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Cholestestectomy PDF
Cholestestectomy PDF
Cholecystectomy
Surgical Removal of the Gallbladder
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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
Informed
This information will help you
understand your operation and
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Cholecystectomy is the surgical removal
of the gallbladder. The operation is
done to remove the gallbladder due to
gallstones causing pain or infection.
Common Symptoms
possibility of continued pain, worsening
symptoms, infection or bursting of the
gallbladder, serious illness, and possibly
death.1-2
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,
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Before your operation—Evaluation
mid abdomen, or right shoulder usually includes blood work, a urinalysis,
Education is provided on:
● 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.
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This first page is an overview. For more detailed information, review the entire document.
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Gallbladder
• Are Native American
• Have a family history
of gallstones
The Condition Symptoms
• Are overweight
• Have sickle cell
disease
• Are pregnant
• Lose weight rapidly
The Gallbladder PL
The gallbladder is a small pear-shaped
organ under the liver. The liver makes
about 3 to 5 cups of bile every day. Bile
The most common
symptoms of
cholecystitis are:1
●● Sharp pain in the
right abdomen
Right
Right
Upper
Left
Left
manage menopause gallbladder. When fatty foods are eaten, ●● Low fever
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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
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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
pain may occur after History and Physical Exam
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
bile duct is called choledocholithiasis. your pain and any stomach problems.
• Acute cholecystitis
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
• Pain on the right side ●● Liver function tests
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)
cholecystectomy.9 ●● Magnetic resonance
cholangiopancreatography (MRCP)
Nonsurgic al Treatment
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presence of common bile
duct stones.10-11
Surgical Treatment
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Open Cholecystectomy
years old, are male, and have
acute cholecystitis; have had
past abdominal operations; or
have high fever, high bilirubin,
repeated gallbladder attacks,
or conditions that limit your
A cholecystectomy, or removal of the The surgeon makes an incision approximately activity.10-11
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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 Cholecystitis in
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3
Cholecystectomy
Percent for
Risks Keeping You Informed
Average Patient
Pneumonia: Infection in the lungs Open 1.7% You can decrease your risk by rinsing with mouthwash the morning of
Laparoscopic 0.2% your operation (to decrease mouth bacteria), quitting smoking before
your operation, and getting up often to walk post-operatively.
Heart complication: Heart attack Open 0.7% Problems with your heart or lungs can be affected by general
or sudden stopping of the heart Laparoscopic 0.1% anesthesia. Your anesthesia provider will take your history and suggest
the best option for you.
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Wound infection Open 7.6% Antibiotics are not routinely given except for high-risk patients. You
Laparoscopic 1% should wash your abdomen with an antimicrobial soap such as dial
the night before the operation.
Open 1%
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Laparoscopic 0.5%
Laparoscopic 0.2%
A Foley catheter is placed during surgery to drain the urine. Let your
surgical team know if you have trouble urinating after the tube is
removed—this is more common in older men or if an epidural is used
for pain.
Longer surgery and bed rest increase the risk. Walking 5 times/day and
wearing support stockings reduce the risk.
Return to surgery Open 3.3 % Bile leakage or a retained stone may cause a return to surgery. Your
Laparoscopic 0.8% surgical team is prepared to reduce all risks of return to surgery.1
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Death Open 0.8% Your surgical team will review for possible complications and be
Laparoscopic 0.1% prepared to decrease all risks.
Discharge to nursing or Open 5.4% Pre-existing health conditions can increase this risk.
rehabilitation facility Laparoscopic 0.6%
Bile Duct Injury/Leakage*1,16 0.5% Injury can happen between 1 week to 6 months after the operation
from fever, pain, jaundice, or bile leakage from the incision. Further
testing and surgery may be needed.1,17
Retained common bile 4% to 40% A gallstone may pass after surgery and block the bile from draining.
duct stone*1 The stone should be removed because of an increased risk of biliary
obstruction or inflammation of the pancreas or bile duct.1
Pregnancy Complications, Fetal loss 4% Most pregnant women with gallstones will have no symptoms during
premature labor and fetal loss* (uncomplicated removal) pregnancy. If you have biliary disease or pancreatitis, gallbladder
up to 60% if pancreatitis removal will be offered to reduce maternal complications.18
1% means that 1 of 100 people will have this complication *Results from the last 10 years of literature
The ACS Surgical Risk Calculator estimates the risk of an unfavorable outcome. Data is from a large number of patients
who had a surgical procedure similar to this one. If you are healthy with no health problems, your risks may be below
average. If you smoke, are obese, or have other health conditions, then your risk may be higher. This information is not
intended to replace the advice of a doctor or health care provider. To check your risks, go to the ACS Risk Calculator at
http://riskcalculator.facs.org.
