Cholecystectomy (gallbladder removal)

What is a cholecystectomy?

A cholecystectomy refers to a surgery to remove the gallbladder. The gallbladder is a small organ under the liver. It's on the upper right side of the belly (abdomen). The gallbladder stores a digestive juice known as bile, produced in the liver.

There are two types of surgery to take out the gallbladder:

Open (traditional) method

• In this method, 1 cut about 4 to 6 inches long is done in the upper right-hand side of the belly.
• The surgeon locates the gallbladder and takes it out through the cut.

Laparoscopic method

• This method uses 3 to 4 tiny incisions. It utilises a long, thin tube known as a laparoscope. 
• The tube has a small video camera as well as surgical tools. The tube, camera, and tools are inserted inside through the cuts. 
• The surgeon performs the surgery while looking at a TV monitor. The gallbladder is taken out through one of the incisions. 
• A laparoscopic cholecystectomy is less invasive. That means it uses tiny incisions in the belly. There is less Bleeding. The recovery time is usually shorter than that for open surgery.
• In some cases, the laparoscope may show that the gallbladder is very diseased. Or it may depict other problems. Then, the surgeon may have to utilise an open surgery method to remove gallbladder safely. 

Need of a cholecystectomy

A cholecystectomy may be done if the gallbladder:

• Has lumps of solid material (gallstones)
• Is inflamed or infected. 
• Is cancerous.
• Gallbladder problems may cause pain which:
• Is typically on the right side or middle of upper belly.
• May be constant or may get worse post a heavy meal.
• May certain times feel more like fullness than pain. It may be felt in back and in the tip of right shoulder blade. Other symptoms may comprise nausea, vomiting, fever, and chills.

What are the risks of a cholecystectomy?

Some possible complications of a cholecystectomy may comprise:

• Bleeding
• Infection
• Injury to the tube (bile duct) that transports bile from the gallbladder to the small bowel.
• Liver injury
• Scars and a numb feeling at the cut site
• A bulging of organ or tissue (hernia) at the incision site

During a laparoscopic procedure, surgical tools are put into the belly. This may hurt the intestines or blood vessels.

How to get ready for a cholecystectomy?

• Healthcare provider will take history and physical examination. Patient may also require blood tests and other diagnostic tests.
• Patient must not eat or drink for 8 hours before the procedure. This often means no food or drink post-midnight.
• If this is an outpatient procedure, patient will need to have someone drive him/her home afterward. 
• Patient won’t be able to drive because of the medication given to relax before and during the procedure.

What happens during a cholecystectomy?

Patient may have a cholecystectomy as an outpatient or as part of stay in a hospital. The way the surgery is conducted may differ depending on patient's condition and healthcare provider's practices.

A cholecystectomy is generally done while patient is given medications to put patient into a deep sleep (under general anaesthesia).

Generally, a cholecystectomy follows this process:

• Patient will be asked to take off any jewellery or other objects that might get in the way during the process of surgery.
• Patient will be asked to take out clothing and be provided a gown to get dressed.
• An IV (intravenous) line will be put in arm or hand.
• Patient will be placed on back on the operating table. The anaesthesia will be commenced.
• A tube will be put down throat to aid patient breathe. The anaesthesiologist will check patient's heart rate, blood pressure, breathing, and level of blood oxygen during the surgery.
• If there is too much hair at the surgical site, it may be trimmed off.
• The skin over the surgical portion will be cleaned with a sterile (antiseptic) solution.

Open method cholecystectomy

• An incision will be made. The incision may slant under ribs on the right side of abdomen. Or it may be made in the upper part of abdomen.
• Patient's gallbladder is removed.
• In few cases, one or more drains may be put into the incision. This allows drainage of fluids or pus.

Laparoscopic method of cholecystectomy

• Nearly 3 or 4 small cuts will be made in abdomen. Carbon dioxide gas will be put into abdomen so that it swells up. This allows the gallbladder and nearby organs be easily observed. This can cause referred pain in shoulder.
• The laparoscope will be put into cut. Surgical tools will be put through the other cuts to take out gallbladder.
• When the surgery is done, the laparoscope as well as tools are taken out. The carbon dioxide gas is let out through the cuts. Most of it will be reabsorbed by body.

Procedure completion with both methods

• The gallbladder will be sent for testing to a lab.
• The cuts will be closed with the aid of stitches or surgical staples.

Either a sterile bandage or dressing or adhesive strips will be utilised to cover the wounds.

What happens after a cholecystectomy?

• Post the procedure, patient will be taken to the recovery room to be observed. Recovery process will depend on the surgery type and the type of anaesthesia patient had. Once blood pressure, pulse, as well as breathing are stable and patient is awake as well as alert, patient will be taken to hospital room.
• A laparoscopic cholecystectomy may be performed on an outpatient basis. In this case, patient may be discharged home from the recovery room. Patient will get pain medicine as required. A nurse may give it to patient. Or patient may give it to themselves through a device connected to IV line.
• Patient may have a thin plastic tube that goes through nose into stomach. This is to remove air that patient swallows. The tube will be taken out when bowels are working normally. Patient won’t be able to eat food or drink until the tube is taken out.
• Patient may have one or more drains in the cut if an open procedure was done. The drains will be taken out in a day or so. Patient might be discharged with the drain still in and covered with a dressing.
• Patient will be asked to get out of bed a few hours post a laparoscopic procedure or by the next day post an open procedure. Depending on situation, patient may be given liquids to drink a few hours after surgery. Patient will slowly be able to eat more solid foods as tolerated. Patient should schedule a follow-up visit with healthcare provider. This is usually 2 to 3 weeks post-surgery.

Conclusion

In a nutshell, cholecystectomy, the surgical removal of the gallbladder, is a common procedure performed to address various gallbladder issues such as gallstones, infection, or cancer. It can be carried out using either an open or laparoscopic method, with the latter being less invasive and associated with shorter recovery times. Despite its advantages, there are risks involved, including bleeding, bile duct injury, and others. Preparation for the surgery involves medical evaluation, fasting, and arranging transportation home post-procedure. During the surgery, patients are generally under general anaesthesia, and afterwards, they are monitored in a recovery room before being discharged or transferred to a hospital room. Post-surgery care comprises pain management, monitoring for complications, and gradually resuming normal activities and diet under medical supervision. Follow-up visits with healthcare providers are essential to ensure proper healing and address any concerns.