The main treatment for acute cholecystitis is surgery to remove the gallbladder (cholecystectomy). Often this surgery can be done through small incisions in the abdomen (laparoscopic cholecystectomy), but sometimes it requires a more extensive operation. Your doctor may try to reduce swelling and irritation in the gallbladder before removing it. Sometimes acute cholecystitis is caused by one or more gallstones getting stuck in the main tube leading to the intestine, called the common bile duct. Treatment may involve an endoscopic procedure (endoscopic retrograde cholangiopancreatography, or ERCP) to remove the stones in the common bile duct before the gallbladder is removed.
What is a cholecystectomy?
A cholecystectomy is surgery to remove your gallbladder.
The gallbladder is a small organ under your liver. It is on the upper right side of your belly or abdomen. The gallbladder stores a digestive juice called bile which is made in the liver.
There are 2 types of surgery to remove the gallbladder:
Open (traditional) method. In this method, 1 cut (incision) about 4 to 6 inches long is made in the upper right-hand side of your belly. The surgeon finds the gallbladder and takes it out through the incision.
Laparoscopic method. This method uses 3 to 4 very small incisions. It uses a long, thin tube called a laparoscope. The tube has a tiny video camera and surgical tools. The tube, camera and tools are put in through the incisions. The surgeon does the surgery while looking at a TV monitor. The gallbladder is removed through 1 of the incisions.
A laparoscopic cholecystectomy is less invasive. That means it uses very small incisions in your belly. There is less bleeding. The recovery time is usually shorter than an open surgery.
In some cases the laparoscope may show that your gallbladder is very diseased. Or it may show other problems. Then the surgeon may have to use an open surgery method to remove your gallbladder safely.
Why might I need a cholecystectomy?
A cholecystectomy may be done if your gallbladder:
- Has lumps of solid material (gallstones)
- Is red or swollen (inflamed), or infected (cholecystitis)
- Is cancerous
Gallbladder problems may cause pain which:
- Is usually on the right side or middle of your upper belly
- May be constant or may get worse after a heavy meal
- May sometimes feel more like fullness than pain
- May be felt in your back and in the tip of your right shoulder blade
Other symptoms may include nausea, vomiting, fever, and chills.
The symptoms of gallbladder problems may look like other health problems. Always see your healthcare provider to be sure.
Your healthcare provider may have other reasons to recommend a cholecystectomy.
What are the risks of a cholecystectomy?
Some possible complications of a cholecystectomy may include:
- Injury to the tube (the bile duct) that carries bile from the gallbladder to the small intestine
- Liver injury
- Scars and a numb feeling at the incision site
- A bulging of organ or tissue (a hernia) at the incision site
During a laparoscopic procedure, surgical tools are put into your belly. This may hurt your intestines or blood vessels.
You may have other risks that are unique to you. Be sure to discuss any concerns with your healthcare provider before the procedure.
How do I get ready for a cholecystectomy?
- Your healthcare provider will explain the procedure to you. Ask him or her any questions you have.
- You may be asked to sign a consent form that gives permission for the procedure. Read the form carefully and ask questions if anything is not clear.
- Your provider will ask questions about your past health. He or she may also give you a physical exam. This is to make sure you are in good health before the procedure. You may also need blood tests and other diagnostic tests.
- You must not eat or drink for 8 hours before the procedure. This often means no food or drink after midnight.
- Tell your provider if you are pregnant or think you may be pregnant.
- Tell your provider if you are sensitive to or allergic to any medicines, latex, tape, and anesthesia medicines (local and general).
- Tell your provider about all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.
- Tell your provider if you have a history of bleeding disorders. Let your provider know if you are taking any blood-thinning medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.
- If this is an outpatient procedure, you will need to have someone drive you home afterward. You won’t be able to drive because of the medicine given to relax you before and during the procedure.
- Follow any other instructions your provider gives you to get ready.
What happens during a cholecystectomy?
You may have a cholecystectomy as an outpatient or as part of your stay in a hospital. The way the surgery is done may vary depending on your condition and your healthcare provider's practices.