4 AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation
Expectations: Cholecystectomy
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Anesthesia clinic number will be placed on your wrist. the gallbladder—
These should be checked by all health team laparoscopic
Let your anesthesia provider know if you have
members before they perform any procedures or open?
allergies, neurologic disease (epilepsy, stroke), heart
disease, stomach problems, lung disease (asthma, or give you medication. Your surgeon will • Ask your surgeon
emphysema), endocrine disease (diabetes, thyroid
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apples, greens, and nuts. ●● When you wake up from the anesthesia, You may take a shower after the second
you will be able to drink small amounts postoperative day unless you are told not to.
of liquid. If you do not feel sick, you ●● Follow your surgeon’s instructions on
can begin eating regular foods. when to change your bandages.
●● Continue to drink about 8 to 10
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glasses of water per day.
●● Eat a high-fiber diet so you don’t strain
while having a bowel movement.
Activity
●● A small amount of drainage from the
incision is normal. If the dressing is
soaked with blood, call your surgeon.
●● If you have Steri-Strips in place,
they will fall off in 7 to 10 days.
●● If you have a glue-like covering
●● Slowly increase your activity. Be sure
over the incision, just let the
to get up and walk every hour or so
glue to flake off on its own.
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to prevent blood clot formation.
●● Avoid wearing tight or rough clothing.
●● Patients usually take 1 to 3 weeks to
It may rub your incisions and make
return comfortably to normal activity.16
it harder for them to heal.
●● You may go home the same day after
●● Your scars will heal in about 4 to 6
a laparoscopic repair. If you have other
weeks and will become softer and
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or swelling of your abdomen Pain Control without Medicine
●● No bowel movement 2 to 3 days Splinting your stomach by placing
after the operation a pillow over your abdomen with
firm pressure before coughing or
Pain Control
Everyone reacts to pain in a different way. A
scale from 0 to 10 is used to measure pain.
At a “0,” you do not feel any pain. A “10” is
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movement can help reduce the pain.
Distraction helps you focus on other activities
instead of your pain. Listening to music,
playing games, or other engaging activities
can help you cope with mild pain and anxiety.
Splinting Your Stomach
the worst pain you have ever felt. Following Guided imagery helps you direct and
a laparoscopic procedure, pain is sometimes control your emotions. Close your eyes
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felt in the shoulder. This is due to the gas and gently inhale and exhale. Picture
inserted into your abdomen during the yourself in the center of somewhere
procedure. Moving and walking help to beautiful. Feel the beauty surrounding
decrease the gas and the right shoulder pain. you and your emotions coming back to
Extreme pain puts extra stress on your body your control. You should feel calmer.
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PHONE:
Guided imagery
7
Cholecystectomy
More Information
For more information on tests and procedures, please go to the National Institutes of Health website at www.nlm.nih.gov/medlineplus/encyclopedia.html.
GLOSSARY REFERENCES
Abdominal ultrasound: A handheld Endoscopic retrograde The information provided in this brochure is chosen from
transducer, or probe, is used to project cholangiopancreatography recent articles based on relevant clinical research or trends. The
and receive sound waves to determine (ERCP): A tube with a light and research listed below does not represent all of the information
the location of deep structures in the a camera on the end is passed that is available about your operation. Ask your doctor if he or
she recommends that you read any additional research.
body. A gel is wiped onto the patient’s through your mouth, stomach, and
skin so that the sound waves are not intestines to check for conditions of 1. Jackson PG, Evans S. Biliary System. In: Townsend CM Jr, Beauchamp RD,
distorted as they cross through the skin. the bile ducts and main pancreatic Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed.
duct and to remove gallstones. Philadelphia, PA: Saunders Elsevier; 2012:chap 55.
Advance directives: Documents
signed by a competent person giving Gallstones: Hardened deposits 2. Gurusamy KS, Davidson BR. Surgical treatment of gallstones.
Gastroenterol Clin N Am. 2010 Jun;39(2):229-44, viii.
direction to health care providers of digestive fluid that can
about treatment choices. They give form in your gallbladder. 3. Duca S, Bala O, Al-Hajjar N, et al. Laparoscopic cholecystectomy
you the chance to tell your feelings incidents and complications. A retrospective analysis of 9542
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about health care decisions. Hepatobiliary iminodiacetic acid consecutive laparoscopic operations. HPB (Oxford). 2003;5(3):152–158.
scan or gallbladder scintigraphy 4. Mestral C, Rotstein O, Laupacis A, et al. A population-based analysis
Adhesions: A fibrous band or (HIDA): A scan that shows images of the clinical course of 10, 304 patients with acute cholecystitis,
scar that causes internal organs of the liver, gallbladder, and discharged without cholecystectomy. Trauma Acute Care Surg.
to adhere or stick together. bile ducts following injection 2012;74(1):26-30.
http://riskcalculator.facs.org. Last accessed August 2015.
