Procedures

Gallbladder removal (Cholecystectomy)

Description:

A cholecystectomy, or removal of the gallbladder, can be performed with either a laparoscopic or open approach.

With a laparoscopic cholecystectomy, the surgeon will make 4 small incisions in the abdomen. A nozzle is inserted into one of the incisions and carbon dioxide is used to fill the abdomen with gas. The gas allows the surgeon to see the gallbladder more easily. The surgeon will then insert a laparoscope through another port. The laparoscope has a light at the end as well as a camera for the surgeon to see. Other surgical instruments are inserted through other ports. The gallbladder is removed, the carbon dioxide is released through the four slits, and the incisions are closed. The incisions are closed with sutures, staples, or with a glue like substance called a steri strip. The total surgery takes about 1 to 2 hours. There is a chance that the surgeon will need to switch to a open cholecystectomy. This change is for your safety.

In an open cholecystectomy, the surgeon will make an incision about 6 inches long on the upper right side of the abdomen. The gallbladder is then removed and any ducts are closed off. There may be a small drainage tube left in the abdomen. This tube should be removed before you leave the hospital. The incision will be closed with sutures, staples, or with a glue like substance called a steri strip.

Risks

The significant risks of this procedure were discussed with emphases on: damage to liver, bowel, (pancreas) bile ducts, or bile leak (both higher than open surgery), retained stones, open cholecystectomy.

Pre operative information:

Before your surgery, you will be required to have a pre admission testing appointment. At this appointment, you will be registered at the hospital; you will have lab work done and possibly a x-ray. You will also meet with an anestheologist.

Information about the day of surgery:

No food starting midnight the night before surgery. Solid food must be avoided the day of surgery-regardless of the surgery time. Clear liquids must be stopped four (4) hours before your surgery.

Clear liquids are considered: water, apple juice, cranberry juice, black coffee (no cream), tea, and soda (7-UP, pepsi, ect).

Length of recovery:

You will be allowed to go home the same day of your surgery.

Post operative information:

Cholecystectomy Post-Surgery Guide

The following information is intended to guide you through your post-op recovery:

Diet:

Follow a low fat (35-50 gm per day) diet for approximately 30 days after your surgery. For the first few days you should eat foods that you easily tolerate normally. A diet instruction sheet will be given to you at the office.

Medications:

Follow the directions on any new prescriptions that your doctor has given you. You may return to taking your regularly scheduled medications on the day of your surgery, unless your doctor has directed you otherwise.
Pain management is an important part of your post-surgery care. You should expect some discomfort after your surgery. You may be sent home with a prescription for pain medication. It is important to take your pain medicine prior to your pain becoming intense in severity.

PLEASE NOTE:

No pain medication refills will be authorized on the weekends. If a refill is needed, the request must be made before 12:00 noon on Friday.

Some side effects from the pain medications include nausea and constipation. If you experience nausea or vomiting related to your pain medications, you should stop the medication and take ibuprofen or acetaminophen for pain management.

Bowel Care:

To prevent constipation you should drink plenty of fluids and take a stool softener daily.
If you have not had a bowel movement within 48 hours after your return home, you should increase your fluid intake. You may take one single dose of Milk of Magnesia, as long as you have no abdominal distention.

Incision Care:

Please leave your dressings on for 48 hours after your surgery. Unless your doctor specified otherwise you may then remove your dressing and shower. Remove the outer dressing and leave the strips of tape that cover your incision.
If your dressing becomes soiled, or loosens and comes off prior to 48 hours after surgery, you may replace it with a dry sterile dressing and tape.
You will have steri-strips of tape across your incision. Those strips should remain in place for 5-14 days. The strips will gradually loosen and come off. If they do not come off within 2 weeks you may remove them yourself.
You must observe your incision daily for signs or symptoms of infection. These signs would include: increased swelling, redness or smelly wound drainage. It is normal to have some swelling and bruising around your incision.

Bathing and Showering:

You may shower after you remove your dressing which will be 48 hours post-surgery. You may shower with your steri-strips in place. Do not scrub across your steri-strips. Do not bathe in a tub for 10-14 days after your surgery. This includes a “hot tub”.

Driving:

You may drive when you no longer are taking narcotic pain medications and you feel you can quickly respond to situations that will not place others in jeopardy.

Return to Work:

As a general guideline the following will give you a guide for when to return to work:
Light lifting or no lifting type jobs: You may return to work from a few days to one week post-surgery.
Heavy lifting or physical type jobs: You may return to work one week after surgery, with a weight/lifting restriction of no greater than 10-20# for 2 weeks total. If your job does not allow for light duty, then you will need to be off of work for 2 weeks after your surgery.

Follow-up Appointments:

You will need to return to the office for a follow-up visit usually within 2 weeks after your surgery. Please make sure you have your appointment scheduled.

Problems to Observe For:

Call the office for the following:
1. Fever >101.0
2. Uncontrolled pain. That is on a scale of 1-10 (10 being the worst pain imaginable) your pain is a level 7 or above.
3. Nausea and / or vomiting that continue for 12-24 hours.
4. Diarrhea that continues for 12-24 hours.
5. Signs of a wound infection.
6. Chest pain or difficulty breathing
7. Your incision separates or opens up.

If you have further questions after reading this handout, the office is open from 9:00AM to 5:00PM Monday through Friday. For emergencies after office hours, the answering service will be available when you call the office number.


References:

Northwest Surgical Specialists, LLP
American College of Surgeons www.facs.org

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