Cholecystectomy

Overview

The surgical procedure to remove your gallbladder is called cholecystectomy. Please refer to the figure below.

Cholecystectomy is done due to gallstones causing pain and infection. The pain is referred to in medicine as biliary colic, sudden pain in the abdomen caused by spasm or blockage of the cystic or bile duct.

Common Symptoms

If you suffer from the following symptoms, you may be a candidate for cholecystectomy:

• Sharp pain in the upper right part of the abdomen that may go to the back, mid-abdomen, or right shoulder
• Low fever
• Nausea and feeling bloated
• Jaundice (yellowing of the skin) if gallstones are blocking the common bile duct

Gallbladder and Gallstones

The Gallbladder

The gallbladder is a small pear-shaped organ situated under the liver. The liver makes about three to five cups of bile every day. Please refer to the figure below.

Bile helps in the digestion of fats and is stored in the gallbladder.

When fatty foods are eaten, the gallbladder squeezes bile out through the bile duct and into the small intestine.

Gallstones

Gallstones are hardened digestive fluid that can form (cholelithiasis) in your gallbladder.

When gallstones move to the common bile duct and get stuck, it can cause pain, yellowish discoloration of the skin (jaundice) and inflammation.

A condition in which a gallstone is lodged in the common bile duct is called choledocholithiasis.

When the inflammation develops in the gallbladder, which can occur suddenly (acute) or over a longer period of time (chronic), the condition is called cholecystitis. Please refer to the figure below.

Risks and Complications

The same as any surgical procedure, complications could happen. A few potential complications of cholecystectomy can include, but are not limited to, the following:

• Bleeding
• Infection
• Bile duct injuries – the tube that transport bile from the gallbladder to the small intestine.

During the course of laparoscopic cholecystectomy, insertion of the instruments into the abdomen could cause an injury to the intestines or blood vessels.

There are added risks influenced by your specific medical condition. Be sure that you talk about any concerns with your doctor ahead of the surgery.

Preparing for the Surgery

Medications & Other Conditions

Provide a list of medicines and vitamins that you are taking like aspirin or NSAIDS to the surgical team. Some medicines can affect your recovery and response to anesthesia and might need to be adjusted before and after surgery.

Inform your anesthesiologist if you have allergies, neurologic disease (epilepsy, stroke), heart disease, stomach problems, lung disease (asthma, emphysema), endocrine disease (diabetes, thyroid conditions), or loose teeth; if you smoke, drink alcohol, use drugs, or take any herbs or vitamins; or if you have a history of nausea and vomiting with anesthesia.

If you smoke, it is important to inform your surgical team, and you should decide to stop. Quitting before your surgery can lessen you rate of respiratory and wound complications and maximize your chances of staying smoke-free for life.

The Surgery

The Day of Your Surgery

• No food or drink for at least 6 hours before the operation.
• Shower and clean your abdomen and groin area with a mild antibacterial soap.
• Brush your teeth and rinse your mouth out with mouthwash.
• Do not shave the surgical site; your surgical team will clip the hair nearest the incision site.

During the Surgery

Most of the time your surgeon will perform the procedure while you are asleep under general anesthesia. Typically, a cholecystectomy follows the process described below:

• You will be required to take off any jewelry or other objects that may interfere with the procedure.
• You will be asked to take off your clothing and will be provided with a gown to wear.
• An intravenous (IV) line is inserted in your arm or hand.
• If you have too much hair at the surgical site, it will be clipped off.
• You will be placed on the operating table on your back.
• Your anesthesiologist will constantly keep an eye on your heart rate, blood pressure, breathing, and blood oxygen level throughout the procedure.
• The skin over the surgical area will be cleaned with an antiseptic solution.

Open Method

• A slanting incision (approximately 6 inches long) will be made just under the ribs on the right side of the abdomen. It can also be an up-and-down incision in the upper part of the abdomen.
• The gallbladder is removed.
• Generally, one or two drains may be inserted by way of the incision to provide drainage of fluids or pus.

Laparoscopic Method

• Small incisions will be made in the abdomen.
• Carbon dioxide gas will be delivered into the abdomen to expand the abdominal cavity allowing the surgeon to see the gallbladder and the surrounding organs more clearly.
• The laparoscope is inserted through one of the incisions and the instruments will be inserted through the other incisions to remove the gallbladder.

After the Surgery

Once the surgery is done, you will be transferred to a recovery room where your heart rate, breathing rate, oxygen saturation, blood pressure, and urine output will be carefully monitored. After one to two hours, you will be transferred to your room in the ward.

Movement and deep breathing after surgery will help prevent after-surgery complications like blood clots, fluid in the lungs, and pneumonia. You can take 5 to 10 deep breaths every hour and hold each breath for 3 to 5 seconds.

During the surgery, you are prone to get blood clots because of the absence of movement while on anesthesia. The longer and more complicated the surgery, the greater the risk.

This risk is reduced by standing up and walking 5 to 6 times per day while wearing special support or compression stockings on your legs. High-risk patients will be given blood-thinning medications.