Cholecystectomy

A cholecystectomy, also called “gallbladder removal procedure”, is a surgical procedure done to remove the gallbladder.

The gallbladder is a small pear-shaped organ that is located in the upper right side of your abdomen just below your liver. This organ is responsible for the collection and storage of a digestive juice called “bile” which is produced in the liver.

TYPES OF CHOLECYSTECTOMY

A gallbladder operation is a common but major surgery where the gall bladder is removed and as with many other surgeries, this can be performed in two ways.

The 2 methods of gallbladder removal are:

• Open Cholecystectomy or Gallbladder Removal Surgery.

In open cholecystectomy, a large incision of about 4 to 6 inches long is made on the upper right side of your abdomen (where the gallbladder is located). Once opened up, the surgeon locates the gallbladder, cuts and shuts off the connective tissues linked to it, and removes it.

This type of cholecystectomy is often performed when there are other problems associated with the gallbladder to provide long-lasting relief.

• Laparoscopic Cholecystectomy

This type of gallbladder removal is less invasive. It is performed by making four incisions on the right side of the abdomen. 3 of the incisions of about 1 inch and the last one of about 2 inches. 

After the incisions are made, a long thin tube with a tiny camera attached to it called “laparoscope” and other surgical probes are inserted. The tiny camera is linked to a monitoring screen and through this screen, the surgeon locates the gallbladder guides the probes to cut away and remove the gallbladder from the abdomen through the slightly bigger incision.

Lap cholecystectomy is the most common type of gallbladder removal and is often used when there is a presence of gallstones.

PURPOSE OF CHOLECYSTECTOMY

(Reason For Gallbladder Removal)

Cholecystectomy is recommended when certain conditions affect your gallbladder. These conditions may include:

1. Gallstones; which are lumps of solidified material either found in the gallbladder (cholelithiasis) or the bile duct (choledocholithiasis).
2. Cholecystitis; inflamed and/or infected gallbladder.
3. Pancreatitis; pancreas inflammation caused by gallstones stuck in the bile duct which also blocks the pancreatic duct.
4. Cancerous gallbladder.
5. A benign tumor in the gallbladder causing gallbladder mass.
6. Biliary dyskinesia; the inability of the gallbladder to correctly empty bile.
7. Leaking or perforated gallbladder.

POSSIBLE RISKS OR COMPLICATIONS OF CHOLECYSTECTOMY

Although gallbladder removal procedure is considered a very safe surgical procedure, like every other surgery, it carries few risks. 

The possible complications of cholecystectomy include:

• Reaction to the anesthesia
• Bleeding
• Infections may arise such as lung infection (pneumonia), UTIs, infection, and inflammation in the abdomen (peritonitis).
• Blood clots can pulmonary embolism.
• Bile duct injury leading to the leakage of bile.
• Damage to the surrounding organs (liver, intestines) and blood vessels.
• Hernia; bulging tissues or organs at the incision site.
• Pancreatitis.
• Numbness and adhesions/scars at the incision site.
• Rapid heartbeat, heart attack.

Specialty: A general surgeon.

CHOLECYSTECTOMY PREPARATION

Before undergoing a gallbladder operation, you must consult with your surgeon about the chances, the possible risk, and the best procedure to undergo. Your surgeon will check your medical history and perform an overall physical examination. You may also need to undergo the following tests:

Urinalysis

1. Blood tests
2. Chest X-ray
3. EKG
4. Abdominal ultrasound.

After the results, you will have to sign a consent form with a guardian. Then your date for surgery can be fixed. Your surgeon will give you a list of instructions to adhere to among which includes the medications to avoid taking for the time being such as blood-thinning medications, NSAIDs, some nutritional supplements, etc.

Make sure to tell your surgeon about conditions that are likely to disrupt the procedure such as allergic reactions, being pregnant, medications you may be taking.

You should also make arrangements for who comes with you on the day of the surgery and through till when you are discharged.

CHOLECYSTECTOMY PROCEDURE

Before the Surgery, 

You are expected to not eat or drink at least 8 hours before your gallbladder removal. Before being taken into the surgery room, you will take off every piece of jewelry from your body and you will change into the hospital gown. 

In the room, you will be laid on the operating table. An IV line will be inserted into your arm and a tube into your throat to enable you to breathe. 

You will then be administered general anesthesia and your breathing, heart rate, blood level, and blood pressure will be monitored. Once approved as stable, the surgical area will be wiped clean with antiseptic.

