Gallbladder removal

About gallbladder removal

Your gallbladder is a small pouch connected to your liver and your intestines by tubes called bile ducts. It collects and stores liquid called bile. Bile contains chemicals that help you to digest the fat in your food. Bile also helps your body to use some vitamins, such as vitamin A, D and E. Bile passes from your gallbladder into your intestine and is released from your gallbladder when you eat.

Gallstones are lumps of solid material that develop from the chemicals and substances in bile. They vary in size and can take years to develop. Sometimes they become large and can block your bile duct, or the smaller ones may travel through the bile duct and block the opening to your pancreas causing a serious condition called pancreatitis or ‘inflammation of the pancreas’.

You may need your gallbladder removed if you have gallstones and they are:

  • causing pain and inflammation
  • causing jaundice (your skin and the whites of your eyes will become yellow)
  • blocking the opening to your pancreas and causing pancreatitis

If you have gallbladder cancer you may also need to have your gallbladder removed.

There are two main surgical techniques used to remove the gallbladder.

  • Laparoscopic cholecystectomy – your gallbladder is removed through small puncture holes in your abdomen (tummy), using the surgical technique of keyhole surgery.
  • Open cholecystectomy – your gallbladder is removed through one large cut in your abdomen, using a surgical technique called open surgery.

Animation - how gallbladder removal surgery is carried out

What are the alternatives?

There are a number of alternative treatments for gallstones. The main ones are listed below.

  • You can manage your symptoms using painkillers and other medicines and see if the problem gets any worse. This is called watchful waiting. Your GP will monitor your condition and he or she may suggest further treatment if your symptoms get worse.
  • If gallstones are in your bile duct they can be removed during ERCP. ERCP is a test that can be used to diagnose gallstones, and if they are found during the procedure they can sometimes be removed.
  • Gallstones can be broken up using shock waves. This is called extracorporeal shockwave lithotripsy (ESWL). A special probe uses high energy sound waves to break up the stones. This treatment is now rarely used.

If you have gallbladder cancer you may have treatment using radiotherapy and/or chemotherapy instead of surgery.

Your surgeon will discuss any possible alternative treatments with you.

Preparing for gallbladder removal

Your surgeon will explain how to prepare for your gallbladder removal. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Gallbladder removal using keyhole surgery is usually done as a day-case procedure, but you may need to stay overnight in hospital. Gallbladder surgery is usually done under general anaesthesia. This means you will be asleep during the operation.

If you're having general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do so by signing a consent form.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

What happens during gallbladder removal?

A gallbladder removal operation is usually done as keyhole surgery. Your surgeon will make small cuts in your abdomen. He or she will gently inflate your abdomen using carbon dioxide gas to create space and to make it easier to see. Your surgeon will pass a laparoscope (a long, thin telescope with a light and camera lens at the tip) through one of the cuts, so that he or she can see your internal organs on a television screen.

At the end of the operation, the carbon dioxide gas is allowed to escape and the instruments are removed. Your surgeon will close the wounds with stitches or metal clips and cover them with a dressing.

Sometimes it isn’t possible to remove your gallbladder using keyhole surgery and your surgeon may do an open cholecystectomy instead. This is where your surgeon makes one larger cut in your abdomen to remove your gallbladder.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

If you have keyhole surgery you may have some discomfort and bloating caused by the carbon dioxide gas put into your abdomen during the operation. This can also cause pain in your shoulder. This usually eases within 48 hours after your operation.

If you have had your operation as a day-case, you will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. Try to have a friend or relative with you for the first 24 hours after your surgery.

Before you go home your nurse will give you some advice about caring for your healing wounds. You may also be given antibiotic tablets to take to prevent an infection. You may be given a date for a follow-up appointment.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

If your wounds are closed with metal clips or stitches, these will be removed by a nurse after about a week. Commonly, dissolvable stitches are used with this procedure. The length of time your dissolvable stitches will take to disappear depends on what type you have.

Recovering from gallbladder surgery

It usually takes two to three weeks to make a full recovery from keyhole surgery to remove your gallbladder, but this varies between individuals, so it's important to follow your surgeon's advice.

If you have an open operation with a large cut to your abdomen, your recovery will take longer. It may take four to six weeks for you to make a full recovery.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Following keyhole surgery you may be advised not to drive for two weeks after your operation. Ask your surgeon for more information.

What are the risks?

