What Is Cholecystectomy

Comprehensive guide to cholecystectomy

Are you dealing with gallbladder issues and wondering what cholecystectomy is? This comprehensive article on cholecystectomy will provide you with the confidence to make informed decisions about your health.

Cholecystectomy is the surgical removal of the gallbladder. The most common reasons for this procedure are gallstones and inflammation of the gallbladder. It aims to relieve symptoms and enhance overall well-being.

Read on to understand the indications for surgery, explore the various types of procedures, the preoperative preparations, intraoperative details, postoperative care, potential complications, and more.

Introduction

The gallbladder is a pear-shaped organ located in the right upper part of our abdomen, resting on the undersurface of the liver. It measures about 7 to 10 centimetres long and 4 centimetres wide. Though it is a very small organ, it is a known troublemaker as it is one of the common causes of abdominal pain due to the presence of gallstones. The gallbladder stores a digestive fluid, bile, and releases it into our digestive system when we eat.¹

Why would you need a cholecystectomy?

You may require cholecystectomy if you are diagnosed with any of the following conditions:

• Inflammation of the gallbladder (Cholecystitis) 
• Stones in the gallbladder, referred to as Gallstones or Cholelithiasis. Gallstones usually are formed when there is high cholesterol content inside the gallbladder. Some types of gallstones can also be seen in certain blood disorders and infections
• Mass or polyps in the gallbladder which could be cancerous
• Inflammation of the pancreas (pancreatitis) due to gallstones 
• Biliary dyskinesia is a condition where the gallbladder cannot contract efficiently to eject the bile stored in it

While some patients with gallbladder disease may experience no symptoms at all, some may experience pain typically in the right upper part of the abdomen. This pain may also be felt in the back or right shoulder region, usually starting about 30 minutes to two hours after eating a fatty meal and lasting about two hours. It may become more severe, continuous and constant later in the disease course. The other symptoms seen in gallbladder disease are nausea, vomiting, bloating sensation, diarrhoea and fever.²

Types of cholecystectomy

Open cholecystectomy

Here a large incision measuring about 6 inches long is made in the abdomen to remove the gallbladder. A drain may be placed through which fluid or pus can be drained out from the wound site. In case of cancer of the gallbladder, a more extensive surgery may be required.

Laparoscopic cholecystectomy

In this type of surgery, 3-4 small incisions are made on the abdomen, and a laparoscope with a camera and light is inserted through one of the cuts. Surgical tools or instruments are then inserted through the other incisions, and the gallbladder is removed.³ 

The surgeon views the organs inside the abdomen on a monitor. In some cases, the surgeon may start with laparoscopic surgery but then decide to do an open surgery, depending on the patient’s condition.

Both these procedures are done under general anaesthesia, which helps you sleep during the surgery and not experience any pain or discomfort and the surgery usually lasts 1-2 hours.^4,5

After the surgery, the cuts are stitched and covered with sterile dressing. The gallbladder is sent to the laboratory for testing.

What to expect before the surgery

• A detailed clinical history will be taken and your surgeon will do a thorough physical examination. Here, you must mention any of your past surgeries and the regular medications you are on
• A blood work will be done to ensure you are fit to go through the surgery
• A chest X-ray, ultrasound abdomen and ECG would be required before the surgery
  
  The other tests that may be performed are:
  
• The HIDA Scan is a test that checks how well your gallbladder works.
• ERCP, or endoscopic retrograde cholangiopancreatography, is a test that can find gallstones stuck in the bile duct
• Your doctor will get a consent form signed by you after clearly explaining the procedure and the possible risks and complications
• Your surgeon will ask you to avoid eating or drinking for at least 8 hours before the procedure⁶

Postoperative phase

After the procedure, you will be monitored closely in the recovery room. IV fluids and some medications to manage pain would be given.

If you have had a laparoscopic surgery, you would be able to go home the same day, but if it was an open cholecystectomy, then 2-3 days of hospital stay may be advised. The drain placed during the open surgery would be removed in a day or so.⁴

Returning to your routine depends on your body’s healing capacity and might take a few days to a few weeks.^4,7

Here are a few things you should know about dealing with the postoperative phase:

Pain 

As with any surgery, you can expect pain and discomfort. In the case of laparoscopic surgery, you would experience some shoulder pain. All of this gets better within a few days. However, your surgeon would prescribe pain medications that you can take as instructed so you feel more comfortable.

