What is Gallbladder Surgery?
Gallbladder surgery, also known as cholecystectomy, is a surgical procedure to remove your gallbladder.
Gallbladder surgery can be performed as an open surgery or as a laparoscopic surgery. Your surgeon will recommend open surgery if complications are present. Open surgery involves making a long incision on the abdomen to remove the gall bladder. Laparoscopic surgery involves making 3 to 4 tiny incisions in the abdomen, insertion of a laparoscope (a tiny flexible tube with a lighted device and video camera at its end) and surgical instruments, followed by removal of the gallbladder.
The gallbladder is not an essential organ and therefore you can live a normal life even after the gallbladder is removed. Digestion of fats will be continued by the liver even after gallbladder removal. Dietary changes are recommended if you experience side effects such as indigestion, bloating, or diarrhea after the surgery. Increase your fiber intake gradually and avoid caffeinated or spicy food. Continue eating a healthy well balanced diet to aid recovery and improve your health.
Indications for Gallbladder Surgery
Surgery to remove the gallbladder is most commonly performed if you have gallstones in the gallbladder (cholelithiasis).
The gallbladder is a pear-shaped organ located on the right side of the abdomen, just below the liver. It stores bile fluid which is produced in the liver. Bile fluid contains water, proteins, fats, cholesterol, bile salts, and bile pigments, which aid in the digestion of food. The gall bladder releases bile fluid into the intestine through the common bile duct following the ingestion of food. An imbalance in the components that form bile can lead to the formation of gallstones. Gallstones are small, hard deposits that form inside the gallbladder.
Gallbladder surgery may also be recommended by your doctor if you are suffering from other gallbladder conditions, such as inflammation of the gallbladder (cholecystitis), gallstones in the bile duct (choledocholithiasis), gallbladder polyps, or inflammation of the pancreas (pancreatitis) due to gallstones, which are unresponsive to medications or other conservative treatments.
Preparation for Gallbladder Surgery
In general, preparation for gallbladder surgery will involve the following steps:
- Preoperative workups, such as medical evaluation, blood work, and imaging will be done.
- Additional tests may be advised if required depending on your medical history.
- An anesthesiologist will meet you to discuss the type of anesthesia that will be used during surgery.
- You should inform your doctor of any medications or supplements that you are taking or any medical conditions you have such as lung or heart disease.
- If you are on any medicines such as blood thinners or any supplements, they may need to be stopped temporarily prior to surgery.
- You will be asked if you have allergies to medications, anesthesia, or latex (surgical gloves).
- You may take a shower with an antibacterial soap the night prior to or the morning of the operation.
- You should refrain from food or drink at least 8 hours prior to your surgery.
- Refrain from smoking and alcohol at least a week before surgery and several weeks after surgery as it can hinder the healing process.
- Arrange for someone to drive you home after surgery.
- Your surgeon will thoroughly explain the procedure in detail and obtain your written consent for surgery.
Procedure for Gallbladder Surgery
Gallbladder surgery is usually performed through a minimally invasive laparoscopic technique. In some instances, your surgeon may perform gallbladder surgery through an open surgery technique.
Laparoscopic Technique
Laparoscopic gallbladder surgery is a less invasive surgical method that uses a device called a laparoscope and takes about an hour or two. The laparoscope is a small, thin tube with a light and tiny video camera (connected to a television monitor) attached at the end, which helps visualize inside the abdomen during the operation.
The procedure is performed under general anesthesia. Your surgeon makes 3 to 4 small incisions on your abdomen. The laparoscope is inserted into the body through one of the incisions. The television monitor will guide the surgeon to insert other surgical instruments through the other incisions. Air or carbon dioxide is injected into the abdomen to inflate the abdominal cavity so that the gallbladder and other adjacent organs can be visualized easily. Your surgeon first cuts the bile duct and blood vessels leading to the gallbladder and then removes the gallbladder. At the end of the procedure, the scope and the surgical instruments are withdrawn, and the incisions are closed with sutures and bandaged.
Robotic Technique
Robotic cholecystectomy is performed under general anesthesia. However, instead of directly manipulating the surgical instruments, the surgeon controls robotic arms from a console in the operating room. These robotic arms are equipped with tiny instruments and a high-definition camera, providing a three-dimensional view of the surgical site.
The procedure begins with the surgeon making small incisions in the abdomen, typically ranging from 0.5 to 1 centimeter in size. These incisions serve as ports for the insertion of the robotic arms and instruments. One of the ports accommodates the robotic camera, providing a magnified, high-resolution view of the surgical field.
Once the ports are in place, the surgeon maneuvers the robotic arms to access the gallbladder. The robotic system offers greater dexterity and range of motion compared to traditional laparoscopic instruments, allowing for precise movements in tight spaces. This enhanced precision is particularly beneficial when dissecting delicate structures and minimizing trauma to surrounding tissues.
With the assistance of the robotic arms, the surgeon carefully dissects the tissues surrounding the gallbladder, including the cystic duct and blood vessels. Once the critical structures are identified and safely isolated, the gallbladder is detached from the liver and carefully extracted through one of the incisions. Throughout the procedure, the surgeon maintains full control over the robotic system, ensuring optimal surgical outcomes. After the gallbladder is removed, the robotic arms and instruments are withdrawn, and the incisions are closed with sutures or surgical glue.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after gallbladder surgery will involve the following steps:
- You will be transferred to the recovery room where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover from the effects of anesthesia.
- You may go home the same day of the surgery or require an overnight stay in the hospital before being discharged home the next day.
- You may experience pain and discomfort in the abdominal area, as well as in the shoulder area due to the air or carbon dioxide used during the laparoscopic technique. Medications are prescribed as needed to address these.
- Application of ice packs on the operated area is also recommended for additional comfort.
- Your doctor may prescribe antinausea medications for side effects associated with anesthesia such as nausea and vomiting and antibiotics to address the risk of surgery-related infection.
- Refrain from strenuous activities and lifting anything heavier than 5 pounds until 4 to 6 weeks. These activities include housework, yard work, gardening, and mowing.
- You are instructed to eat high-fiber foods and drink 8 to 10 glasses of water per day to avoid problems related to bowel movements. Refrain from spicy and fatty foods and include a diet rich in fruits and vegetables.
- Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
- You should be able to resume your daily activities in a week or two. You can return to work 1 week after the surgery. However, if your work requires lifting heavy objects, you can resume these activities only after 4 to 6 weeks.
- A follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Gallbladder surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Infection
- Bleeding
- Hernias
- Blood clots
- Leakage of bile fluid
- Allergic/anesthetic reactions
- Injury to nerves and blood vessels
- Damage to the liver, bile ducts, or intestines.
