Patient Education Partners in Your Surgical Care AMericaN COLLege OF SUrgeoNS DIVisioN OF EDUcatioN Cholecystectomy Surgical Removal of the Gallbladder LaparoscopicLaparoscopic versus versus Open Open Cholecystectomy Cholecystectomy LLaparoscopicaparoscopic Cholecystectomy Cholecystectomy OpenOpen Cholecystectomy Cholecystectomy Patient Education This educational information is to help you be better informed about your operation and empower you with the skills and knowledge needed to actively participate in your care. Keeping You Informed Treatment Options Expectations Information that will help you further understand your operation. Surgery Before your operation— Evaluation usually Education is provided on: Laparoscopic cholecystectomy—The includes blood work, an gallbladder is removed with instruments abdominal ultrasound, Cholecystectomy Overview ............. 1 placed into 4 small slits in the abdomen. and an evaluation by your Condition, Symptoms, Tests ............ 2 Open cholecystectomy—The gallbladder surgeon and anesthesia Treatment Options ......................... 3 is removed through an incision on the provider to review your right side under the rib cage. health history and Risks and Possible Complications ..... 4 medications and to discuss Preparation and Expectations ......... 5 Nonsurgical pain control options. Your Recovery and Discharge ........... 6 Stone retrieval The day of your operation— Pain Control .................................. 7 For gallstones without symptoms You will not eat or drink for at least 4 hours Glossary/References ....................... 8 Watchful waiting before the operation. Increased exercise Most often you will take Diet changes your normal medication with a sip of water. The Condition Benefits and Risks Your recovery—If you Cholecystectomy is the surgical Benefits and Risk have no complications, removal of the gallbladder. The you are often discharged operation is done to remove Gallbladder removal will relieve pain, treat home the same day after gallstones or to remove an infected infection, and in most cases stop gallstones from a laparoscopic procedure or inflamed gallbladder. coming back. The risks of not having surgery and in 2 to 3 days after are the possibility of worsening symptoms, an open procedure. Call Common symptoms infection, or bursting of the gallbladder. your surgeon if you are in Sharp pain in the upper Possible complications include bleeding, severe pain, have stomach center or right abdomen bile duct injury, fever, liver injury, cramping, a high fever or chills, your skin turns Low fever infection, numbness, raised scars, hernia yellow, or there is odor Nausea and feeling bloated at the incision, anesthesia complications, puncture of the intestine, and death. and increased drainage from your incision. This first page is an overview. For more detailed information, review the entire document. AMericaN COLLege OF SUrgeoNS • 633 N. SaiNT CL air ST. • CHicago, IL 60611 • WWW.FACS.ORG 1 Laparoscopic versus Open Cholecystectomy Laparoscopic Cholecystectomy Open Cholecystectomy Cholecystectomy The Condition, Signs and Symptoms, and Diagnostic Tests Common hepatic duct Common bile duct Keeping You Cystic duct Informed Pancreas Most people with gallstones Liver do not have symptoms. Pancreatic duct Eighty percent of people with gallstones go 20 years or Gallbladder Small intestine longer without symptoms.1,2 Gallstones are more Gallbladder common in people who: are Native American have a family history of gallstones The Condition Symptoms are overweight The Gallbladder The most common eat a lot of sugar symptoms of cholecystitis are: The gallbladder is a small pear-shaped are pregnant organ under the liver. Sharp pain do not exercise regularly in right Upper The liver makes about 3 to 5 cups of Right Left lose weight rapidly abdomen bile every day. Bile is stored in the Low fever use estrogen to manage gallbladder, and when food is eaten, 3,4 menopause especially fatty foods, the gallbladder Nausea and Right Left Gallbladder pain or biliary squeezes bile out through the cystic duct bloating colic is usually temporary. It and into the small intestine. Jaundice Lower starts in the middle or right (yellowing side of the abdomen and can Gallstones of the skin) may occur if gallstones last from 30 minutes to 24 The medical term for gallstone are in the common bile duct hours. The pain may occur formation is cholelithiasis. A gallstone after eating a fatty meal. in the common bile duct is called Common Acute cholecystitis pain choledocholithiasis. Gallstones in the lasts longer than 6 hours, ducts can block the flow of bile and cause Diagnostic Tests swelling of the gallbladder. and there is abdominal History and Physical tenderness and