Cholecystectomy

Your doctor may recommend a cholecystectomy to treat diseases and conditions of the gallbladder and sometimes the pancreas. Your doctor may only consider cholecystectomy if other treatment options that involve less risk of complications have not worked. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on gallbladder removal surgery.

Cholecystectomy treats the following conditions: 

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

• Choledocholithiasis, which is a gallstone that moves through 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 

• Gallstone pancreatitis, which is inflammation of the pancreas caused by a gallstone that gets stuck in the bile duct. The stone 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

• Gallbladder cancer, a rare cancer

General surgeons commonly perform cholecystectomies. A general surgeon specializes in the surgical treatment of a variety of diseases, disorders and conditions, including gallbladder disease. General surgeons who focus on gastrointestinal surgery (which includes the gallbladder) are also known as gastrointestinal, or GI surgeons. General surgeons who practice minimally invasive surgery may be called laparoscopic surgeons. 

Your cholecystectomy will be performed in a hospital. The surgery involves by one large incision or several small incisions in the abdomen. This section describes both an open and laparoscopic (minimally invasive) cholecystectomy. For more information on laparoscopic cholecystectomy, click here. 

Surgical approaches to cholecystectomy

Your surgeon will perform a cholecystectomy using one of the following approaches: 

• Minimally invasive surgery involves inserting special instruments and a laparoscope through four small incisions in the abdomen. The laparoscope is a thin, lighted instrument with a small camera that sends pictures of the inside of your abdomen to a video screen. Your surgeon sees the images on the video screen while removing your gallbladder. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision instead of a larger one used in open surgery. Surgical tools are threaded around muscles and other tissues instead of cutting through or displacing them as in open surgery.

• Open surgery involves making a large incision in the abdomen. Open surgery allows your surgeon to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may still be a safer or more effective method for certain patients.

Doctors sometimes combine a minimally invasive procedure with an open surgery. Your doctor will advise you on which type of surgery is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. 
Learn about the different cholecystectomy surgeries and ask why your surgeon will use a particular type for you.

Types of anesthesia that may be used

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

You may receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

What to expect the day of your cholecystectomy

The day of your surgery, you can 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 have.

• 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 surgery and recovery until you are alert, breathing effectively, and your vital signs are stable.

As with all surgeries, a cholecystectomy involves risks and possible complications. Most cholecystectomies are successful, but cholecystectomy complications may become serious in some cases. Complications can develop during gallbladder removal surgery or recovery.

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, in particular a deep vein thrombosis

• Infection

• Pneumonia, which is a lung infection

Potential cholecystectomy complications

Potential cholecystectomy complications include:

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

• Abdominal bleeding

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

• Leakage of bile into the abdomen

• Opening of the external abdominal incision

Reducing your risk of complications

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

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

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

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

• 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 surgery can improve your comfort and outcome. You can prepare for 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. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.

• 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 a cholecystectomy 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 cholecystectomy? Are there any other options for treating my condition?

• What type of cholecystectomy procedure will I need?

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

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

• When and what can I eat after surgery?

• What kind of assistance will I need at home?

• Will I need physical therapy or rehabilitation?

• How should I take my medications? 

• How will you treat my pain?

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

• When should I follow up with you?

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

Knowing what to expect can help make your road to recovery after cholecystectomy as smooth 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. 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.

You will stay in the hospital for most of the day after outpatient laparoscopic cholecystectomy. You will go home when you can tolerate eating and your pain is controlled with pills. Some laparoscopic cholecystectomies require an overnight stay. An open cholecystectomy requires three to five days in the hospital.

Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes four to six weeks.

Patients often go back to school or work  within about two weeks. You will need to avoid heavy lifting, strenuous exercise, and contact sports for a longer period of time. Tell your doctor about all of your physical activities and follow instructions for when it is best to return to them.

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your procedure. 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 in any way because it may be a sign of a complication.

You might feel a little drowsy if you had narcotic pain medications. General anesthesia can also cause drowsiness for a day or so. You may also have some nausea. Tell your doctor or care team 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 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 in 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 surgery. It is 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 discomfort that changes or gets worse

• 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)

A 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 healthy diet and live a healthy lifestyle without your gallbladder. Some people, the effects of gallbladder removal may include softer, more frequent stools. This is usually temporary as your body adjusts to digestion without a gallbladder. Some people need further treatment for complications of gallstones, such as gallstone pancreatitis.