As with every procedure, there are some risks associated with gallbladder removal. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

Possible side-effects may include:

  • shoulder pain
  • abdominal pain
  • bloating and abdominal discomfort
  • diarrhoea
  • flatulence (wind passed from your back passage)
  • indigestion

If your skin or the white of your eyes become yellow, or if you develop a high temperature or a severe pain that gets worse, you should contact your GP straight away or go to the Accident and Emergency department.

Complications

Complications are when problems occur during or after the procedure. The possible complications of any procedure include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

During the operation your surgeon may need to convert from a keyhole procedure to open surgery. He or she will need to make a bigger cut in your abdomen. This will only be done if it’s not possible to complete your operation safely using the keyhole technique. Other possible complications may include:

  • accidental damage to your bile duct or other organs
  • infection
  • leakage of bile from your bile duct

I recently had my gallbladder removed and have had diarrhoea ever since - is this a result of my operation?

Answer

You may get diarrhoea after having your gallbladder removed. Speak to your GP for advice on how to manage your diarrhoea.

Explanation

About one in 10 people get diarrhoea after having their gallbladder removed.

The exact reasons why you may develop diarrhoea aren't fully understood at present. After your gallbladder is removed, bile will drain continuously into your bowel, rather than being stored and released only when you eat. This causes your liver to produce more bile salts and, if your bowel can’t absorb these, it will produce more water and salt than usual. This may cause diarrhoea. You may also develop diarrhoea because your stools tend to move through your bowel more quickly after gallbladder removal.

If you have diarrhoea for long periods of time, it can be very distressing. However, there are some things that you can do to help yourself.

  • Eat high-fibre foods such as wholegrain breads, cereals, oats, lentils, fruit and vegetables. This will help to absorb excess water and bulk up your faeces, making them firmer.
  • Try not to eat foods that make your diarrhoea worse, such as spicy and fatty foods and dairy products.

If your diarrhoea doesn’t get better, or if it’s severe, your GP may suggest medicines to ease your symptoms.

Will having my gallbladder removed affect how I can digest my food?

Answer

Most people can digest food and drink normally without a gallbladder. However, around one in 10 people get diarrhoea after the operation. You can help yourself by making some changes to your diet.

Explanation

You don't usually have to stop eating particular foods after having your gallbladder removed. However, you may find you get increased wind, bloating or diarrhoea for several weeks afterwards.
 

Increasing the amount of fibre you eat may help reduce diarrhoea because it bulks up your faeces and makes them firmer.

Good sources of fibre include:

  • wholegrain bread
  • wholegrain breakfast cereals
  • brown rice
  • fruit and vegetables
  • beans and lentils
  • oats

It's important to drink enough water if you have diarrhoea.

How much time will I have to spend off work after having my gallbladder removed?

Answer

If you have your gallbladder removed using keyhole surgery (a procedure called laparoscopic cholecystectomy), you will usually be able to go back to work within two to three weeks. It may be four to six weeks before you can go back to work if you have your gallbladder removed using open surgery.

Explanation

Most people can usually go home on the same day, or the day after keyhole surgery. It usually takes two to three weeks to make a full recovery, but this varies from person to person, so it's important to follow your surgeon's advice.

If you have open surgery to remove your gallbladder, a larger cut in your abdomen is made. This means your recovery will take longer than if you have keyhole surgery. You can usually get back to work within four to six weeks.

It's important to remember that everyone is different – some people may need to rest for longer while others may return to work after a few days. If you have a manual job where you’re doing heavy lifting, you may need to recover for longer before you can get back to work.

What is ERCP?

Answer

ERCP is a procedure that can be used to diagnose and treat gallstones.

Explanation

ERCP (endoscopic retrograde cholangio-pancreatography) is a procedure that can be used to diagnose gallstones and sometimes remove them. 

ERCP is done using a narrow, flexible, tube-like telescopic camera called an endoscope. The endoscope is passed through your mouth and down to your stomach to reach the place where the bile duct opens out into your intestine. Dye is squirted down a tube inside the endoscope and an X-ray is taken. This helps to show any gallstones.



If your surgeon sees a gallstone during the procedure he or she can remove it using special instruments, or widen the bile duct to allow the stone to pass through naturally. Your surgeon can also put very small drainage tubes in, called stents, which help the bile to flow around a gallstone.

You can have ERCP done as an outpatient. You will probably be awake during the procedure, though you may be given a sedative. This relieves anxiety and helps you to relax. When the procedure is finished you may need to rest until the effects of the sedative have passed. You will be able to go home when you feel ready. You will need to arrange for someone to drive you home.