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A Cholecystectomy (Removal of the Gallbladder)

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A Cholecystectomy (Removal of the Gallbladder) AMERICAN COLLEGE OF SURGEONS • DIVISION OF EDUCATION Cholecystectomy Surgical Removal of the Gallbladder Benefits and Risks Gallstones blocking the cystic duct of the Operation Gallbladder Benefits—Gallbladder removal will relieve pain, treat infection, and, in most cases, stop gallstones from coming back. Possible risks include—Bile leak, bile Gallstones blocking duct injury, bleeding, infection of the the common bile duct abdominal cavity (peritonitis), fever, liver injury, infection, numbness, raised Gallstones scars, hernia at the incision, anesthesia complications, puncture of the intestine, and death.1-3 The Condition Risks of not having an operation—The Keeping You Cholecystectomy is the surgical removal possibility of continued pain, worsening of the gallbladder. The operation is symptoms, infection or bursting of the Informed done to remove the gallbladder due to gallbladder, serious illness, and possibly gallstones causing pain or infection. death.1-2 This information will help you understand your operation and Common Symptoms provide you with the skills to ● Sharp pain in the upper right part of Expectations actively participate in your care. the abdomen that may go to the back, Before your operation—Evaluation mid abdomen, or right shoulder Education is provided on: usually includes blood work, a urinalysis, ● Low fever and an abdominal ultrasound. Your Cholecystectomy Overview .........1 ● Nausea and feeling bloated surgeon and anesthesia provider will Condition, Symptoms, Tests .........2 discuss your health history, home ● Jaundice (yellowing of the skin) if stones Treatment Options….. ....................3 medications, and pain control options. are blocking the common bile duct1 Risks and The day of your operation—You will Possible Complications ..................4 not eat for 4 hours but may drink clear Preparation Treatment Options liquids up to 2 hours before the operation. and Expectations .............................5 Surgical Procedure1-3 Most often, you will take your normal Your Recovery medication with a sip of water. You will and Discharge ....................................6 Laparoscopic cholecystectomy—The need someone to drive you home. Pain Control.............................................7 gallbladder is removed with instruments Your recovery—If you do not Glossary/References........................8 placed into small incisions in the abdomen. have complications, you usually Open cholecystectomy—The gallbladder will go home the same day after a is removed through an incision on the right laparoscopic procedure or in 1 to 2 side under the rib cage. days after an open procedure.5 Nonsurgical Procedure Call your surgeon if you have severe ● Stone retrieval by endoscopy pain, stomach cramping, chills, a high fever (over 101°F or 38.3°C), odor or For Gallstones without Symptoms increased drainage from your incision, ● Watchful waiting for all patients1,4 your skin turns yellow, no bowel ● Increased exercise movements for three days, or vomiting and the inability to keep fluids down. This first page is an overview. For more detailed information, review the entire document. AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation The Condition, Symptoms, Cholecystectomy and Diagnostic Tests SAMPLE Common hepatic duct Keeping You Common bile duct Informed Cystic duct Most adults with gallstones do not have Pancreas Liver symptoms. Eighty Pancreatic duct percent of people with gallstones go 20 years without symptoms.1,6 Gallbladder Gallstones are Small intestine more common in 1,7-8 people who: Gallbladder • Are Native American • Have a family history of gallstones • Are overweight The Condition Symptoms Upper Right Left • Have sickle cell The Gallbladder The most common disease symptoms of The gallbladder is a small pear-shaped 1 • Are pregnant cholecystitis are: organ under the liver. The liver makes Right Left • Lose weight rapidly about 3 to 5 cups of bile every day. Bile ● Sharp pain in the right abdomen • Use estrogen to helps in digesting fats and is stored in the Lower manage menopause gallbladder. When fatty foods are eaten, ● Low fever the gallbladder squeezes bile out through ● Nausea and bloating Gallbladder pain or the duct and into the small intestine. biliary colic is usually ● Jaundice (yellowing of the skin) may occur temporary. It starts in Gallstones if gallstones are in the common bile duct the middle or the right Gallstones are hardened digestive fluid that can side of the abdomen form in your gallbladder. The medical term for and can last from 30 gallstone formation is cholelithiasis. Gallstones Common Tests minutes to 24 hours. The can leave the gallbladder and