Wound care 

The wound site has to be kept clean and dry. If there is any redness or bleeding from the site, inform your doctor immediately. The incisions are usually closed with dissolvable stitches. If staples are used to close the site, they will be removed during your follow-up appointment. You can shower once the bandage is removed. In case of any doubt, speak to your healthcare team about wound care.

Diet 

If you are concerned about what you can eat after cholecystectomy, do not worry. A few days after the surgery, most patients prefer a bland diet that is easy to digest as it might take a few days for your appetite to get back to normal, and you will certainly be able to tolerate various foods without any issues.

Driving 

You may resume driving after about a week, ensuring you can comfortably wear a seatbelt.

Work

If your work involves strenuous activities like bending and lifting heavy objects you should discuss with your doctor when it would be the right time for you to get back to work. But generally, if it is desk work most patients can resume their work within a week or two after the procedure.

Bowel habits 

Changes in bowel habits are common after surgery, often due to anaesthesia and pain medicines, leading to constipation. So, it is recommended to increase fibre and fluid intake. Some patients may experience mild diarrhoea after a cholecystectomy, which usually resolves on its own. However, if it is severe, do talk to your doctor so it can be treated with medications if necessary. 

Exercise 

You can resume light activities a few days post-operation. Consider incorporating deep breathing and relaxation exercises into your routine, especially during the initial week or whenever you feel particularly tense. Deep breathing exercises and taking a few moments to rest can effectively manage postoperative pain and maintain lung health following anaesthesia. Walking is also encouraged for better circulation, but avoiding lifting anything heavy for the first two weeks is advised.

Sexual Activity

You can engage in sexual activity as soon as you feel physically ready. However, avoid putting weight on your wounds until they have completely healed to ensure a smooth recovery.^4,7

Complications

A few complications that could occur due to gallbladder removal surgery are:

• Bleeding
• Infection
• Scarring at the incision 
• Damage to the surrounding organs like the liver
• Bile leak that can cause vague pain in the abdomen within a week of surgery
• Pneumonia due to general anaesthesia^2,5
• Hernia: A hernia occurs when tissues protrude through a weakened area in your incision. Although not common after laparoscopic surgery, it can still happen. A surgery is required to repair this defect^2,7

What is post-cholecystectomy syndrome (PCS)?

Post-cholecystectomy syndrome (PCS) refers to the persistence of abdominal pain and gastrointestinal symptoms resembling those experienced before gallbladder removal procedure.⁸ These symptoms can include intolerance to fatty foods, nausea, vomiting, heartburn, bloating, indigestion, diarrhoea, jaundice, and occasional abdominal pain. PCS may occur shortly after the surgery or can begin months to years later. While some cases can be managed with medicines, some may require a surgical procedure.⁶

Signs to contact your healthcare team immediately

• Fever or chills
• Bleeding or any kind of discharge from the incision site
• Increasing pain at the site
• Persistent cough and difficulty breathing
• Nausea/vomiting
• Yellowing of the skin or whites of the eyes (jaundice)
• Increasing swelling or bloating of the abdomen
• No bowel movement for three consecutive days
• Grey or pale stools^4,5

FAQs

What is the main cause of cholecystectomy? 

The primary reasons for cholecystectomy are gallstones and gallbladder inflammation, both of which can lead to persistent abdominal pain and discomfort. Additionally, other factors like gallbladder polyps, cancer, and pancreatitis due to gallstones may require cholecystectomy.

Is cholecystectomy a major surgery? 

While advancements in medical techniques, such as laparoscopic procedures, have minimised invasiveness, the removal of the gallbladder is still a significant surgical intervention that requires careful preoperative and postoperative care.

What foods should you avoid if you have no gallbladder?

If you no longer have a gallbladder, it's advisable to avoid high-fat foods that may trigger digestive discomfort for a week or two after the surgery. Do talk to your surgeon if you have any particular concerns regarding your diet.

Summary

Understanding cholecystectomy is crucial for those dealing with gallbladder issues. This surgical procedure, aimed to relieve symptoms of gallbladder diseases, can be done in two ways: open and laparoscopic. 

Preoperative evaluations involve thorough examinations and tests. Postoperatively, you can anticipate temporary changes in bowel habits, manage pain, and gradually resume daily activities. 

Additionally, awareness of potential complications, such as post-cholecystectomy syndrome (PCS), emphasises the need for vigilant postoperative care. By comprehending these key aspects, you can approach cholecystectomy with informed decision-making and focusing on your overall well-being.