Overview of gallbladder removal
Gallbladder removal (cholecystectomy) is an operation to take out the gallbladder, most often because gallstones are causing problems, and it is usually done by keyhole surgery. The gallbladder is a pear-shaped organ on the underside of the liver, on the right. It collects and concentrates bile, a digestive fluid made by the liver. After you eat, bile is released and flows through narrow tubes (bile ducts) into the small intestine, where it helps with digestion. For most people, removing the gallbladder does not cause digestive problems, because bile still flows from the liver into the intestine.
Gallbladder problems are usually caused by gallstones: small, hard deposits of bile salts and cholesterol in the gallbladder or bile ducts. In some people the cause is unknown, and there is no reliable way to prevent them. Gallstones can block the flow of bile. The gallbladder then swells, which can cause abdominal pain, vomiting, indigestion and, at times, a fever. If a stone blocks the main bile duct, jaundice (yellowing of the skin and eyes) can develop.
In keyhole gallbladder removal (laparoscopic cholecystectomy), the surgeon works through several small openings instead of one large cut. The laparoscope is a thin, long tube with a camera at its tip, and the surgeon follows the operation on a screen. The gallbladder is removed through one of the small openings.
Who is it for?
The operation is considered for people whose gallstones cause symptoms or complications. Gallstones are usually found with an ultrasound scan. In more complicated cases, further X-ray tests may be needed. Gallstones do not dissolve on their own. Some can be cleared with medicines or a low-fat diet, but only for a while. For this reason the gallbladder is usually removed with surgery.
After previous abdominal operations, or with certain conditions, the keyhole method is not always suitable. Whether your gallbladder can be removed by keyhole surgery is decided together with you after a medical examination.
Risks
Every operation carries risks. Complications after keyhole gallbladder removal are not common, but they can include:
- bleeding, infection, pneumonia, blood clots or heart problems
- injury to nearby structures, such as the main bile duct or the small intestine, which may need a further operation
- rarely, a bile leak after an injury to the bile ducts between the liver and the intestine
In a very small number of patients, keyhole surgery is not possible. Severe obesity, extensive scar tissue (adhesions) from previous abdominal operations, a poor view of the organs or bleeding during the operation can mean that open surgery is needed. Your surgeon makes this decision before or during the operation. It is not a complication, but a decision made for your safety.
Preparation
Preparation depends on your own situation, but it usually follows the same steps:
- depending on your age and health, blood tests, a medical examination, a chest X-ray and an ECG (heart tracing)
- a discussion of the risks and benefits, and your written consent
- nothing to eat or drink from midnight before the operation, apart from any morning medicines you have been told to take, with a little water
- stopping blood-thinning and anti-inflammatory medicines for a few days to a week before the operation
- stopping weight-loss medicines two weeks before the operation
- stopping smoking and drinking alcohol
What happens
Before the procedure
The operation is done under general anaesthesia, so you are asleep throughout.
On the day
The operation follows a series of careful steps:
- The surgeon enters the abdomen through a thin tube (trocar) near the belly button.
- The laparoscope with its camera is passed through this tube, and the organs are shown enlarged on a screen.
- Instruments are passed through further tubes. With these, the gallbladder is carefully separated from the surrounding tissue and removed through one of the openings.
- If needed, the bile ducts are shown on X-ray with a contrast dye (cholangiography) to look for stones in the ducts.
- If stones are found in the main bile duct, they can be removed with a special endoscope, treated in a second minimally invasive procedure, or removed by changing to open surgery.
- Finally, the small cuts are closed with stitches or adhesive strips.
Instead of a cut 10 to 15 cm long, there are only four small openings. Compared with open surgery, there is usually less pain afterwards and recovery is quicker.
After the procedure
Gallbladder removal is an abdominal operation, so some pain afterwards is to be expected. Nausea and vomiting are common. Once you can keep down fluids or food, you go home on the day of the operation or the day after. You should get up and walk soon, and you can shower from the day after the operation.
Aftercare
Recovery after the keyhole operation is usually quick, and you can build up your activities step by step:
- You can go back to everyday activities such as driving, climbing stairs, lifting or working within a week, depending on how you feel.
- Most people return to work within seven days after keyhole surgery, depending on their job. After open surgery it takes four to six weeks.
- As part of your follow-up, a routine blood test check is done at 6 months.
Please contact your doctor if you have:
- a fever above 39 °C that does not go away
- bleeding
- increasing swelling of the abdomen
- pain that does not ease despite medicines
- nausea or vomiting that does not stop
- shivering (chills)
- a cough or shortness of breath
- yellowing of the skin or eyes
- pus or increasing redness at a wound
- difficulty drinking or eating anything
Keyhole surgery is also used for other operations on the abdomen, such as hernia surgery and reflux surgery.