Open gallbladder removal, or open cholecystectomy, is a surgery to remove the gallbladder via a large open incision in the abdomen. Doctors perform the procedure to provide permanent relief to a patient suffering from gallstones and other problems associated with the gallbladder.
The gallbladder is a small organ located on the underside of the liver. Its primary purpose is bile storage. The liver makes bile, a substance that helps the body break down fats. The gallbladder then stores the extra bile the liver makes, releasing it when you eat a meal with fats that need to be digested. Normal digestion is possible without a gallbladder. Bile will continue to reach your small intestine, but it just won’t be stored along the way in the gallbladder.
According to the Mayo Clinic, laparoscopic or minimally invasive removal is the most common type of gallbladder removal surgery. However, open gallbladder surgeries are still used for a variety of patients, especially those who have scar tissue or other complications from prior abdominal surgeries.
Why Open Gallbladder Removal Is Done
Unfortunately, the gallbladder isn’t always the most efficient organ. Bile can be thick and can create blockages along the patterns where it typically empties. The gallbladder is also prone to develop gallstones. Gallstones are hard deposits of substances in the bile that get stuck inside the gallbladder. They can be as small as a grain of sand or as large as a golf ball. Gallstone disease, called cholelithiasis, can cause short or lasting pains in the abdomen. Gallstones can also cause infections to form, which can cause bloating, nausea, vomiting, and further pain. A surgeon will remove your gallbladder if gallstones cause pain and other complications.
Other conditions that could make you a candidate for open gallbladder removal include:
- biliary dyskinesia, which is when the gallbladder doesn’t fill or empty correctly due to a defect
- choledocholithiasis, which is when gallstones have moved to the common bile duct (CBD) and may be causing a blockage that doesn’t allow the gallbladder to drain
- cholecystitis, which is an inflammation of the gallbladder
- pancreatitis, which is an inflammation of the pancreas
A doctor will recommend gallbladder removal if your gallbladder is causing a severe, acute problem or has become a chronic concern. Some symptoms that may indicate the need for gallbladder removal include:
- sharp pain in the upper portion of your abdomen that can extend to the middle of your stomach, right shoulder, or back
- yellowing of your skin (jaundice), which indicates a bile duct blockage
Sometimes a doctor will recommend watchful waiting to see if gallbladder-related symptoms lessen. Diet changes, such as reducing overall fat intake, may also help. If symptoms persist, a doctor may recommend surgery.
Whenever possible, laparoscopic surgery is preferred over traditional open surgery because it is less invasive and usually has a shorter recovery time. However, certain complications can make open surgery a better choice, such as when the gallbladder is severely diseased. A severely diseased gallbladder can be more difficult to remove because it may have affected surrounding areas, which makes a laparoscopic procedure more difficult.
Sometimes, a surgeon will begin using the laparoscopic method but will not be able to safely remove the gallbladder. In this case, he or she will finish the procedure in the open fashion. According to the American College of Surgeons (ACS), a surgeon starts with a laparoscopic method and converts to an open method. The likelihood of an open method is:
- less than 1 percent of the time in young, healthy individuals
- 1.3 to 7.4 percent of the time when gallstones are present in the common bile duct
- as high as 30 percent if you are older than 65, male, and have complicating risk factors such as previous abdominal surgeries, high fever, high bilirubin levels, or a history of frequent gallbladder attacks
The Risks of Open Gallbladder Removal
Open gallbladder removal is considered a safe operation and complications are rare. However, every surgical procedure carries some risks. Before the procedure, your doctor will perform a complete physical examination and medical history to minimize these risks.
Risks of open gallbladder removal include:
- allergic reaction to anesthesia or other drugs
- excessive bleeding
- blood clots
- damage to blood vessels
- heart problems, such as rapid heart rate
- injury to the bile duct or small intestine
- pancreatitis, or inflammation of the pancreas
Your surgeon will explain these risks to you and give you the chance to ask questions prior to the procedure.
How to Prepare for Open Gallbladder Removal
Prior to surgery, you’ll undergo several tests to ensure you’re healthy enough for the procedure. These will include blood tests and imaging tests of your gallbladder. A complete physical exam and record of your medical history will also be needed.
During these appointments, tell your doctor if you’re taking any medications, including over-the-counter drugs or nutritional supplements. Certain medications can interfere with the procedure, and you may have to stop taking them prior to surgery. Also, tell your doctor if you’re pregnant or may be pregnant.
Your doctor will give you complete instructions on the best way for you to prepare for surgery.
These instructions may include:
- arranging to have someone stay with you immediately after surgery and drive you home
- drinking a prescription solution that flushes out your bowels
- fasting (not eating or drinking) for six hours or more before surgery
- planning for a hospital stay in case of complications
- showering using a special, antibacterial soap
How Open Gallbladder Removal Is Performed
At the hospital or surgery center, you’ll change into a hospital gown and an intravenous (IV) line will be inserted into a vein in your arm for the purpose of anesthesia. An open gallbladder procedure is performed under general anesthesia, so you’ll be in a painless sleep before the surgery starts.
Your stomach will first be cleansed with an antiseptic solution to reduce infection risk. Your surgeon will make an incision in your stomach. There are two incision types your surgeon may choose. The surgeon might create a slanted incision just below the ribs on the right side of your stomach, or they could create an up-and-down incision on the upper part of your stomach.
The skin, muscle, and other tissues are pulled back to expose your gallbladder. Your surgeon will then remove your gallbladder, close the wound with stitches, and then bandage the area. According to UC San Diego Health, a laparoscopic gallbladder removal procedure takes about an hour and a half. An open procedure can take longer, but the length of time depends on the severity of the gallbladder disease.
After your surgery, you will be brought back to your hospital room. Your vital signs will continue to be monitored until you’re released home.
After Open Gallbladder Removal
Your doctor will discharge you from the hospital or surgery center once your vital signs have stabilized and you show clinical signs of recovery without complications.
Hospital stays are typically longer after an open procedure because open procedures are more invasive than laparoscopic procedures. Your doctor will want to make sure you aren’t having excessive bleeding or pain. The medical staff will also monitor you for signs of infection, like fever or drainage at the surgical site.
According to the Mayo Clinic, you’ll typically spend up to three days in the hospital while you begin to recover. A full recovery from open gallbladder surgery takes about four to six weeks.
Some ways you can prevent complications after surgery include:
- walking around frequently to prevent blood clots
- drinking plenty of fluids to prevent dehydration
- not lifting more than 10 pounds for four to six weeks
- washing your hands before and after touching the area around your incision site
- changing your bandages as directed
- avoiding wearing tight clothing that could rub against the incision
While you can expect some mild to moderate pain after surgery, it should not be severe. Pain medication taken after surgery can cause constipation. Your doctor may prescribe a stool softener to reduce straining. You may also wish to eat a high-fiber diet that includes fruits and vegetables. This will help you pass your stools easier.
The risk of complications after surgery is low. However, you should call your doctor if you have the following symptoms because they could indicate an infection:
- pain that gets worse, not better
- fever higher than 101°F
- vomiting that won’t subside
- foul-smelling or bloody drainage from the incision
- significant redness and swelling of the incision
- not passing a bowel movement for two to three days after surgery