Cholecystectomy (pronounced co-lee-sist-ect-omy) means surgical removal of the gallbladder. The gallbladder is the small, pear-shaped pouch in the upper-right part of your abdomen that stores the bile produced by the liver. Bile, the digestive fluid that helps to break down fatty food, is carried from the gallbladder to the intestine through a tube called the bile duct.
There are two ways of performing a cholecystectomy:
- Laparoscopic cholecystectomy
This is the most common way of having your gallbladder removed. This is a recent technique that was developed in the US in 1988 and is also known as keyhole surgery. Keyhole surgery means the surgeon can remove your gallbladder without having to make a large incision on your abdomen. It's also often carried out as a day case, which means you won’t have a long stay in hospital and a long recovery period.
- Open cholecystectomy
During this procedure the surgeon removes the gallbladder through a five- to eight-inch incision in your abdomen. This procedure has been performed for more than 100 years and is quite safe. However, because it's open surgery, you need to be in hospital for four to five days and need several weeks of recuperation at home after the operation.
Why do I need the operation?
Gallstones are often discovered by accident when a patient is having an X-ray or ultrasound scan for another reason. In these cases, it's usually best to leave the gallstones alone, unless they go on to produce symptoms. This wait-and-see approach is called expectant management or watchful waiting.
However, if your gallstones have been causing symptoms, you may have been advised to have a cholecystectomy (although less than 20% of the people who have gallstones have painful symptoms). Symptoms can include:
- Biliary colic
If the gallstones have passed into one of the bile ducts leading from the gallbladder to the intestine, or a gallstone gets stuck in the narrow neck of the gallbladder, it can lead to biliary colic, which can be painful and feels similar to severe indigestion.
- Cholecystitis
When the presence of gallstones has led to the gallbladder becoming inflamed, it can cause pain below the ribs on the right side. You may also be feeling pain in the back and the right shoulder. Other symptoms include fever, nausea and vomiting.
- Obstructive jaundice
Sometimes a gallstone can block the bile duct and lead to obstructive jaundice. This causes yellowing of the skin and the whites of the eyes, a darkening of the urine and pale, clay-coloured stools.
- Acute pancreatitis
This happens when a small gallstone passes through a bile duct and blocks a pancreatic duct or causes a reflux of fluids and bile into this duct. Acute pancreatitis is rare. It develops in about 5% of people who have gallstones, and is more common in patients with small, multiple stones.
How long will I have to wait for an operation?
There may be a wait of a few months for this operation, but this depends on your local hospital and the length of waiting lists. Ask your consultant about estimated waiting times when you discuss the operation.
Why would I be recommended to have open surgery instead of keyhole surgery?
An open cholecystectomy is something that your consultant will advise on. It involves the removal of the gallbladder under general anaesthetic through a larger cut in the abdomen. An open cholecystectomy is recommended over laparoscopic surgery if your gallbladder is severely inflamed. In this case it can be difficult or dangerous to remove it via laparoscopic cholecystectomy. In addition, if a stone has passed out of the gallbladder and into the bile duct, it can be more difficult to remove via keyhole surgery. If complications arise during a laparoscopic cholecystectomy, it becomes necessary to turn the operation into open surgery.
