Cholecystectomy—Open Surgery Overview

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Cholecystectomy is the surgical removal of the gallbladder organ. This organ lies near the liver. It stores bile that is made by the liver. Bile helps in the digestion of fatty foods. The gallbladder releases bile into a system of ducts that lead to the small intestine.

The open version of this surgery is done when the surgeon may not be able to perform a less invasive version called laparoscopic surgery .

Laparoscopic Cholecystectomy vs. Open Cholecystectomy © 2009 Nucleus Medical Media, Inc.

Prior to Procedure

Your doctor will probably do some or all of the following:

• Blood tests to evaluate liver function
• Ultrasound to visualize gallstones
• HIDA scan (hepatobiliary iminodiacetic acid scan)—an x-ray test that uses a chemical injected into the gall bladder to create pictures of your liver, gallbladder, ducts, and small intestines
• Other radiological scans to better view the gallbladder
• EKG and chest x-ray to make sure that your heart and lungs are healthy enough to withstand the stresses of surgery

Leading up to your procedure:

• Talk to your doctor about your current medicines. Certain medicines may need to be stopped before the procedure, such as:

• Aspirin or other anti-inflammatory drugs for up to one week before surgery
• Blood-thinning drugs such as warfarin (Coumadin)
• clopidogrel (Plavix)
• Arrange for a ride to and from the procedure.
• Arrange for help at home after returning from the hospital.
• The night before, eat a light meal. Do not eat or drink anything after midnight.
• You may be given laxatives and/or an enema to clean out your intestines.
• You may be given antibiotics.
• You may be asked to shower the morning before surgery. You may be given a special anti-bacterial soap.

Anesthesia

General anesthesia will be used. You will be asleep for the procedure.

Description of Procedure

The doctor will make an incision in the upper right area of your abdomen. The gallbladder will be separated from the surrounding structures, including the liver, bile ducts, and arteries.

Once the gallbladder is gone, your doctor may squirt dye into the remaining ducts. This will help show if there is a gallstone in the ducts. The duct may be opened to remove any stones. While your abdomen is open, your doctor will carefully examine the other organs and structures in the area. This will be done to make sure that you do not have any other problems. The incision will be closed with either sutures or staples. It will then be covered with a bandage.

Your doctor may place a tiny, flexible tube into the area where the gallbladder was removed. This tube will exit from your abdomen into a little bulb. This is to drain any fluids that may build during the first few days after surgery. The tube is usually removed within one week after your operation.

Immediately After Procedure

The gallbladder will be examined by a pathologist. You will be taken to a room to recover where you will be monitored closely.

How Long Will It Take?

About 30-60 minutes

How Much Will It Hurt?

You will most likely feel some pain after the surgery. Your doctor will arrange for pain medicines.

Average Hospital Stay

2-6 days

Post-procedure Care

At the Hospital

• You will be monitored for any problems.

• You may need medicines for nausea.

• You may have a nasogastric tube, which is a tube that will go from your nose, down your throat, and into your stomach. The tube will help to drain fluids and stomach acid. You will not be able to eat or drink until this is removed and you are no longer nauseated. You will continue to receive fluids and sugar through an IV.

• Once you are able to take things by mouth, you will be started on a liquid diet. Your diet will be progressed through soft foods to a regular diet.

At Home

Recovery takes about 4-6 weeks.

When you return home, do the following to help ensure a smooth recovery:

• Be sure to follow your doctor’s instructions .

• You will get a diet and physical activity plan to help you through recovery. Following the plan will help your recovery.

• Your liver will take over the functions of the gallbladder. Some people notice that they have a little more trouble digesting fatty foods, particularly for the first month after surgery.

RESOURCES:

American Gastroenterological Association
http://www.gastro.org/

National Digestive Diseases Information Clearinghouse
http://digestive.niddk.nih.gov/

CANADIAN RESOURCES:

The Canadian Association of Gastroenterology
http://www.cag-acg.org/

Canadian Digestive Health Foundation
http://www.cdhf.ca/

References:

About cholecystectomy: surgical removal of the gallbladder. American College of Surgeons. Medem website. Available at: http://www.medem.com/ . Accessed July 11, 2008.

Clayton ES, Connor S, Alexakis N, Leandros E. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg. 2006;93:1185-91.

Gallbladder removal. Baylor College of Medicine Department of Surgery website. Available at: http://www.debakeydepartmentofsurgery.org/home/content.cfm?procname=cholecystectomy&contentid=272 . Accessed July 11, 2008.

Gallbladder surgery: laparoscopic cholecystectomy. University of California at Davis website. Available at: http://www.ucdmc.ucdavis.edu/surgery/specialties/gastro/gall.html . Accessed July 11, 2008.

Laparoscopic surgery: bile, duct, and gallbladder. New York University School of Medicine website. Available at: http://www.nyulaparoscopy.org/surgeries/gallbladder.html#stones . Accessed July 11, 2008.

Martin DJ, Wernon DR, Toouli J. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. Apr 2006;19(2):CD003327.

Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston Textbook of Surgery. 16th ed. Philadelphia, PA: WB Saunders; 2001;1076-1095.

What are the surgical procedures for gallstones and gallstone disease? University of California at Davis website. Available at: http://www.ucdmc.ucdavis.edu/ . Accessed August 16, 2003.