A cholecystectomy is generally done while you are given medicines to put you into a deep sleep (under general anesthesia).
Generally, a cholecystectomy follows this process:
- You will be asked to take off any jewelry or other objects that might interfere during surgery.
- You will be asked to remove clothing and be given a gown to wear.
- An intravenous (IV) line will be put in your arm or hand.
- You will be placed on your back on the operating table. The anesthesia will be started.
- A tube will be put down your throat to help you breathe. The anesthesiologist will check your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- If there is a lot of hair at the surgical site, it may be clipped off.
- The skin over the surgical site will be cleaned with a sterile (antiseptic) solution.
Open method cholecystectomy
- An incision will be made. The incision may slant under your ribs on the right side of your abdomen. Or it may be made in the upper part of your abdomen.
- Your gallbladder is removed.
- In some cases, 1 or more drains may be put into the incision. This allows drainage of fluids or pus.
Laparoscopic method cholecystectomy
- About 3 or 4 small incisions will be made in your abdomen. Carbon dioxide gas will be put into your abdomen so that it swells up. This lets the gallbladder and nearby organs be easily seen.
- The laparoscope will be put into an incision. Surgical tools will be put through the other incisions to remove your gallbladder.
- When the surgery is done, the laparoscope and tools are removed. The carbon dioxide gas is let out through the incisions. Most of it will be reabsorbed by your body.
Procedure completion, both methods
- The gallbladder will be sent to a lab for testing
- The incisions will be closed with stitches or surgical staples
- A sterile bandage or dressing or adhesive strips will be used to cover the wounds
What happens after a cholecystectomy?
In the hospital
After the procedure, you will be taken to the recovery room to be watched. Your recovery process will depend on the type of surgery and the type of anesthesia you had. Once your blood pressure, pulse, and breathing are stable and you are awake and alert, you will be taken to your hospital room.
A laparoscopic cholecystectomy may be done on an outpatient basis. In this case, you may be discharged home from the recovery room.
You will get pain medicine as needed. A nurse may give it to you. Or you may give it to yourself through a device connected to your IV (intravenous) line.
You may have a thin plastic tube that goes through your nose into your stomach. This is to remove air that you swallow. The tube will be taken out when your bowels are working normally. You won’t be able to eat or drink until the tube is removed.
You may have 1 or more drains in the incision if an open procedure was done. The drains will be removed in a day or so. You might be discharged with the drain still in and covered with a dressing. Follow your provider’s instructions for taking care of it.
You will be asked to get out of bed a few hours after a laparoscopic procedure or by the next day after an open procedure.
Depending on your situation, you may be given liquids to drink a few hours after surgery. You will slowly be able to eat more solid foods as tolerated.
Arrangements will be made for a follow-up visit with your provider. This is usually 2 to 3 weeks after surgery.
Once you are home, it’s important to keep the incision clean and dry. Your provider will give you specific bathing instructions. If stitches or surgical staples are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and usually will fall off within a few days.
The incision and your abdominal muscles may ache, especially after long periods of standing. If you had a laparoscopic surgery, you may feel pain from any carbon dioxide gas still in your belly. This pain may last for a few days. It should feel a bit better each day.
Take a pain reliever as recommended by your provider. Aspirin or other pain medicines may raise your risk of bleeding. Be sure to take only medicines your healthcare provider has approved.
Walking and limited movement are generally fine. But you should avoid strenuous activity. Your provider will tell you when you can return to work and go back to normal activities.
Call your provider if you have any of the following:
- Fever or chills
- Redness, swelling, bleeding, or other drainage from the incision site
- More pain around the incision site
- Yellowing of your skin or the whites of your eyes (jaundice)
- Belly or abdominal pain, cramping, or swelling
- No bowel movement or gas for 3 days
- Pain behind your breastbone
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- The risks and benefits of the test or procedure
- When and where you are to have the test or procedure and who will do it
- When and how will you get the results
- How much will you have to pay for the test or procedure