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Cholecystectomy
Surgical Removal of the Gallbladder
This first page is an overview. For more detailed information, review the entire document.
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
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
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.
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.
Urinary tract infection: Infection of Open 1.5% A Foley catheter is placed during surgery to drain the urine. Let your
the bladder or kidneys Laparoscopic 0.5% 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.
Blood clot: A blood clot in the legs Open 1% Longer surgery and bed rest increase the risk. Walking 5 times/day and
can travel to the lung Laparoscopic 0.2% wearing support stockings reduce the risk.
Renal (kidney) failure: Kidneys Open 0.9% Pre-existing renal problems, Type 1 diabetes, being over 65 years old,
no longer function in making urine Laparoscopic 0.1% and other medications may increase the risk.
and/or cleaning the blood of toxins
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
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
PHONE:
Guided imagery
7
Cholecystectomy
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
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.
of a dye into the veins. 5. American College of Surgeons. ACS Risk Calculator.
Bile: A fluid produced by the liver http://riskcalculator.facs.org. Last accessed August 2015.
and stored in the gallbladder which Intraoperative cholangiogram:
6. NIH Consensus Development Panel on Gallstones and Laparoscopic
helps in the digestion of fats. During surgery to remove the Cholecystectomy Gallstones and laparoscopic cholecystectomy.
gallbladder (cholecystectomy), JAMA. 1993;269:1018-1024.
Biliary colic: Sudden pain in the a small tube called a catheter is
abdomen caused by spasm or 7. Nakeeb A, Cumuzzie AG, Martin L, et al. Gallstone: genetics versus
inserted into the cystic duct, which environment. Ann Surg. 2002;235:842-849.
blockage of the cystic or bile duct drains bile from the gallbladder to
lasting for more than 30 minutes. 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.
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
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.