Laparoscopic Cholecystectomy

Your doctor may recommend a laparoscopic cholecystectomy to treat diseases and conditions of the gallbladder and sometimes the pancreas. Your doctor may only consider surgery for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a laparoscopic cholecystectomy.

Your doctor may recommend a laparoscopic cholecystectomy to treat:

• Cholecystitis, which is inflammation of the gallbladder resulting in severe pain called biliary colic. A gallstone that gets stuck in a bile duct that that carries bile to or from the gallbladder causes cholecystitis.

• Choledocholithiasis, which is a gallstone that moves into the bile duct. In some cases, the gallstone will pass by itself. If it gets stuck in the bile duct it can cause inflammation of the gallbladder and possibly the pancreas. 

• Cholelithiasis (gallstones) in the gallbladder, if they cause frequent or severe pain

• Gallbladder mass, which can be due to gallbladder cancer or from a benign (noncancerous) tumor

• Gallstone pancreatitis, which is inflammation of the pancreas caused by a gallstone that gets stuck or passes through the bile duct. A gallstone in the bile duct can also block the pancreatic duct. The pancreatic duct carries digestive juices from the pancreas.

• Perforated gallbladder, which is leaking or bursting of the gallbladder

• Biliary dyskinesia, occurs when the gallbladder does not empty bile correctly. This can cause symptoms similar to cholecystitis.

A general surgeon performs laparoscopic cholecystectomy. A general surgeon specializes in the surgical treatment of a wide variety of diseases, disorders and conditions. 

Your laparoscopic cholecystectomy will be performed in a hospital. Your surgeon will make four small incisions in your upper abdomen and insert tiny instruments and a laparoscope through the incisions. A laparoscope is a long, thin camera that transmits pictures of the inside of your body to a video screen. Your surgeon sees the surgical area on the video screen while performing the surgery.

Dye may be injected via a catheter into the bile duct to confirm the anatomy and to ensure that no stones are in the common bile duct. After the dye injection and X-ray, the gallbladder duct is clipped and the gallbladder removed from one of the small openings.

Surgeons sometimes combine laparoscopic cholecystectomy with open surgery. Open surgery involves making a larger incision to directly view and treat the surgical area. 

Your doctor may decide after beginning your laparoscopic cholecystectomy that you require an open surgery to safely and most effectively complete your surgery.

Types of anesthesia that may be used

Your surgeon will perform laparoscopy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.

What to expect the day of your laparoscopic cholecystectomy

The day of your surgery, you can generally expect to:

• Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

• Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

• Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.

• A surgical team member will start an IV.

• The anesthesiologist or nurse anesthetist will start your anesthesia.

• A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

• The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

Laparoscopic cholecystectomy generally involves a faster recovery and less pain than open surgery to remove the gallbladder. This is because it causes less trauma to tissues and organs. Your doctor will make small incisions instead of a larger one used in open surgery. He or she can thread the surgical tools around muscles and organs instead of cutting through or displacing them as in open surgery.

Despite this, laparoscopic surgery involves risks and possible complications.  Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

Conditions that increase your risk of complications include severe gallbladder inflammation from gallstones, severe obesity, and abdominal adhesions (scar tissue) from prior surgeries.  

General risks of surgery

The general risks of surgery include: 

• Anesthesia reaction, such as an allergic reaction and problems with breathing 

• Bleeding, which can lead to shock

• Blood clot, which can cause a loss of blood flow to your legs or feet or travel to your lungs and cause a pulmonary embolism

• Infection 

• Pneumonia, which is a lung infection

Potential complications of laparoscopic cholecystectomy

Complications of laparoscopic cholecystectomy include: 

• Abdominal adhesions, which is a formation of scar tissue in the abdomen

• Damage to nearby organs, such as the common bile duct and small intestine

• Leakage of bile into the abdomen

• Gallstones left in the bile duct

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and: 

• Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery

• Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy

• Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

• Taking your medications exactly as directed 

• Telling all members of your care team if you have any allergies

You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome. 

You can prepare for a laparoscopic cholecystectomy by:

• Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

• Getting preoperative testing as directed. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed. Other tests may include testing for signs of infection, biliary obstruction, pancreatitis, or jaundice (yellowing of the skin and eyes).

• Losing excess weight before the surgery through a healthy diet and exercise plan

• Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

• Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

• Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

• Why do I need a laparoscopic cholecystectomy? Are there any other options for treating my condition?

• If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?

• How long will the surgery take? When can I go home?

• What restrictions will I have after the surgery? When can I return to work and other activities?

• What kind of assistance will I need at home? 

• What medications will I need before and after the surgery? How should I take my regular medications? 

• When should I follow up with you?

• How will you treat my pain?

• How should I contact you? Ask for numbers to call during and after regular hours.

Knowing what to expect after a laparoscopic cholecystectomy can help you get back to your everyday life as soon as possible.

How long will it take to recover?

You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. This generally takes an hour or two.

You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.

If you had an outpatient procedure, you will stay in the hospital for most of the day and go home when you can tolerate eating and your pain is controlled. Laparoscopic cholecystectomy may require an overnight stay, depending on the reasons for surgery and general health.

Full recovery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. 

You may go back to school or work in about 10 to 14 days. You will need to avoid heavy lifting, strenuous exercise, and contact sports for about a month. 

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your laparoscopic cholecystectomy. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.

You might feel a little drowsy if you have narcotic pain medications. You should not drive while you are taking narcotics. General anesthesia can also cause drowsiness for a day or so. You may also have some nausea. Tell a care team member if you are nauseated so it can be treated. 

When should I call my doctor?

It is important to keep your follow-up appointments after a laparoscopic cholecystectomy. Contact your doctor for questions and concerns between appointments.  Call your doctor right away or seek immediate medical care if you have:

• Bleeding

• Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

• Change alertness, such as passing out, unresponsiveness, or confusion

• Chest pain, chest tightness, chest pressure, or palpitations

• Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after a major laparoscopic surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

• Inability to urinate, pass gas, or have a bowel movement

• Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

• Nausea and vomiting or diarrhea

• Pain that is not controlled by your pain medication or worsening abdominal pain

• Sore throat or hoarseness that lasts longer than expected 

• Unexpected drainage, pus, redness or swelling of your incision

• Yellowing of the skin or eyes (jaundice)

How might a laparoscopic cholecystectomy affect my everyday life?

A laparoscopic cholecystectomy, sometimes combined with a procedure to remove gallstones from the bile ducts, can completely cure gallstone-related problems. It also prevents the formation of new gallstones. 

Be assured that you can eat a normal diet and live a healthy life without your gallbladder. Occasionally, some people may have softer, more frequent stools after a cholecystectomy. This typically resolves about a month after surgery once your liver adjusts to not having your gallbladder to store the bile it makes.