Gallbladder removal - open

Cholecystitis, CT scan — This is a CT scan of the upper abdomen showing cholecystitis (gall stones).

Also known as: Cholecystectomy - open

Definition

Open gallbladder removal is surgery to remove the gallbladder.

Description

In gallbladder removal surgery, a surgeon makes a large incision (cut) in your belly to open it up and see the area. The surgeon then removes your gallbladder by reaching in through the incision and gently lifting it out.

Surgery is done while you are under general anesthesia (unconscious and unable to feel pain).

The surgeon will make a 5 to 7 inch incision in the upper right part of your belly, just below your ribs. The surgeon will cut the bile duct and blood vessels that lead to the gallbladder. Then your gallbladder will be removed.

A special x-ray called a cholangiogram will be done during the surgery. This involves squirting some dye into your common bile duct. This duct will be left inside you after your gallbladder has been removed. The dye helps locate other stones that may be outside your gallbladder. If any are found, the surgeon may be able to remove these other stones with a special medical instrument.

Open gallbladder removal surgery takes about an hour.

Why the Procedure Is Performed

Your doctor may recommend gallbladder removal surgery if you have gallstones or your gallbladder is not functioning normally (biliary dyskinesia).

You may have some or all of these symptoms:

Pain after eating, usually in the upper right or upper middle area of your belly (epigastric pain)
Nausea and vomiting
Indigestion
Infection (cholecystitis)

The most common way to remove the gallbladder is by using a medical instrument called a laparoscope. See also: Gallbladder removal - laparoscopic

Other reasons for this surgery may be:

You have had many surgeries in this part of your belly in the past
Breathing problems
Severe liver problems
Bleeding problems
You are in your third trimester of pregnancy
Obesity
Pancreatitis

Risks

Talk with your doctor about any of these risks.

The risks for any anesthesia are:

Reactions to drugs you are given
Breathing problems
Pneumonia
Heart problems
Blood clots in the legs or in the lungs

The risks for gallbladder surgery are:

Bleeding
Infection
Injury to the common bile duct
Injury to the small intestine
Pancreatitis (inflammation in the pancreas)

Before the Procedure

Your doctor may ask you to have these medical tests done before you have surgery:

Blood tests (complete blood count, electrolytes, and kidney tests)
Chest x-ray or electrocardiogram (EKG), for some patients
Several x-rays of the gallbladder

Always tell your doctor or nurse:

If you are or might be pregnant
What drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription

During the week before your surgery:

You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
Your doctor may ask you to "clean out" your colon or intestines.
Ask your doctor which drugs you should still take on the day of your surgery.

On the day of the surgery:

Do not eat or drink anything after midnight the night before your surgery.
Take the drugs your doctor told you to take with a small sip of water.
Shower the night before or the morning of your surgery
Your doctor or nurse will tell you when to arrive at the hospital.

Prepare your home for after the surgery.

After the Procedure

People usually stay in the hospital for 2 to 6 days after open gallbladder removal. During that time:

You will be asked to breathe into a medical device called an incentive spirometer. This helps keep your lungs working well so that you do not get pneumonia.
The nurse will help you sit up in bed, hang your legs over the side, and then stand up and start to walk.
At first you will receive fluids into your vein through an intravenous tube (IV). Soon, though, the doctors and nurses will ask you to start drinking liquids and then eat other foods.
You will be able to begin showering again while you are still in the hospital.
You may be asked to wear pressure stockings on your legs to help prevent a blood clot from forming. These help keep your blood circulating well.

If there were problems during your surgery, or if you have bleeding, a lot of pain, or a fever, you may need to stay in the hospital longer.

Outlook (Prognosis)

Most people do very well and recover quickly.

References

Chari RS, Shah SA. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 54.

Afdhal N. Diseases of the gallbladder and bile ducts. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 159.

Siddiqui T. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2008;195(1):40-47.

Review date:: November 15, 2008
Reviewed by:: A.D.A.M. Editorial Team: David Zieve, MD, MHA, David R. Eltz. Previously reviewed by Robert J. Fitzgibbons, Jr., MD, FACS, Harry E. Stuckenhoff Professor of Surgery, Chief of General Surgery, and Associate Chairman, Department of Surgery, Creighton University School of Medicine (11/15/2008).

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