Cholecystectomy: Overview, Types, Procedure and Risks

The gallbladder is a small-pear-shaped organ located in the right abdomen, under our liver. It holds a digestive fluid called bile and releases it into our small intestines to break down fatty foods.

However, sometimes individuals may develop hardened deposits within the gallbladder of different sizes, known as gallstones. Under such circumstances, one must undergo gallbladder removal or cholecystectomy. Scroll down to learn how many types of cholecystectomy are there, what their procedures are, complications and what to expect before, during and after gallbladder removal surgery.

Cholecystectomy is the gallbladder removal process due to the formation of gallstones in the bile duct (choledocholithiasis) or in the gallbladder (cholelithiasis). The gallbladder performs functions of collecting and storing a digestive fluid called bile which is produced by the liver. There are two types of cholecystectomy procedures: laparoscopic cholecystectomy and open cholecystectomy.

Gallstones are formed due to an imbalance in the substances that produce bile. Most people with gallstones do not have any symptoms and do not need treatment.

Doctors recommend gallstone removal surgery to those who have signs such as:

• Pain in the upper right area of the stomach
• Vomiting
• Nausea

If left untreated, gallstones can lead to other serious threats. Under the following conditions, doctors also recommend cholecystectomy.

• Gallbladder inflammation or cholecystitis
• Gallstones in the bile duct or choledocholithiasis
• Pancreas inflammation due to gallstones or pancreatitis
• Bile ducts inflammation or cholangitis
• Large gallbladder polyps

Surgeons perform cholecystectomy surgery in two different ways. They are:

1. Laparoscopic Cholecystectomy

In this process, surgeons make a few small incisions on the right side of the abdomen. These incisions are made to insert a laparoscope, a thin tube with a camera, for visualising the inside of the abdomen and other surgical instruments to remove the gallbladder.

Laparoscopic cholecystectomy is less invasive than open one and is performed under general anaesthesia.

Survival Rate After Surgery : 81.8% 

Cost of the Surgery: Approximately ₹ 50,000 to ₹ 70,000

2. Open Cholecystectomy

In this process, surgeons make a large incision in the right abdomen below the ribs. This area is opened to visualise the gallbladder and cut it off from other organs. Surgeons also separate the bile duct and blood vessels leading to the gallbladder.

Open cholecystectomy is invasive and performed under general anaesthesia like laparoscopic gallbladder removal surgery.

Survival Rate After Surgery: 84.2%

Cost of the Surgery: Approximately ₹ 45,000 to ₹ 1,00,000

To avoid any complications, individuals must take care of the followings:

1. No Dinner

Doctors ask not to eat dinner the night before cholecystectomy. They only allow drinking a sip of water with the medicines. Further, patients should strictly avoid eating and drinking at least four hours before the surgery.

2. Medication

Doctors prescribe certain medicines to prepare the patient for the surgery. However, they may also ask to stop certain medicines and supplements that may increase the risk of bleeding.

3. Clothing and Personal Belongings

Patients may go home on the same day of the surgery. However, depending on the complications, doctors may suggest staying one or more nights in the hospital for observation. Therefore, individuals must carry personal belongings, like clothes, personal hygiene items, etc., during admission.

Though the cholecystectomy procedure is safe, like every other surgery, it, too, has certain complications, such as:

• Bleeding: It is among the rarest risks after the operation and may require another surgery to stop it.
• Infection: Some patients may develop an internal infection or wound after the surgery. A few signs include swelling or redness, pus coming out of the wound and more pain.
• Bile Leakage: After removing the gallbladder, surgeons use special clips to seal the tube that bridges the gallbladder to the main duct. However, the bile fluid can sometimes leak into the abdomen after surgery. A few symptoms of the leakage include pain, fever, swollen stomach, etc.
• Deep Vein Thrombosis: Some patients may be at greater risk of blood coagulation after the surgery, called deep vein thrombosis or DVT. Under this condition, the blood clot can travel around the body and block the blood flow to the lungs. This condition is called pulmonary embolism.
• Post-cholecystectomy Syndrome: Even after the surgery, patients may experience symptoms that they did before the operation. These are indigestion, pain in the stomach, high fever, jaundice (yellowing of the eyes and skin) and diarrhoea. Though mild, these signs may persist for months.
• Bile Duct Injury: During the surgery, the bile duct may get damaged.
• Complication from General Anaesthesia: General anaesthesia may trigger allergies and, in a worse scenario, death. Patients must be fit and healthy before the surgery to avoid such complications.
• Intestine, Bowel and Blood Vessels Injury: The surgical instruments used in cholecystectomy may damage the surroundings, including the intestine, bowel and blood vessels.

Here are a few things you can expect before cholecystectomy.

Apart from no food and drinks and specified medications, surgeons give some other preoperative orders, including:

• Take a shower before going to the outpatient clinic or hospital.
• Avoid shaving the abdomen (surgical area).
• Do not wear contact lenses and jewellery.
• Avoid wearing lotion, perfumes or nail polish.
• Carry a photo ID proof to the outpatient clinic or hospital.
• Sign the consent form.

An IV will be placed in the vein to administer medicines and fluids and help relax before the surgery.

On the day of surgery, you will receive a dose of anaesthesia drugs through the vein of your arm. Once this drug shows its effect, surgeons will insert a tube down your throat to help you breathe during the procedure.

Depending on your condition, doctors may suggest one of the two surgical approaches.

• Laparoscopic Cholecystectomy: Laparoscopic cholecystectomy takes around one to two hours. In this process, surgeons make four small incisions less than an inch in the abdomen. Then, they insert a micro video camera into the abdomen through one of the incisions. They monitor through this camera and use surgical tools accordingly through the other incisions to remove the gallbladder. If surgeons find gallstones or other issues in the bile duct, a patient may undergo an X-ray called cholangiogram or laparoscopic ultrasound (LUS). Then, surgeons will suture the incisions.
• Open Cholecystectomy: Open cholecystectomy takes around one to two hours. In this process, surgeons make a six-inch incision in the right abdomen below the ribs. Next, they pull the muscle and tissue to assess the liver and gallbladder and remove the gallbladder. Lastly, they will suture the incision.

After the surgery, patients are taken to a recovery area when the anaesthesia drugs wear off. Later, they will be shifted to a hospital room to recover. 

However, recovery time is indicative and varies based on the cholecystectomy procedure.

• Laparoscopic Cholecystectomy: Commonly, patients can go home on the same day of this surgery. However, depending on their post-surgery condition, they may have to stay for a night at the hospital. Once they can eat and drink without pain and walk without support, they can return home. To fully recover, patients may take up to a week.
• Open Cholecystectomy: After this surgery, patients must spend two to three days in the hospital to recover under doctors’ surveillance. After returning home, they may take four to six weeks to recover completely.

Individuals experiencing symptoms like chronic pain in the lower abdomen, nausea and vomiting, frequent indigestion or heartburn must approach a specialist for a check-up. Cholecystectomy or gallbladder surgery is required if the patient is suffering from symptoms resulting from the presence of gallstones.