Gallbladder Removal Surgery (Cholecystectomy)

Types of Gallbladder Surgery

There are two types of gallbladder removal surgery: laparoscopic and open surgery. The medical term for gallbladder removal surgery is cholecystectomy ^[2].

What is laparoscopic cholecystectomy?

The term laparoscopic refers to the examination of the loin (lapara) with an endoscope and cholecystectomy means the removal (ectomy) of the gallbladder (cholecystis) ^[1]. Other names for laparoscopic cholecystectomy are “lap chole” and “keyhole” gallbladder surgery.

Laparoscopic cholecystectomy is a minimally invasive procedure to remove the gallbladder, which involves the insertion of the laparoscope–a tube with a camera, light and instruments–through 4 small incisions in the abdominal wall (Video 1). The procedure is performed under general anesthesia, usually in an outpatient setting.

Whenever possible, a surgeon will recommend laparoscopic over open surgery, because it has a shorter recovery time and fewer complications and leaves less scarring.

You can be a candidate for laparoscopic gallbladder removal if you have ^[3]:

• Gallstones causing recurrent pain
• Gallbladder sludge causing complications, such as pancreatitis ^[16]
• Acute cholecystitis ^[7,17,18]
• Gallbladder polyps smaller than 18 mm ^[6]
• Chronic inflammation with calcified (porcelain) gallbladder
• Gallbladder dyskinesia, which refers to gallbladder pain in the absence of gallstones

Laparoscopic gallbladder removal can be performed in children and adults, including pregnant women (preferably in the second trimester) ^[3].

Video 1. Laparoscopic gallbladder removal

According to New Choice Health, a laparoscopic gallbladder surgery in the United States can cost between 2,550 and 9,500 dollars.

What is open cholecystectomy?

Open cholecystectomy is gallbladder removal through a 4-6 inch long incision in the right upper abdomen. You can expect to have open instead of laparoscopic surgery in case of ^[4]:

• Severe heart or lung disease
• Trauma of the upper right abdomen
• Gallbladder polyps greater than 18 mm ^[6]
• A bleeding disorder
• Severe liver cirrhosis

Reasons to convert laparoscopic into open surgery during the procedure include suspected gallbladder cancer, inability to control bleeding and excessive adhesions (internal scars) from previous gallbladder inflammation episodes or abdominal surgeries.

Video 2. Open gallbladder surgery

Chart 1. Laparoscopic vs Open Cholecystectomy
	Laparoscopic	Open
Indications	Gallstones, gallbladder polyps, inflammation (cholecystitis), gallbladder dyskinesia	Gallbladder cancer, abdominal injury, previous abdominal surgery, heart disease, severe liver cirrhosis
Anesthesia	General	General
Duration	1-2 hours	1-2 hours
Hospital stay	<24 hours	2-5 days
Scars	4 scars: 3 x 5 mm in the upper abdomen and 1 x 10 mm below the belly button	One 4-6 inch (10-15 cm) long scar below the right rib cage

What kind of doctor performs cholecystectomy?

It is a gastrointestinal surgeon who helps you prepare and who performs cholecystectomy. In complicated cases, a hepatobiliary surgeon who deals specifically with the liver and gallbladder can get involved.

How long does gallbladder removal surgery last?

Both laparoscopic and gallbladder removal surgery usually last for 1 to 2 hours ^[5,28]. After the procedure, you will be likely monitored in a room in a health facility for 4-6 hours for eventual complications, such as infection or bleeding ^[3]. If you can drink and walk and have no fever, you can expect to be discharged the same day after laparoscopic and the next day after open surgery.

What happens with a removed gallbladder?

After removal, a surgeon usually cuts the gallbladder open to check its content. If only gallstones are found and the walls of the gallbladder look normal from the inside, the gallbladder can be discarded. If abnormal growths (polyps) are found, the gallbladder is sent to a pathologist who checks it for cancer.

