Gallbladder removal

The gallbladder might need to be removed if it turns into diseased or damaged.

You will meet the surgeon carrying out your procedure to talk about your care. It may differ from what is explained here as it will be designed to meet your individual needs.
 > Diagnosis of Gallstone

Preparing for Gallbladder Removal

Your surgeon will clarify how to prepare for your gallbladder removal. For example, in case you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Gallbladder removal using keyhole surgery is routinely done as a day-case procedure but you may also need to stay overnight in hospital. Gallbladder surgery is usually done under general anaesthesia. This means you will be asleep during your operation.

If you're having general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.
At the hospital your nurse may check your heart rate, blood pressure and test your urine.

Your surgeon will talk to you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do so by signing a consent form.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

What are the Risks?

As with several procedure, there are several risks associated with gallbladder removal. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to clarify how these risks apply to you.

What to Expect Afterwards

You might need to rest till the effects of the anaesthetic have passed. You may need pain relief to help with any irritation as the anaesthetic wears off.

If you're a day-case patient, you will usually be able to go home when you feel ready but you will need to arrange for someone to drive you home. Try to have a friend or relative with you for the first 24 hours after your surgery.

Before you go home your nurse will give you some advice about caring for your healing wounds. You may be given a date for a follow-up appointment.
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

If your wounds are closed with metal clips or stitches, these will be removed by a nurse after about a week. Commonly, dissolvable stitches are used with this procedure. The period of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure they should disappear in about two weeks.

Once your gallbladder has been removed, your body can't produce new gallstones. On the other hand, if gallstones have passed into your bile ducts and remain there after surgery, you may still get symptoms. Gallstones that have passed into your bile ducts can be removed by ERCP.

Diagnosis of Gallstone

You might need your gallbladder removed if:
• you have gallstones that are causing you pain caused by inflammation or infection of your gallbladder
• you have jaundice (yellowing of your skin or the whites of your eyes) caused by a gallstone blocking your bile duct
• you have inflammation of the pancreas (pancreatitis) caused by gallstones
• you have cancer of your gallbladder

There are two surgical techniques used to remove the gallbladder.
• Laparoscopic cholecystectomy - your gallbladder is removed through small cuts in your abdomen (tummy), using a surgical technique called keyhole surgery.
• Open cholecystectomy - your gallbladder is removed through one large cut in your abdomen, using a surgical technique called open surgery.

Complications

Complications are when difficulties take place during or after the procedure. The possible complications of any procedure include an unpredicted reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

There is a chance that during the operation your surgeon may need to convert from a keyhole procedure to open surgery. He or she will need to make a bigger cut in your abdomen. This will only be done if it’s not possible to complete your operation safely using the keyhole technique. It’s likely to take you longer to recover from this type of surgery than keyhole surgery, and you may need to spend more time in hospital.

Other possible complications may include:
• pain in your abdomen, bloating, wind and diarrhoea
• accidental damage to your bile duct or other organs
• infection
• bleeding (haemorrhage)
• leakage of bile from your bile duct


Side-effects

Side-effects are the not needed but mostly temporary effects you might get after having the procedure.

Possible side-effects may include:
• shoulder pain
• abdominal pain
• diarrhoea

Recovering from Gallbladder Surgery

It always takes between one or two weeks to make a full recovery from keyhole surgery to remove your gallbladder, but this varies between individuals, so it's important to follow your surgeon's advice.

When you need pain relief, you may take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. Your surgeon may give you painkillers when you're discharged from hospital.

What Happens During Gallbladder Removal?

Gallbladder removal is often done using keyhole surgery, which means your surgeon won't have to make a large cut in your abdomen.

Keyhole surgery to remove your gallbladder normally takes between 30 and 90 minutes. Your surgeon will usually make four small cuts in your abdomen. He or she will inflate your abdomen using harmless carbon dioxide gas to create space and to make it easier to see your internal organs. Your surgeon will then pass a laparoscope (a long, thin telescope with a light and camera lens at the tip) through one of the cuts to view your internal organs on a monitor.

Your surgeon will then insert specially adapted surgical instruments through the other cuts so that he or she can remove your gallbladder.

During the operation your surgeon may take X-rays to check there are no gallstones in the bile duct.

At the end of the operation, the carbon dioxide gas is allowed to escape and the instruments are removed. Your surgeon will close the wounds with stitches or metal clips and cover them with a dressing.

What are the Alternatives to Gallbladder Removal?

For those who have gallstones but they aren't producing any symptoms, or surgery to remove them isn't suitable for you, there may be alternative treatments. Sometimes gallstones can be dissolved using medicines, however gallstones often return after this kind of remedy and it is therefore rarely used.

If gallstones are in your bile duct and not in your gallbladder, they may be removed during ERCP. An endoscope, which is guided using X-rays, is passed into your mouth and down to your bile duct. Unique instruments can also be inserted inside the endoscope to allow your surgeon to remove the gallstones from your bile duct. ERCP can only be used to remove gallstones if they are found in your bile ducts. If gallstones are in your gallbladder itself, you may need gallbladder surgery as well. Your surgeon will talk about any possible optional treatments with you.