Gallbladder Removal: Types, Side effects, Diet, & complications
Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.
Gallbladder removal (cholecystectomy) by surgery or laparoscopy is one of the most common surgeries. Gallbladder removal is a common and relatively safe procedure.
Here is what you need to know about gallbladder removal:
- It is a common and relatively safe surgery.
- Gallbladder removal is done either by laparoscopy (the commonest and gold standard) or open surgery.
- Laparoscopic gallbladder removal is generally safer, results in less operative pain, and better cosmetic appearance.
- Gallbladder removal (laparoscopic and open) are done under general anesthesia.
- You will leave the hospital on the same day of laparoscopic gallbladder removal. In open surgery, recovery takes longer, and you may stay in the hospital for 3-5 days.
- Common side effects: post-operative abdominal pain, feeling sick (nausea), bloating, and diarrhea.
- Complications are bile duct injury, bleeding, bowel injury, infection, missed stones, etc.
1. Types of gallbladder removal surgery (laparoscopic and open cholecystectomy).
A. Laparoscopic cholecystectomy.
Laparoscopic cholecystectomy is the commonest and the gold standard procedure of cholecystectomy. It is preferred over open cholecystectomy because it is associated with (reference):
- Less pain.
- Less post-surgery stay in the hospital.
- Cosmetically better (small incisions).
However, laparoscopic surgery’s overall complications are slightly higher than open cholecystectomy.
Preparation and procedure:
- Your doctor will perform pre-operative liver function tests, ultrasonography, and other routine laboratory tests.
- Prophylactic antibiotics are given in selected high-risk cases (Not a routine).
- Fasting for at least 6 hours before the operation.
- General anesthesia (with a tracheal tube) is the first step (you won’t be aware during the operation).
- 4 Small incisions (one above the umbilicus and three other smaller incisions under the rib margin).
- Then, the surgeon removes the gallbladder under vision through the large umbilical incision.
- The procedure typically takes between one and two hours.
B. Open cholecystectomy.
Gallbladder removal by open surgery is less commonly used nowadays. It is done by making a larger incision under the right rib cage (4-6 inches).
Open cholecystectomy isn’t as popular as it used to be because it leaves a bigger scar, takes longer to heal, and requires a longer hospital stay.
However, it is preferred in certain conditions, as with:
- When gallbladder removal is indicated for suspected gallbladder cancer.
- When gallbladder removal is done in combination with other intra-abdominal operations.
- When laparoscopic cholecystectomy is difficult (your surgeon may decide to convert it into open surgery during the laparoscopy if there is a difficulty or a complication in the procedure.
2. Gallbladder removal: Indications & Contraindications.
The most common indication for gallbladder removal is the presence of symptomatic gallstones. In the United States, gallstones in the gallbladder are very common (present in 6% of men and 9% of women).
Indications of gallbladder removal:
- Recurrent biliary colics due to gallstones: Patients who have recurrent gallbladder pain that comes and goes.
- Acute cholecystitis: a severe form of biliary colics due to acute infection and severe gallbladder inflammation. It may lead to complications such as gallbladder gangrene or perforation.
- Other complications of gallstone disease:
- Choledocholithiasis: gallstones in the bile ducts leading to their obstruction.
- Gallstone pancreatitis: obstruction of the pancreatic duct due to a slipped stone in its duct.
- Acalculous cholecystitis (acute cholecystitis without stones): 10% of acute cholecystitis cases are without stones (due to infection or a cut in its blood supply).
- High risk of gallbladder cancer in patients with asymptomatic gallstones.
- Gallbladder polyps greater than 0.5 cm.
- Porcelain gallbladder: calcifications (hardening) of the gallbladder due to chronic inflammation.
- Gallbladder dyskinesia (abnormal motility of the gallbladder leading to gallbladder pain.
Contraindications of gallbladder removal surgery:
- Inability to tolerate general anesthesia (as with patients with heart disease, liver failure, etc.). They are considered a relative contraindication, meaning that your surgeon may decide to operate when there is no choice (as with severe acute cholecystitis).
- Diffuse peritonitis (inflammation of the peritoneum, a double-layered membrane that surrounds your abdominal organs).
- Bleeding disorders such as low platelets count.
- Laparoscopic cholecystectomy is contraindicated if there is a suspicion of cancer (open cholecystectomy is better).
- Low blood pressure (shock).
- Other relative contraindications such as multiple previous abdominal operations (for fear of adhesions), pregnancy, obesity, cholangitis (infection and inflammation of the biliary system of ducts), and other severe co-morbid diseases.
A. Recovery in laparoscopic gallbladder removal:
Recovery is faster if you are undergoing laparoscopic cholecystectomy. You are expected to leave the hospital on the same day your gallbladder is removed.
Gallbladder removal or any abdominal operation often requires strong analgesia for postoperative pain.
You can return to work after a week or two.
B. Recovery after open gallbladder surgery.
Typically, you will stay in the hospital for two to five days.
In both open and laparoscopic procedures to remove the gallbladder, surgeons usually use stitches that dissolve on their own.
However, your doctor may use a non-dissolvable stitch. Your nurse or doctor will remove them after 7 to 10 days.
Returning to work may take longer after an open cholecystectomy (6–8 weeks).
4. Side effects of gallbladder removal surgery (The common and the serious).
A. Common & often benign side effects:
- Post-operative pain in the upper right abdomen (the gallbladder area) and around the incision. Your doctor often will prescribe analgesics (oral or intravenous) for the pain, such as ibuprofen or ketorolac.
- Temporary postoperative nausea (feeling sick), vomiting, or constipation (due to general anesthesia and intestinal manipulation during the surgery.
- Soreness, swelling, or redness around the incision sites.
- Difficulty waking and lifting objects for the first few weeks after the operation.
- Bloating after surgery.
- Shortness of breath due to discomfort when you breathe in and out.
B. Less common but potentially serious:
The rate of complications is generally higher in laparoscopic surgery than in open surgery. A recent study showed that the overall rate of complications (minor and major) is 16% and 9% for laparoscopic and open cholecystectomies, respectively.
Less common but potentially serious complications of gallbladder removal include:
- During the operation:
- Bowel perforation.
- Bile duct ligation or injury.
- Gallbladder perforation and bile leakage into the peritoneal cavity.
- After Gallbladder removal operation:
- Infection (fever and chills) of the surgical site.
- A Missed stone inside the bile ducts.
- Gallbladder or cystic duct remnants.
- Hernia (at the site of open cholecystectomy).
- Long-term side effects include post-cholecystectomy syndrome (recurrence of biliary pain, nausea, vomiting, and diarrhea) for several months or years.
- Prolonged diarrhea (bile acid diarrhea).
- Bile duct strictures.
- Intraabdominal adhesions.
We’ve discussed the long-term problems after gallbladder problems in this article. Read to learn more.
5. Diet after gallbladder surgery.
Generally speaking, there is no specific gallbladder removal diet plan to follow. However, there are a few things to consider:
- You can start eating 12-24 hours after the operation as long as you’ve passed a flatus and there is no vomiting.
- Your doctor may prescribe a liquid or plain diet for the first few days.
- Then, you can slowly return to your normal diet.
- To avoid long-term diarrhea, bloating, and nausea, try to:
- Avoid a high-fat diet.
- Increase fiber such as oat and barley to help bowel movements.
- Eat smaller, more frequent meals.
- Limit the use of dairy, high-sugar, and high-caffeine diets.