6. NIH Consensus Development Panel on Gallstones and Laparoscopic
Cholecystectomy Gallstones and laparoscopic cholecystectomy.
JAMA. 1993;269:1018-1024.
7. Nakeeb A, Cumuzzie AG, Martin L, et al. Gallstone: genetics versus
environment. Ann Surg. 2002;235:842-849.
8. Weinsier RL, Wilson LJ, Lee J. Medically safe rate of weight loss
check for remaining gallstones. for the treatment of obesity: a guideline based on risk of gallstone
Bilirubin: A yellow breakdown Magnetic resonance formation. Am J Med. 1995;98:115-117.
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product of the red blood cells. cholangiopancreatography 9. Leitzmann MF, Giovannucci EL, Rimm EB, et al. The relation of
High levels may indicate diseases (MRCP): A medical imaging physical activity to risk for symptomatic gallstone disease in men.
of the liver or gall bladder. technique that uses magnetic Ann Intern Med. 1998;128:417-425.
Complete blood count (CBC): A CBC resonance imaging to visualize the 10. Sakpal SV, Bindra SS, Chamberlain RS. Laparoscopic cholecystectomy
biliary and pancreatic ducts. conversion rates two decades later. JSLS. 2010 Oct-Dec;14(4):476-483.
measures your red blood cells (RBCs)
and white blood cells (WBCs). WBCs 11. Clayton ES, Connor S, Alexakis N, et al. Meta-analysis of endoscopy
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increase with inflammation. The normal and surgery versus surgery alone for the common bile duct stone
with the gallbladder in situ. Br J Surg. 2006;93:1185-1191.
range for WBCs is 5,000 to 10,000.
12. Leitzmann MF, Rimm EB, Willet WC, et al. Recreational physical
activity and the risk of cholecystectomy in women. N Engl J Med.
DISCLAIMER 1999;341:777-784.
13. Schwarz S, Hebra A, Miller M. Pediatric cholecystitis. Medscape
This information is published to educate you about your specific surgical procedure. It reference, 2011. Available at: http://emedicine.medscape.com/
is not intended to take the place of a discussion with a qualified surgeon who is familiar article/927340-overview. Accessed December 6, 2011.
with your situation. It is important to remember that each individual is different, and the 14. Dellacorte C, Falchetti D, Nebbia G, et al. Management of
reasons and outcomes of any operation depend on the patient’s individual condition. cholelithiasis in Italian children; a national multicenter study.
World J Gastroenterol. 2008;14(9):1383-1388.
The American College of Surgeons (ACS) is a scientific and educational organization 15. Gumiero AP, Bellomo-Brandao MA, Costa-Pinto EA. Gallstones in
that is dedicated to the ethical and competent practice of surgery. It was children with sickle cell disease followed up at a Brazilian
founded to raise the standards of surgical practice and to improve the quality hematology center. Arq Gastroenterol. 2008;45(4):313-318.
of care for the surgical patient. The ACS has endeavored to present information 16. Nawaz H, Papachristou GI. Endoscopic treatment of post-
for prospective surgical patients based on current scientific information; there cholecystectomy bile leaks: updates and recent advances.
is no warranty on the timeliness, accuracy, or usefulness of this content. Ann Gastroenterol. 2011;24(3):161-163. Open access at
www.annalsgastro.gr/index.php/annalsgastro/article/view/988/718.
Originally Reviewed 2009 by: Revised 2013 and 2015 by: 17. Society for Surgery of the Alimentary Tract (SSAT) Patient Care
Patricia Lynne Turner, MD, FACS Kathleen Heneghan, RN, MSN Committee. SSAT Patient Care Guidelines: Treatment of gallstone
Kathleen Heneghan, RN, MSN Nancy Strand, MPH, RN and gallbladder disease. J Gastrointest Surg. 2004 Mar-Apr;
8(3):363-364. Available online at http://ssat.com/guidelines/
Mark Malangoni, MD, FACS Nicholas J. Zyromski, MD, FACS
Gallstone-and-Gallbladder-Disease.cgi. Accessed August 13, 2015.
Stephen Richard Thomas Evans, MD, FACS
18. Chiappetta P, Napoli E, Canullan C, et al. Minimally invasive
management of acute biliary tract disease during pregnancy.
HPB Surg. 2009;2009:829020. doi: 10.1155/2009/829020. Epub
2009 Jul 12.