Open gallbladder removal
Open gallbladder removal is a surgery to remove the gallbladder via a single, large open incision in the abdomen. It’s also called open cholecystectomy. Doctors perform the procedure to provide permanent relief to a person with 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 and absorb fats. The gallbladder then stores the extra bile the liver makes. It releases bile 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 cholecystectomy is the most common type of gallbladder removal surgery performed. It’s a minimally invasive surgery. However, open gallbladder surgeries are still used for a variety of people, especially those who have scar tissue or other anatomical complications from prior abdominal surgeries.
Unfortunately, the gallbladder isn’t always the most efficient organ. Bile can be thick and create blockages along the pathway where it typically empties. The gallbladder is also prone to develop gallstones in certain people.
Gallstones are hard deposits of substances in the bile that can get stuck inside the gallbladder and biliary ducts. They can be as small as a grain of sand or as large as a golf ball. Gallstones can also lead to acute or chronic gallbladder inflammation, sometimes with an associated infection, which can cause:
A surgeon will remove your gallbladder if gallstones cause significant pain and other complications.
Other conditions that could make you a candidate for gallbladder removal include:
- Biliary dyskinesia. This occurs when the gallbladder doesn’t empty bile correctly due to a defect in its motion.
- Choledocholithiasis. This happens when gallstones have moved to the common bile duct where they may be stuck, causing a blockage that doesn’t allow the gallbladder or rest of the biliary tree to drain.
- Cholecystitis. This is inflammation of the gallbladder.
- Pancreatitis. This is 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 right upper portion of your abdomen that can radiate to the middle of your abdomen, right shoulder, or back
- jaundice, or yellowing of your skin, which typically indicates a bile duct blockage when due to biliary disease
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.
Open gallbladder removal is considered a safe operation. 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, heart attack, or heart failure
- injury to the bile ducts or small intestine
Your surgeon will explain these risks to you and give you the chance to ask questions prior to the procedure.
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.
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. 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:
- Arrange to have someone stay with you immediately after surgery and drive you home.
- Fast (no eating or drinking) for at least four hours or more before surgery.
- Plan for a hospital stay in case of complications.
- Shower using a special, antibacterial soap.
Whenever possible, laparoscopic surgery is preferred over traditional open surgery. This is because it’s 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.
If someone has had prior abdominal surgeries that caused inflammatory changes near the gallbladder area, such as scar tissue adhesions, this may also make a laparoscopic cholecystectomy less possible.
Sometimes, a surgeon will begin using the laparoscopic method, but won’t be able to safely remove the gallbladder. In this case, they’ll 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 if needed. 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’re older than 50, male, and have complicating risk factors, such as acute gallbladder inflammation, previous abdominal surgeries, high fever, high bilirubin levels, or a history of frequent gallbladder attacks
At the hospital or surgery center, you’ll change into a hospital gown. An intravenous (IV) line will be inserted into a vein in your arm or hand for the purpose of anesthesia. An open gallbladder procedure is typically performed under general anesthesia, so you’ll be in a painless, deep sleep before the surgery starts.
Your abdomen will first be cleansed with an antiseptic solution to reduce infection risk. Your surgeon will then make an incision in your abdomen. 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 abdomen. Or they could create an up-and-down incision on the right upper part of your abdomen. This is less common.
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 the ACS, a laparoscopic gallbladder removal procedure takes about one to two hours. An open procedure can take longer, but the length of time depends on the severity of the gallbladder disease.
After your surgery, you’ll be taken to the postoperative recovery area and then back to your hospital room. Your vital signs, pain levels, intake and output, and incision site will continue to be monitored until you’re released home.
Your doctor will discharge you from the hospital once your vital signs have stabilized and you show clinical signs of recovery without complications.
Hospital stays are typically longer after an open procedure. This is because open procedures are more invasive than laparoscopic procedures. Your doctor will want to make sure you aren’t having excessive bleeding, nausea, or pain. The medical staff will also monitor you for signs of infection, like fever or pus containing 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 could take about four to six weeks.
Some ways you can prevent complications after surgery include the following:
- Walk around frequently to prevent blood clots.
- Drink plenty of fluids to prevent dehydration.
- Don’t lift more than 10 pounds for four to six weeks.
- Wash your hands before and after touching the area around your incision site.
- Change your bandages as directed.
- Avoid wearing tight clothing that could rub against the incision.
While you can expect some mild to moderate pain after surgery, it shouldn’t be severe. Certain pain-relieving medications taken after surgery can cause constipation. Your doctor may prescribe a stool softener or laxative 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 an open gallbladder removal surgery is low. However, some symptoms could indicate an infection. Call your doctor if you experience any of the following:
- pain that gets worse, not better
- fever higher than 101°F (38.3°C)
- 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