What is cholecystectomy?
Cholecystectomy is a surgical procedure to remove the gallbladder, a pear-shaped organ that is located just below the liver, in the upper right part of the abdomen. The gallbladder collects and stores bile, a digestive juice produced in the liver.
A cholecystectomy is a common surgery and carries a small risk of complications. In most cases, you will be able to go home the same day as your cholecystectomy or the next morning.
Cholecystectomy is performed primarily to treat gallstones and the complications they cause. Your doctor may recommend a cholecystectomy if you have the following:
- Gallstones in the gallbladder (cholelithiasis).
- Gallstones in the bile duct (choledocholithiasis).
- Inflammation of the gallbladder (cholecystitis).
- Large polyps in the gallbladder.
- Inflammation of the pancreas (pancreatitis) due to gallstones.
Before any surgery, an assessment should be carried out by the anesthetist where they will advise you which medication you should stop taking and which you should continue taking. Sometimes you must be evaluated by another specialist if you have underlying diseases.
In the case of anticoagulant treatment or treatment that facilitates bleeding, the anesthesiologist, haematologist, cardiologist or family doctor will inform about the attitude to follow.
In the case of smoking, the habit should be stopped because it facilitates anesthetic management, smoker patients have more complications than smokers in anesthetic procedures.
It is recommended to perform moderate-intensity exercise before any intervention, unless there is a specific contraindication, such as walking at least 60 minutes a day.
How is the preparation prior to the intervention?
FOOD AND MEDICINE
In preparation for a cholecystectomy, your surgeon may ask you to:
- Do not eat anything before surgery. You may have a sip of water with your medications, but avoid eating and drinking for at least six hours before surgery.
- Discontinue certain medications and supplements. Talk to your doctor about all medications and supplements you take. You continue to take most medications as directed by your doctor. Your doctor may ask you to stop certain medications and supplements because they can increase your risk of bleeding.
How is the surgery performed? (type of incision, resection, type of drainage, anesthesia)
BEFORE THE INTERVENTION
A cholecystectomy is performed under general anesthesia, so you won’t be conscious during the procedure. Numbing medications are given intravenously into the arm. Once the medications take effect, the health care team will insert a tube down your throat to help you breathe. Your surgeon will perform the cholecystectomy using a laparoscopic or open procedure.
DURING THE PROCEDURE
Depending on your situation, your surgeon will recommend one of two surgical approaches:
Minimally invasive (laparoscopic) cholecystectomy
During a laparoscopic cholecystectomy, the surgeon makes four small incisions in the abdomen. A tube with a tiny video camera is inserted into your abdomen through one of the incisions. The surgeon watches a video monitor in the operating room while using surgical tools inserted through the other incisions in the abdomen to remove the gallbladder.
Afterward, you may undergo an imaging test, such as an X-ray, if your surgeon is concerned about possible gallstones or other bile duct problems. The incisions are then sutured and you are moved to a recovery area. A laparoscopic cholecystectomy takes one to two hours.
A laparoscopic cholecystectomy is not appropriate for everyone. In some cases, the surgeon may start with a laparoscopic approach and determine that a larger incision is necessary due to scar tissue from operations, previous complications, or an inability to safely continue with the procedure.
Traditional (open) cholecystectomy.
During an open cholecystectomy, the surgeon makes an incision about 15 centimeters in the abdomen below the ribs on the right side. Muscle and tissue are retracted to reveal the liver and gallbladder. The surgeon then removes the gallbladder.
The incision is sutured and you are taken to a recovery area. An open cholecystectomy takes one to two hours. It is usually performed when the procedure cannot be carried out with maximum safety through the laparoscopic approach.
Sometimes it is necessary to place a tube or drain inside the abdomen with an outlet through the skin to allow the discharge of fluid from the area where the gallbladder was. This tube will be removed prior to discharge home.
What happens after the surgery?
After surgery, the patient slowly awakens from the effects of the anesthetic drugs, so they may have a feeling of not remembering the process. He will spend a short period of time in an area called post-anesthetic recovery, before being taken to his room.
HOW IS THE RECOVERY IN THE HOSPITAL?
It is possible to feel nausea or abdominal pain after the intervention but they will be controlled with the prescribed medication. After about 6 hours, you will begin with the intake of liquids and then solid foods. We recommend sitting down and starting to walk about 8 hours after the intervention. You will be supervised by nursing staff at all times.
If your surgery was performed in the morning and you have no previous illnesses, you may be discharged at the end of the day. If your surgery took place in the afternoon, you will usually leave the following noon.
HOW IS THE RECOVERY AT HOME?
Our premise is to be active in recovery. For this reason, we encourage the patient to walk daily, we recommend walking at least 60 minutes each day both inside and outside the house. Important physical efforts that may affect wound healing should always be avoided.
When you are discharged home, you will be prescribed medication to make you feel as comfortable as possible. You will resume your previous medication following the surgeon’s recommendations, since some drug may not be recommended in the first days after surgery. Normally the taking of painkillers is indicated to control the pain and the injection of heparin to avoid the appearance of thrombi in your legs. Occasionally, you may need antibiotics for a few days if your gallbladder was infected during the procedure.
In relation to food, we recommend the first week to avoid copious and fat-rich meals. Subsequently, all types of food will be progressively reintroduced, with possible intolerance of some of them, so their intake will be suspended and they will be tried again in the following weeks. Occasionally diarrhea may appear that usually lasts a few days or a week in relation to the new situation of the digestive system without gallbladder.
You can wet your wounds when you wash yourself and then gently dry them with the application of any antiseptic (chlorhexidine, povidone-iodine, crystalmine…). These wounds should be evaluated by nursing around 7 and 10 days after surgery.
Virtually full recovery can take approximately two to three weeks for laparoscopic cholecystectomy. However, with open cholecystectomy, once at home, full recovery may take four to six weeks.
What are the risks of cholecystectomy?
The normal thing is that your intervention proceeds without incidents but you must know the potential complications.
LESS SERIOUS AND FREQUENT RISKS:
Infection or bleeding from the surgical wound, phlebitis (inflammation of the veins), temporary digestion disorders. Pleural effusion. Prolonged pain in the area of the operation. Laparoscopic surgery may cause gas extension to the subcutaneous tissue or other areas and referred pain, usually to the shoulder.
INFREQUENT AND SERIOUS RISKS:
Biliary fistula. Intra-abdominal bleeding or infection. Intestinal obstruction. Inflammation of the pancreas (pancreatitis). Cholangitis (infection of the bile ducts). Jaundice (your skin may turn yellow). Allergic reactions. Liver failure. Due to laparoscopic surgery, there may be vascular injuries, injuries to neighboring organs, gas embolism and pneumothorax.
In most cases, these complications are resolved with medical treatment (medications, serums, etc.), sometimes other tests are required (ERCP and/or drainage), but they may require a reoperation, usually urgently., and exceptionally death may occur.
Your risk of complications depends on your overall health and the reason you’re having a cholecystectomy.