Cholecystectomy (patient information)

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 * Associate Editor-in-Chief: Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org]

Overview
Cholecystectomy is surgery to remove the gallbladder. It can be either open or laparoscopic. Open gallbladder removal is a surgery to remove the gallbladder. Laparoscopic gallbladder removal is a surgery to remove the gallbladder using a medical device called a laparoscope. Each year more than 500,000 Americans have gallbladder surgery.

How is Cholecystectomy done?
The surgeon makes a large incision (cut) in your belly to open it up and see the area. The surgeon then removes your gallbladder by reaching in through the incision and gently lifting it out. Surgery is done while you are under general anesthesia (unconscious and unable to feel pain). The surgeon will make a 5 to 7 inch incision in the upper right part of your belly, just below your ribs. The surgeon will cut the bile duct and blood vessels that lead to the gallbladder. Then your gallbladder will be removed. A special x-ray called a cholangiogram will be done during the surgery. This involves squirting some dye into your common bile duct. This duct will be left inside you after your gallbladder has been removed. The dye helps locate other stones that may be outside your gallbladder. If any are found, the surgeon may be able to remove these other stones with a special medical instrument. Open gallbladder removal surgery takes about an hour.
 * Open gallbladder removal surgery

It is the most common way to remove the gallbladder. A laparoscope is a thin, lighted tube that lets the doctor see inside your belly. Gallbladder removal surgery is done while you are under general anesthesia (unconscious and not able to feel pain). The surgeon will make 3 to 4 small cuts in your belly. The laparoscope will be inserted through 1 of the cuts. Other medical instruments will be inserted through the other cuts. Gas will be pumped into your belly to expand it. This gives the surgeon more space to work. First, the surgeon cuts the bile duct and blood vessels that lead to the gallbladder. Then the surgeon removes the gallbladder, using the laparoscope. Sometimes the surgeon cannot safely take out the gallbladder using a laparoscope. In this case, the surgeon will instead do an open cholecystectomy.
 * Laparoscopic gallbladder removal

Who needs Cholecystectomy?
Your doctor may recommend gallbladder removal surgery if you have gallstones or your gallbladder is not functioning normally (biliary dyskinesia). You may have some or all of these symptoms:
 * Pain after eating, usually in the upper right or upper middle area of your belly (epigastric pain)
 * Nausea and vomiting
 * Indigestion
 * Infection

Where to find centers that perform Cholecystectomy?
Directions to Hospitals Performing Cholecystectomy

What are the risks of Cholecystectomy?
The risks for any anesthesia include:
 * Reactions to drugs you are given.
 * Breathing problems.
 * Pneumonia.
 * Heart problems.
 * Blood clots in the legs or lungs.

The risks for gallbladder surgery include:
 * Bleeding.
 * Infection in your belly.
 * Injury to the common bile duct.
 * Injury to the small intestine.
 * Pancreatitis (inflammation in the pancreas).

What to expect before the procedure?
Your doctor may ask you to have these medical tests done before you have surgery:
 * Blood tests (complete blood count, electrolytes, and kidney tests).
 * Chest x-ray or electrocardiogram (EKG), for some people.
 * Several x-rays of the gallbladder.

Always tell your doctor or nurse:
 * If you are or might be pregnant.
 * What drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription.

During the week before your surgery:
 * You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
 * Your doctor may ask you to "clean out" your colon or intestines.
 * Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery: Prepare your home for after the surgery.
 * Do not eat or drink anything after midnight the night before your surgery.
 * Take the drugs your doctor told you to take with a small sip of water.
 * Shower the night before or the morning of your surgery.
 * Your doctor or nurse will tell you when to arrive at the hospital.

What to expect after the procedure?
If you do not have any signs of problems, you will be able to go home when you are able to drink liquids easily. Most people go home on the same day or the day after this surgery. If there were problems during your surgery, or if you have bleeding, a lot of pain, or a fever, you may need to stay in the hospital longer. Some people may experience mild diarrhea after the procedure,this usually goes away with time.

Results
Most patients do very well and recover quickly. Most people have fewer problems and a shorter hospital stay when their gallbladder is removed using a laparoscope compared to people who have open surgery. You will also have smaller incisions. Cholecystectomy is the only way to prevent gallstones and to relieve the pain and discomfort of gallstones.

Videos
Gallbladder problems and Laparoscopic removal video. 