Cholecystectomy (Gallbladder Removal)

What is Gallbladder?

The gallbladder is a small, pouch-like organ in the upper right part of your tummy. It stores bile, a fluid produced by the liver that helps break down fatty foods. The gallbladder is not a vital organ, so surgery to remove it is often recommended if you develop any problems with it.

What is Cholecystectomy?

Cholecystectomy is an operation where the gallbladder is removed surgically. It can be done either an open procedure (Open cholecystectomy) or using laparoscope (Laparoscopy cholecystectomy).

Open cholecystectomy is done whereby an incision is made below the right costal margin.

Laparoscopy cholecystectomy is whereby the small incisions are made below the right costal margin and umbilical.

When to do a Cholecystectomy?

• Cholelithiasis (Gallbladder stone) which may cause
  • Gallbladder complication
  • Biliary tract complication
  • Pancreatic complication

• Acute cholecystitis (Inflammation of the gallbladder)

• Chronic cholecystitis
• Mucocele (gallbladder distension due to mucus)
• Choledocholithiasis (gall stone in the bile duct)
• Gallbladder empyema (pus in the gallbladder)
• Early gallbladder cancer

Types of Surgery

a. Laparoscopic Cholecystectomy

The surgeon makes small incisions in your abdomen. A tube with a tiny video camera is placed in your abdomen through one of the incisions. Your surgeon watches a video monitor in the operating room while using tools inserted through the other incisions to remove your gallbladder.

If your surgeon is worried about possible gallstones or other problems in your bile duct, an imaging test may be used. This might include an X-ray or ultrasound. Then your incisions are closed, and you’re taken to a recovery area. A laparoscopic cholecystectomy takes 1-2 hours.

b. Open Cholecystectomy

During an open cholecystectomy, the surgeon makes a 15-centimeter, incision in your abdomen below your ribs on your right side. The muscle and tissue are pulled back to reveal your liver and gallbladder. Your surgeon then removes the gallbladder.

The incision is closed, and you’re taken to a recovery area. An open cholecystectomy takes 2-4 hours.

The nature of the treatment to be given will depend upon the type of CAD as well as the overall medical condition of the patient. 

Pre-Operative Preparation

The patient will need to undergo a complete examination and general health assessment, blood and scans prior to surgery.

The types of surgery and types of anaesthesia will be discussed by the surgeon and anaesthetist with patient. The patient will also be counselled on risks and complications of the surgery by the doctor.

Risks / complications of the surgery

1. Abdominal wall and intra-abdominal injuries:
   • Infection
   • Subcutaneous emphysema
   • Haematoma
   • Port site hernia
   • Bleeding
   • Intra-abdominal abscess collection
   • Bile leak
2. Vascular injuries:
   • Bleeding
   • Gas embolism
3. Visceral (Bowel) injuries
4. Others:
   • Cardiovascular compromise
   • Respiratory distress
   • Renal impairment

Other options if Laparoscopy Cholecystectomy is declined

Open Cholecystectomy

Conversion

Conversion rate is 5-10%. The indication coverting Laparoscopy Cholecsystectomy to Open Cholecystectomy are:

a. Uncontrolled bleeding

b. Adhesion

c. Suspicious other gallbladder pathology

d. Distorted gallbladder/liver stricture due to infection/inflammation

Common side effects after cholecystectomy

• Diarrhoea
• Constipation
• Nausea
• Indigestion
• Acid reflux
• Bloating
• Abdominal pain

Post-Operative Care

i. Follow-up 2-4 weeks after discharge (may change according to patient medical case and logistics).

ii. No heavy lifting for 2 weeks to 3 months

iii. Should resume work in a week to 2 weeks.

iv. Should consume normal diet.

• Eat your normal diet. But don’t eat rich, greasy, or spicy food. Choose fat-free or low-fat diet for the first month after surgery. Don’t eat fried food during this time.

• Increase the fiber in your diet. This can help make bowel movements more regular. Add soluble fiber, such as oats and barley, to your diet. But be sure to increase the amount of fiber slowly, such as over several weeks, because too much fiber at first can make gas and cramping worse.
• Eat smaller, healthier, more frequent meals. This may ensure a better mix with available bile. A healthy meal should include small amounts of lean protein, such as poultry, fish or fat-free dairy, along with vegetables, fruits and whole grains.
• Avoid caffeine, dairy products, very sweet food, high fat food  

v. Advice to come to the Emergency Department if patient having persistent fever or redness or discharge from the surgical wound site.

• Yellowing of your eyes or skin (jaundice)
• Chills
• Fever of 38°C or higher
• Redness or swelling of the incision
• Fluid leaking or a bad smell from the incision
• Incision pain that gets worse
• Dark or rust-colored urine
• Stool that is light in color instead of brown
• Increasing belly pain
• Rectal bleeding
• Trouble breathing or shortness of breath
• Leg swelling