Gallbladder - removal of the

Removal of the gallbladder (cholecystectomy)

Introduction
You will soon be admitted to the Bronovo Hospital to have your gallbladder removed. In this leaflet we provide information on the possible cause and the procedure for the removal of the gallbladder.

Complaints of the gallbladder are caused by gallstones or by an inflammation. These impair the functioning of the gallbladder. The cause of the formation of gallstones is not exactly known.

It is good to know that complaints of the gallbladder differ from person to person. The treatment indication is adjusted to the person in question by the surgeon.

The treatment consists of removing the complete gallbladder by means of an operation.

Types of operations
In general, there are two types of operations. Your specialist has discussed with you the type of operation you need and why you need it.

1. The keyhole surgery (laparoscopic method)
   A small incision under the navel is made. Through this small incision, the stomach is inflated with gas to be able to have a good look at the inside of the stomach. Through the same incision, a small tubular camera (laparoscope) is guided into the patient’s body. The camera is connected to a TV screen.
   
   Then 2 or 3 small incisions are made in your stomach. Through these incisions, special instruments are inserted to completely separate the gallbladder and then to remove it. This operation takes about 1 hour and is always performed under general anaesthesia. After 1 or 2 days you will be allowed to go home.
   
   Important!
   Occasionally (10%) the surgeon may encounter a problem that can not be solved with the laparoscope, for instance a bleeding, accretions or a seriously inflamed gallbladder. The surgeon then has to revert to the “conventional method” during the same anaesthesia.
   
   
2. The “conventional” method (open method)
   The surgeon makes an incision of about ten to fifteen centimetres. This incision runs either downwards in your upper abdomen or diagonaly at the right side under your ribs. The surgeon then removes your gallbladder.
   This operation takes about 1 hour and is also always performed under general anaesthesia. After about 1 week you are allowed to go home.
   
   NB
   If during the operation it is found clear that there are also stones in the bile duct (ductus choledochus), the surgeon will open it to remove the stones. The bile duct will then be closed, leaving behind a drain (a tube) through a separate opening in the abdominal wall to temporarily let the bile run out of the body. The bile is collected in a bag by your bed. A week after the operation some X-rays are made to see whether the bile is flowing well to your bowels and that no stones have been left behind. If everything is all right, the drain can be removed. In this case, you will be in hospital for about 10 days.
   
   In certain cases the internist can also remove gallstones from the bile duct before or after the operation. This is done by means of a flexible tube with a control mechanism (the endoscope) which is led through the mouth into the oesophagus to the small intestine and thus to the bile ducts. Please also see the Bronovo leaflet ERCP-examination.

After the operation
Immediately after surgery you may be nauseous. You can be given anti-nausea medication for this.

Sometimes in the operating theatre a catheter (small tube) will be guided into the stomach through your nose. This ensures that your stomach remains empty after surgery. It prevents you from vomiting. Usually this catheter is removed after a short period of time.

To ensure that you have enough fluid you will get a drip into the arm. The drip will be removed as soon as you are able to drink  enough yourself. The first days after surgery the area surrounding the wound will be painful. Any movement, taking a deep breath and coughing may also cause you pain. Painkillers help to combat these symptoms.

Possible complications
In general, the removal of the gallbladder is a safe operation with little chance of complications. However, the chance of complications is not excluded with any surgery.

General complications:

• also with this surgery there are risks such as thrombosis, pneumonia, subsequent bleeding or a wound infection.

Specific complications:

• Damage to the bile ducts. This happens only very rarely (0.5%).A repair operation may then be required.

Back home
You do not have to follow a diet. However, you have to be careful with large quantities of fat in the first few weeks. Try out what you can tolerate.

Without a gallbladder it is possible to live without problems.
It is advisable to avoid heavy physical exercise during for some time after the operation. Usually, you will be able to work within three weeks after you leave the hospital. However, heavy physical work can only be resumed after a period of six weeks. If you underwent a laparoscopic removal of the gallbladder, you will, in general, be able to get back to work much sooner.

Finally
Upon leaving the hospital an appointment, will be made with you for a check-up and the removal of the stitches at the Outpatients’ Clinic (7 to 14 days after surgery).
In case you have any questions after reading this leaflet, please do not hesitate to contact the Surgery Outpatients’ Clinic, telephone number 070 - 312 43 59 (on working days from 9.00 to 11.30 hours and from 14.00 to 15.30 hours).

Edition: April 2010/50