block the flow of History and Physical Exam pain may occur after bile to the ducts and cause pain and swelling eating a fatty meal. of the gallbladder. A gallstone in the common Your health care provider will ask you about your pain and any stomach problems. • Acute cholecystitis bile duct is called choledocholithiasis. pain lasts longer Cholecystitis is inflammation of the gallbladder, Additional Tests (see Glossary) than 6 hours, and which can happen suddenly (acute) or Other tests may include:1 there is abdominal over a longer period of time (chronic). tenderness and fever. ● Blood tests, including complete blood count Gallstone Pancreatitis is caused by stones Liver function tests • Pain on the right side moving into and blocking the common ● of the abdomen can bile duct, the pancreatic duct, or both. A ● Coagulation profile also be from ulcers, cholecystectomy may be recommended.1 ● Abdominal ultrasound is the most common liver problems, and study for gallbladder disease.1-2 You may be Cholecystectomy is the surgical removal of the heart pain. asked not to eat for 8 hours before the test. gallbladder. Gallstones that cause biliary colic • Standard treatment of (acute pain in the abdomen caused by spasm ● Hepatobiliary iminodiacetic acute cholecystitis is or blockage of the cystic or bile duct) are the acid scan (HIDA scan) intravenous (IV) fluids, most common reason for a cholecystectomy. ● Endoscopic retrograde pain medication, and cholangiopancreatography (ERCP) 9 cholecystectomy. ● Magnetic resonance cholangiopancreatography (MRCP) 2 AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation Surgical and Cholecystectomy Nonsurgical Treatment LaparoscopicLaparoscopic versus Open CholecystectomyOpen LaparoscopicCholecystectomy Cholecystectomy Open CholecystectomyCholecystectomy Keeping You Informed • Conversion rates from a laparoscopic to an open technique are less than 1% for young healthy people. • Conversion rates from laparoscopic to open range from 1.3% to 7.4% in the presence of common bile duct stones.10-11 • The risk of conversion increases up to 30% if you are over 50 years old, are male, and have acute cholecystitis; have had past abdominal operations; or have high fever, high bilirubin, repeated gallbladder attacks, Surgical Treatment Open Cholecystectomy or conditions that limit your 10-11 A cholecystectomy, or removal of the The surgeon makes an incision approximately activity. gallbladder, is the recommended operation 6 inches long in the upper right side of the for gallbladder pain from gallstones. abdomen and cuts through the fat and muscle to the gallbladder. The gallbladder is removed, and any ducts are clamped Laparoscopic off. The site is stapled or sutured closed. A small drain may be placed going from the Cholecystectomy inside to the outside of the abdomen. The Cholecystitis in This technique is the most common for drain is usually removed in the hospital. Children simple cholecystectomy. The surgeon will The procedure takes about 1 to 2 hours. Four of 100 gallbladder removals make several small incisions in the abdomen. are done in children.13 Almost Ports (hollow tubes) are inserted into the 70% of children with gallstones openings. Surgical tools and a lighted Nonsurgical Treatment do have symptoms. Symptoms in camera are placed into the ports. The Watchful waiting is recommended if you have children include abdominal pain, abdomen is inflated with carbon dioxide gas gallstones but do not have symptoms.1,4 nausea, vomiting, jaundice, fatty to make it easier to see the internal organs. food intolerance, and fever.18 The gallbladder is removed, and the port About 1 in 5 newly diagnosed patients with openings are closed with sutures, surgical acute cholecystitis who do not have surgery Children also receiving continuous IV clips, or glue. Your surgeon may start with a readmit to the emergency room within about nutrition and those with long-term 4 laparoscopic technique and need to change 12 weeks. antibiotic use, cystic fibrosis, obesity, (convert) to an open laparotomy technique. Gallstones only, without or a family history have a higher The procedure takes about 1 to 2 hours. chance of developing gallstones.14 cholecystitis Nearly 50% of all children with sickle ● Increase your exercise. Exercising 2 to 3 cell disease develop gallstones and hours a week reduces the risk of should have a screening ultrasound.1,15 11-12 gallstones. Children with cholecystitis confirmed ● Eat more fruit and vegetables, and eat less by ultrasound, those with severe pain, of foods high in sugars and carbohydrates or those not able to take food or fluids like donuts, pastry, and white bread. should be evaluated for surgery. 3 Cholecystectomy Risks of this Procedure SAMPLE Risks Based on the ACS Risk Calculator Open Cholecystectomy and Laparoscopic
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