Gallbladder removal - open

Answer 1

Definition

Open gallbladder removal is surgery to remove the gallbladder.

Alternative Names

Cholecystectomy - open

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.

Answer 2

Definition

Open gallbladder removal is surgery to remove the gallbladder that uses an open surgical cut instead of a scope.

Alternative Names

Cholecystectomy - open

Description

In open gallbladder removal surgery, a surgeon makes a large surgical cut in your belly to open it up and see the area. The surgeon then removes your gallbladder by reaching in through the cut, separating it from other organs, and gently lifting it out.

Surgery is done while you are under general anesthesia (asleep and pain-free).

The surgeon will make a 5- to 7-inch cut 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 may be done during the surgery. This involves squirting some dye into your common bile duct. The dye helps give the surgeon a roadmap of your gallbladder area. It also helps find other stones that may be outside your gallbladder. If any stones are found, the surgeon may be able to remove them with a special medical instrument.

Open gallbladder removal surgery takes about 1 hour.

Why the Procedure Is Performed

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

You may have some or all of these symptoms:

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

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

Sometimes it is not possible to remove the gallbladder using a laparoscope. In this case, the surgery will be changed to an open gallbladder removal.

Other reasons for this surgery may be:

• Bleeding problems
• Lung disease
• Obesity
• Pancreatitis
• Pregnancy (third trimester)
• Severe liver problems
• You have had many surgeries in this part of your belly in the past

Risks

Talk with your doctor about any of these risks.

The risks of any anesthesia are:

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

The risks of gallbladder surgery are:

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

Before the Procedure

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

• Blood tests (complete blood count, electrolytes, liver and kidney tests)
• Chest x-ray or electrocardiogram (EKG), for some patients
• Other x-rays of the gallbladder
• Ultrasound 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 any problems you might have in getting around after the surgery.

After the Procedure

People usually stay in the hospital for 1 to 4 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 stockings 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.

See also: Gallbladder removal -- open -- discharge

Outlook (Prognosis)

Most people do very well and recover quickly.

References

Gurusamy KS. Surgical treatment of gallstones. Gastroenterol Clin North Am. 2010;39:229-244.

Keus F, Gooszen HG, van Laarhoven CJ. Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochraine Hepato-Biliary Group reviews. Cochrane Database Syst Rev. 2010:(1):CD008318. Review.

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.

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.

Reviewed By

Review Date: 08/17/2011

Ann Rogers, MD, Associate Professor of Surgery; Director, Penn State Surgical Weight Loss Program, Penn State Milton S. Hershey Medical Center. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.