During the Surgery, 

(We will explain both types of cholecystectomy).

Open Cholecystectomy Procedure

• An incision of about 4 to 6 inches will be made at the right side of your abdomen just below your ribs–either slanted or up-to-down.
• The skin, muscles, and tissues are pulled apart, exposing the gallbladder.
• The connecting tissues and parts are cut off and the gallbladder is removed.
• The incision is put back in place and sutured.
• The incision is cleaned and bandaged. (A tube can be attached to drain out fluids and pus.)

Laparoscopic Cholecystectomy Procedure

• 4 horizontal small incisions (1.5 inches apart) are made on the right side of the abdomen just below the rib cage.

(3 of the incisions are about 1 inch and 1 is about 2 inches to enable the gallbladder to be propped out of it.)

• Your abdomen is then filled with carbon dioxide gas to make it swell and this enables the organs to be easily spotted.
• The laparoscope and surgical probes are inserted through the incisions.
• With the monitoring screen, the surgical probes are guided to cut free the gallbladder and remove it through the biggest of the incisions.
• To make sure all problems are taken care of, a dye can be injected into the bile duct through a catheter to check for gallstones. If they are present, the ducts can be clipped off and removed.
• The carbon dioxide is let out and the incisions are sutured, cleaned, and bandaged. (A tube can be attached to drain out fluid and pus.)

After the Surgery,

After the gallbladder removal, you will be moved to the recovery room for the anesthesia to wear off and to recover. You will be placed on pain relief tablets to curb the pains.

For laparoscopic gallbladder removal, you can return home after some hours of bed rest. But it is advisable to stay the night at the hospital to watch for signs of complications. If nothing arises after the night, you can go home.

For open gallbladder removal, you are advised to stay 2 to 3 days under the hospital’s supervision till you are considered fit to leave.

RECOVERY FOR CHOLECYSTECTOMY

(Post Cholecystectomy)

For laparoscopic cholecystectomy, the average recovery time is between 1 to 2 weeks. While for open cholecystectomy, it may take 3 to 5 weeks. However, this recovery rate depends on your body type and system. Some people take longer to heal than others.

Also, recovery depends on how efficient you are in taking care of yourself and the wounds. Take pain relief medications as prescribed by your doctor. 

Eat healthy especially foods and enough fruits that can help you heal faster. Drink a lot of water and stay hydrated.

Take care of your incision site to keep it from being infected. Clean it daily with disinfectants, keep it dry and newly bandaged every day. Do not carry heavy objects will your incision is healed. That should be around the sixth week.

Exercise daily but not rigorous exercises. Walking around is highly recommended to prevent blood clots.

OUTLOOK

It is important to note that you can live a normal life after a cholecystectomy. The gallbladder is not necessary for digestion and you may not experience digestive problems after the surgery.

However, if you notice some changes such as excreting loose stools and other bowel changes, they are likely to be resolved few weeks after the surgery. You can discuss the changes with your doctor.

FAQs

Can I live a normal life without a gallbladder?

Yes, you can live a perfectly normal life. The gallbladder is meant to store excess bile made by the liver. So your liver can make enough bile for digestion and whatever is left of the bile with drip into your digestive system instead of the gallbladder.

What are the side effects of having your gallbladder removed?

There are side effects that arise when your gallbladder is newly removed. They include:

• Flatulence
• Diarrhea; exceeding loose stools.
• Constipation
• Difficulty in digesting fat as the body has to adjust to the new method of fat digestion.

However, after a few weeks, these side effects disappear and your digestive system normalizes. But if the side effects stay longer than comfortable with, contact your surgeon.

When should I seek medical attention after gallbladder removal?

If you notice any of these symptoms, you should contact your doctor immediately:

• Consistent and recurrent severe pains.
• High fever and chills.
• Infected incisions such as bleeding, swelling, redness, and pus discharge.
• Absence of bowel movement and inability to excrete after 3 days.
• Yellow paled skin.
• Severe abdominal cramps.

What foods should you avoid if you have no gallbladder?

Make sure to step down your fat consumption levels to not more than 3 grams per serving. Do not eat foods with high-fat. Avoid greasy or fried foods.

Why do people gain weight after gallbladder removal?

Due to the removal of the gallbladder, the body tries to adjust to the changes, and the digestive system is affected, making it unable to digest sugar and fat properly. This leads to weight gain. 

However, once the body adjusts, after few weeks, this normalizes.