeon will make the incision either under the border of the right rib cage or in the middle of the upper part of the abdomen (between the belly button and the end of the breastbone).

Doctors do most open gallbladder surgeries after trying first to remove the gallbladder with laparoscopic surgery. A few people have conditions that require open gallbladder surgery. For more information, see the Why It Is Done section below.

After surgery to remove the gallbladder, bile flows from the liver (where it is produced) through the common bile duct and into the small intestine. Because the gallbladder is gone, bile no longer is stored between meals. In most people, this has little or no effect on digestion.

What to Expect After Surgery

Surgery usually involves a hospital stay of 2 to 4 days or longer. Most people can return to their normal activities within 4 to 6 weeks. Open surgery involves more pain afterward and a longer recovery period than laparoscopic surgery.

This surgery leaves a moderately large scar [4 in.(10.2 cm) to 8 in.(20.3 cm) long].

No special diets or other precautions are needed after surgery.

Why it is Done

Several conditions may lead to surgery to remove the gallbladder. Conditions that may require open rather than laparoscopic surgery include:

• Severe inflammation of the bile duct or gallbladder
  
  
• Inflammation of the abdominal lining (peritonitis)
  
  
• High pressure in blood vessels in the liver (portal hypertension); this is caused by cirrhosis of the liver
  
  
• Being in the third trimester of pregnancy
  
  
• A major bleeding disorder or use of medicines to prevent blood clotting (blood thinners or anticoagulants)
  
  
• Scar tissue from many previous abdominal surgeries
  
  
• Abnormal anatomy in the abdomen
  

In about 5% of cases, a surgeon who starts a laparoscopic gallbladder procedure needs to switch to an open surgical method that requires a larger incision. Examples of problems that can require open rather than laparoscopic surgery include unexpected inflammation, scar tissue, injury, or bleeding.

How Well it Works

Surgery reduces the risk that gallstones will come back. However, gallstones sometimes form in the bile ducts years after cholecystectomy, although this is not common.

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