Cholecystectomy is the medical term for surgery to remove your gallbladder. It is one of the most common surgeries performed in the U.S.
Reasons for gallbladder removal
If you have symptomatic gallstones, you are a good candidate for having your gallbladder removed. Gallstones are small stones that form inside the gallbladder. These stones can block the ducts that bile flows through. Removal of your gallbladder will prevent further complications. Read more on gallstones.
You are a candidate for surgery if your diagnosis is gallbladder polyps, or small benign growths on the inside of the gallbladder. Polyps can act like stones as they can block the opening of the gallbladder.
“Gallbladder dysfunction”means that the gallbladder does not work correctly. We often call this Biliary Dyskinesia. This can also cause abdominal pain, and symptoms like gallstones.
Cancer of the gallbladder, is rare but can occur. If cancer is the reason for your surgery, we usually remove a small part of the liver next to the gallbladder, as well as your gallbladder.
We can remove your gallbladder using either laparoscopic or open surgery methods.
Most gallbladder removals in the US are done using laparoscopic surgery.
Open surgery means your surgeon makes a larger incision under the right ribs. The incision is big enough for your surgeon to see your organ and do the surgery.
Open surgery is necessary if your gallbladder or bile ducts are too infected or scarred to do laparoscopic surgery. Open surgery reduces the risk of injury to surrounding organs, particularly the common bile duct. This duct is a very important tube that connects the liver and the intestines.
Typically, we start your cholecystectomy with the laparoscope. During your surgery your doctor determines you need “open” surgery. Again, this is only if surgery cannot be safely completed with the laparoscope.
Risks of gallbladder removal
The risks of the surgery are low, but they can include:
- Damage to the ducts near the gallbladder and the liver that carry bile from the liver to the intestines
- Bile leak after surgery, needing further procedures
- Damage to the bowels or other surrounding organs
- Need for further surgery or other procedures, such as ERCP or drain placement.
Recovery after gallbladder removal
Your recovery will depend on whether you had laparoscopic or open surgery.
For laparoscopic surgery, you can often leave the hospital the same day you have surgery. There is some chance you will need to stay overnight, especially if you have an inflamed gallbladder. Even though the cuts on the outside are small, the operation inside is still a major surgery. Your doctor will want you to rest and avoid heavy lifting, sports, and swimming for at least 2 weeks. You should expect to have some pain at the incisions for several days, and you may need to be off work for 1-2 weeks. You will be given a prescription for pain medication to take at home.
If you have open surgery, you will stay in the hospital 2 - 5 days. While there, do your best to start walking as soon as possible. Also, do the breathing exercises that your nurse recommends. This is to prevent complications after surgery such as pneumonia and blood clots. After you go home, you can do most of your normal activities. You should avoid heavy lifting, sports, and swimming for a few weeks. You should expect to be off work (or school) for 2-4 weeks. If you are taking narcotic pain medicine during recovery, you might get constipated. Take a stool softener or a laxative to prevent this problem.
For either surgery, if you develop any of these symptoms in the weeks after surgery, call your doctor:
- Fever or chills
- More than ¼ inch of redness or swelling around your incisions
- Severe or cramping abdominal pain, or worsening abdominal pain
- Yellow skin or eyes, or dark colored urine, or pale (white-gray) bowel movements
- Nausea or vomiting more than 24-48 hrs after your surgery
Life after gallbladder removal
The gallbladder has a purpose, but the body can be without it. The gallbladder stores bile made by the liver. It squeezes the bile into your intestines when you eat to help digest your meal. Without your gallbladder, the liver still makes the same amount of bile. Instead of the gallbladder storing the bile for using when you eat, the bile trickles into the intestines continuously.
The surgery does not affect digestion much. Most people are able to resume a completely normal diet 1 - 2 weeks after surgery. About half the people who have surgery have mild symptoms afterward. These can include loose bowel movements, gas or bloating. These symptoms occur especially after eating a fatty meal. They usually get better a few months after surgery.
Gallbladder surgery does not cause weight loss. In fact, some people may gain weight after gallbladder surgery as they no longer have discomfort after eating.
Percutaneous cholecystostomy tube
A percutaneous cholecystostomy tube is the medical term for placing a drainage tube in the gallbladder through the skin.
We place this tube if you have a severe gallbladder infection and are too sick to undergo major surgery. A percutaneous cholecystostomy tube is a way to allow your gallbladder to drain. This will relieve your pain and help with the infection. We also treat your infection with antibiotics.
How is a percutaneous cholecystostomy done?
We complete the procedure in the radiology department, under radiology guidance. A radiologist, a medical doctor trained in radiology imaging and treatments, numbs the area of skin over your liver. He or she will then put a needle through the skin, through the liver, and into your gallbladder. A small tube is pushed over the needle into the gallbladder. One end of the tube will be in the gallbladder, and the other end of the tube will come out your skin and attach to a drainage bag. We stitch the tube in place on your skin.
What happens after a percutaneous cholecystostomy?
Your gallbladder will now drain into the drainage bag rather than into your intestines. You will need to go home with this drain in place with the bag. The drain will need to stay in place for at least 6 weeks. This allows a muscular tract to form around the drainage, so that you do not leak bile into your belly when we remove the tube. You will need to keep the drain site clean, dry (covered while showering) and protected from accidentally getting pulled out . You will need to keep track of the amount of fluid that is draining into the bag. You can become dehydrated and you should try to drink at least 3-4 liters (about twice your normal amount) of fluid per day to keep hydrated.
As the inflammation resolves, the gallbladder may then be able to drain into your intestines again. A few weeks after we place your tube, you will have a diagnostic study in radiology. For the study a contrast dye in squirted into the tube. This is to evaluate the tube and the gallbladder to see if the gallbladder is able to empty normally again. We also check for gallstones. The doctor will likely try to “clamp” the tube as another way to test if your gallbladder is draining properly. If the tube is clamped, the gallbladder can then only drain into the intestines.
If your gallbladder works properly, and if you do not have gallstones, your doctor can remove the tube and leave your gallbladder. The hole from the tube will close on its own in 2-3 days.
Sometimes, you may still need to have surgery to remove your gallbladder. If you have gallstones, or if the gallbladder is still not able to drain properly, we will remove it. During your cholecystectomy, gallbladder removal surgery, we also remove the tube.