fever. Cholecystitis is inflammation of the Pain on the right side of gallbladder, which can happen suddenly Tests (see glossary) the abdomen can also (acute) or over a longer period of time Abdominal ultrasound be from ulcers, liver (chronic). problems, and heart pain. This is the most common test to check Perforated gallbladder is a condition when Standard treatment for gallstones. You may be asked not the gallbladder bursts or leaks, which to eat for 8 hours before the test. of acute cholecystitis happens only in rare cases but can be is intravenous fluids, life threatening. Blood tests antibiotics, pain medication, and cholecystectomy.5 Cholecystectomy is the surgical removal Complete blood count of the gallbladder. The most common Liver function tests reason for a cholecystectomy is to remove Coagulation profile gallstones that cause biliary colic (acute pain in the abdomen caused by spasm or HIDA scan, cholescintigraphy blockage of the cystic or bile duct). Endoscopic retrograde cholangiogram Magnetic resonance cholangiopancreatography 2 AMericaN COLLege OF SUrgeoNS • 633 N. SaiNT CL air ST. • CHicago, IL 60611 • WWW.FACS.ORG AMericaN COLLege OF SUrgeoNS • 633 N. SaiNT CL air ST. • CHicago, IL 60611 • WWW.FACS.ORG Cholecystectomy Surgical and Nonsurgical Treatment The site is stapled or sutured Surgical Treatment closed, and a small drain may be An operation is the recommended placed going from the inside to the Keeping You treatment for gallbladder pain from outside of the abdomen. The drain is Informed gallstones, and it is the only treatment usually removed in the hospital. The for acute cholecystitis. procedure takes about 1 to 2 hours. Conversion rates from a laparoscopic to an open technique are less than 1% LaparoscopicLaparoscopic versus versus Open Open Cholecystectomy Cholecystectomy LLaparoscopicaparoscopic Cholecystectomy Cholecystectomy OpenOpen Cholecystectomy Cholecystectomy Procedure Options for young healthy people. Procedures may be done to remove The need to convert from gallstones from the common bile duct. a laparoscopic to an open Laparoscopic transcystic common bile procedure can increase duct stone extraction is performed significantly if you are over with insertion of instruments into 65 years, are male, have a the abdomen similar to laparoscopic history of acute cholecystitis, cholecystectomy. The bile duct is past abdominal operations, entered, and stones are removed high fever, high bilirubin, directly or with a wire basket. repeated gallbladder attacks, and diseases that Endoscopic retrograde cholangio- limit your activity.5 Laparoscopic Cholecystectomy pancreatography is done by inserting This technique is the most common for an endoscope into your mouth and simple cholecystectomy. The surgeon continuing to pass it through your will make 4 small slits in the abdomen. stomach and then into the common Questions you should ask A port (nozzle) is inserted into one of bile duct. Gallstones are removed the slits, and carbon dioxide gas inflates directly or with a balloon or basket. What type of procedure is right for me and why? the abdomen. This process allows the Complication rates range from 0 surgeon to see the gallbladder more to 9.1 per 1,000 procedures.6 How much experience easily. A laparoscope is inserted through do you have with another port. It looks like a telescope this procedure? with a light and video camera on the Nonsurgical Treatment Has the procedure been end so the surgeon can see inside the Watchful waiting done often at this center? abdomen. Surgical instruments are Do you know the placed into the other small openings If gallstones are seen on your ultrasound approximate cost of and used to remove the gallbladder. but you do not have symptoms, the procedure? watchful waiting is recommended.1,2 The surgeon removes the gallbladder through the incision. The carbon Gallstones only, without cholecystitis dioxide comes out through the small slits and then the sites are closed with Increase your exercise. Exercising 2 to 3 hours a week reduces sutures, metal clips called staples, or 7,8 steri-strips. Your surgeon may start the risk of gallstones. with a laparoscopic technique and Eat more fruit and vegetables, need to change to an open technique. and eat less foods high in sugars and carbohydrates like donuts, The procedure takes about 1 to 2 hours. pastry, and white bread. Open Cholecystectomy Alternative medicine options are available.9 The surgeon makes an incision approximately 6 inches long in the upper right side of the abdomen and cuts through the fat and muscle to the gallbladder. The gallbladder is removed, and any ducts are clamped off. AMericaN COLLege OF SUrgeoNS • 633 N. SaiNT CL air ST. • CHicago, IL 60611 • WWW.FACS.ORG AMericaN COLLege OF SUrgeoNS