NOTE:

• Regular walking for few weeks after surgery helps to prevent complications, such as blood clots and pneumonia.
• Smoking prolongs the healing time of surgical wounds ^[9].
• If you experience any unusual symptoms shortly after surgery, such as severe pain, fever, jaundice, persistent cough or bleeding from the surgical wound, visit a doctor.
• Persistent pain or pain that appears months after gallbladder removal can be due to sphincter of Oddi dysfunction.
• Check for more side effects and complications of gallbladder surgery.

What to eat after a gallbladder surgery?

If you do not experience any gastrointestinal symptoms after gallbladder removal, you can eat whatever you want as soon as you can sit comfortably ^[8]. Usually, there is no need for food restrictions or special diets, such as a liquid or low-fat diet. You also do not need any dietary supplements because gallbladder removal does not affect the digestion or absorption of nutrients.

Foods high in insoluble fiber, such as whole-grain bread and non-starchy vegetables, can help you maintain soft bowel movements, so you do not need to strain and thus allow a surgical wound to heal properly.

Few days after surgery, you can start to drink alcohol, unless your doctor has told you otherwise. Be aware that alcohol can increase the side effects of narcotics or other medications or trigger diarrhea.

If you experience diarrhea after gallbladder removal, it may help if you have small meals and avoid foods high in fat and sugars and spicy foods.

Is there any alternative for gallbladder removal?

Nonsurgical methods are now rarely used to treat gallstones because of the high rate of recurrence.

Oral dissolution of gallstones by ursodeoxycholic acid (UDCA) can be used to treat cholesterol gallstones smaller than 20 mm in the absence of gallbladder inflammation ^[12]. With this therapy, gallstones can decrease by 1 mm per month ^[13].

Contact dissolution with methyl tert-butyl ether (MTBE) involves the instillation of chemicals into the gallbladder through a catheter, which is placed into gallbladder through the abdominal wall ^[14]. With this method, the gallstones can dissolve within several hours to days ^[14].

Extracorporeal shock wave lithotripsy (ESWL) breaks down gallstones into small pieces, which are then naturally eliminated through the bile ducts into the intestine ^[10].

In percutaneous cholecystostomy, a doctor inserts a catheter into the gallbladder through a small incision in the abdominal wall, which allows the gallbladder to drain ^[11]. This method is used to treat acute gallbladder inflammation in critically ill patients who are not able to undergo surgery.

• References

  1. Laparoscopic cholecystectomy  Online Etymology Dictionary
  2. Cholecystectomy  Merriam-Webster
  3. Sherwinter DA, Laparoscopic cholecystectomy  Emedicine
  4. Hope WW, Open cholecystectomy  Emedicine
  5. Cholecystectomy (gallbladder removal)  Mayo Clinic
  6. Sandberg AA, 2012, Diagnosis and Management of Gallbladder Polyps  PubMed Central
  7. Gul R et al, 2013, Comparison of Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: Experience from A Single Center  PubMed Central
  8. de Menezes HL et al, 2013, Randomized study for assessment of hypolipidic diet in digestive symptoms immediately following laparoscopic cholecystectomy  PubMed
  9. Silverstein P, 1992, Smoking and wound healing  PubMed
  10. Dissolution therapy for the treatment of gallstones  UpToDate
  11. Fahrbach TM, Percutaneous Cholecystostomy Technique  Emedicine
  12. Schoenfield LJ et al, 1993, Oral and contact dissolution of gallstones  PubMed
  13. Guarino MPL et al, 2013, Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed PubMed Central
  14. Contact Dissolution for Gallstones  Aetna
  15. Cholecystectomy risks  Mayo Clinic
  16. Shaffer EA, 2001, Gallbladder sludge: what is its clinical significance?  PubMed
  17. Sinha R et al, 2002, Acute Cholecystitis and Laparoscopic Cholecystectomy  PubMed Central
  18. Zafar SN et al, 2015, Optimal time for early laparoscopic cholecystectomy for acute cholecystitis  PubMed
  19. Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES  Sages.org
  20. Gallbladder removal – laparoscopic – discharge  MedlinePlus
  21. When can I fly after surgery? NHS.uk
  22. Cholecystectomy  American College of Surgeons
  23. Gallbladder removal – open – discharge  MedlinePlus
  24. Gallbladder removal – open  University of Maryland Medical Center