Open gallbladder removal, or open cholecystectomy, is a surgery to remove the gallbladder via a large
open incision in the abdomen. Doctors perform the procedure to provide
permanent relief to a patient suffering from gallstones and other problems
associated with the gallbladder.
The gallbladder is a small organ located on the underside of
the liver. Its primary purpose is bile storage. The liver makes bile, a
substance that helps the body break down fats. The gallbladder then stores the
extra bile the liver makes, releasing it when you eat a meal with fats that
need to be digested. Normal digestion is possible without a gallbladder. Bile
will continue to reach your small intestine, but it just won’t be stored along
the way in the gallbladder.
According to the Mayo
Clinic, laparoscopic or minimally invasive removal is the most common type
of gallbladder removal surgery. However, open gallbladder surgeries are still
used for a variety of patients, especially those who have scar tissue or other complications
from prior abdominal surgeries.
Why Open Gallbladder Removal Is Done
Unfortunately, the gallbladder isn’t always the most
efficient organ. Bile can be thick and can create blockages along the patterns
where it typically empties. The gallbladder is also prone to develop
gallstones. Gallstones are hard deposits of substances in the bile that get
stuck inside the gallbladder. They can be as small as a grain of sand or as
large as a golf ball. Gallstone disease, called cholelithiasis, can cause short
or lasting pains in the abdomen. Gallstones can also cause infections to form,
which can cause bloating, nausea, vomiting, and further pain. A surgeon will
remove your gallbladder if gallstones cause pain and other complications.
Other conditions that could make you a candidate for open
gallbladder removal include:
dyskinesia, which is when the gallbladder doesn’t fill or empty
correctly due to a defect
which is when gallstones have moved to the common bile duct (CBD) and may be
causing a blockage that doesn’t allow the gallbladder to drain
which is an inflammation of the gallbladder
which is an inflammation of the pancreas
A doctor will recommend gallbladder removal if your
gallbladder is causing a severe, acute problem or has become a chronic concern.
Some symptoms that may indicate the need for gallbladder removal include:
- sharp pain in the upper portion of your abdomen
that can extend to the middle of your stomach, right shoulder, or back
- yellowing of your skin (jaundice), which
indicates a bile duct blockage
Sometimes a doctor will recommend watchful waiting to see if
gallbladder-related symptoms lessen. Diet changes, such as reducing overall fat
intake, may also help. If symptoms persist, a doctor may recommend surgery.
Whenever possible, laparoscopic surgery is preferred over
traditional open surgery because it is less invasive and usually has a shorter
recovery time. However, certain complications can make open surgery a better
choice, such as when the gallbladder is severely diseased. A severely diseased
gallbladder can be more difficult to remove because it may have affected
surrounding areas, which makes a laparoscopic procedure more difficult.
Sometimes, a surgeon will begin using the laparoscopic
method but will not be able to safely remove the gallbladder. In this case, he
or she will finish the procedure in the open fashion. According to the American
College of Surgeons (ACS), a surgeon starts with a laparoscopic method and
converts to an open method. The likelihood of an open method is:
- less than 1 percent of the time in young,
- 1.3 to 7.4 percent of the time when gallstones
are present in the common bile duct
- as high as 30 percent if you are older than 65,
male, and have complicating risk factors such as previous abdominal surgeries,
high fever, high bilirubin levels, or a history of frequent gallbladder attacks
The Risks of Open Gallbladder Removal
Open gallbladder removal is considered a safe operation and complications
are rare. However, every surgical procedure carries some risks. Before the
procedure, your doctor will perform a complete physical examination and medical
history to minimize these risks.
Risks of open gallbladder removal include:
- allergic reaction to anesthesia or other drugs
- excessive bleeding
- blood clots
- damage to blood vessels
- heart problems, such as rapid heart rate
- injury to the bile duct or small intestine
- pancreatitis, or inflammation of the pancreas
Your surgeon will explain these risks to you and give you
the chance to ask questions prior to the procedure.
How to Prepare for Open Gallbladder Removal
Prior to surgery, you’ll undergo several tests to ensure you’re
healthy enough for the procedure. These will include blood tests and imaging
tests of your gallbladder. A complete physical exam and record of your medical
history will also be needed.
During these appointments, tell your doctor if you’re taking
any medications, including over-the-counter drugs or nutritional supplements.
Certain medications can interfere with the procedure, and you may have to stop
taking them prior to surgery. Also, tell your doctor if you’re pregnant or may
Your doctor will give you complete instructions on the best
way for you to prepare for surgery.
These instructions may include:
- arranging to have someone stay with you
immediately after surgery and drive you home
- drinking a prescription solution that flushes
out your bowels
- fasting (not eating or drinking) for six hours
or more before surgery
- planning for a hospital stay in case of
- showering using a special, antibacterial soap
How Open Gallbladder Removal Is Performed
At the hospital or surgery center, you’ll change into a
hospital gown and an intravenous (IV) line will be inserted into a vein in your
arm for the purpose of anesthesia. An open gallbladder procedure is performed
under general anesthesia, so you’ll be in a painless sleep before the surgery
Your stomach will first be cleansed with an antiseptic
solution to reduce infection risk. Your surgeon will make an incision in your
stomach. There are two incision types your surgeon may choose. The surgeon
might create a slanted incision just below the ribs on the right side of your
stomach, or they could create an up-and-down incision on the upper part of your
The skin, muscle, and other tissues are pulled back to
expose your gallbladder. Your surgeon will then remove your gallbladder, close
the wound with stitches, and then bandage the area. According to UC
San Diego Health, a laparoscopic gallbladder removal procedure takes about
an hour and a half. An open procedure can take longer, but the length of time
depends on the severity of the gallbladder disease.
After your surgery, you will be brought back to your
hospital room. Your vital signs will continue to be monitored until you’re
After Open Gallbladder Removal
Your doctor will discharge you from the hospital or surgery
center once your vital signs have stabilized and you show clinical signs of
recovery without complications.
Hospital stays are typically longer after an open procedure
because open procedures are more invasive than laparoscopic procedures. Your
doctor will want to make sure you aren’t having excessive bleeding or pain. The
medical staff will also monitor you for signs of infection, like fever or
drainage at the surgical site.
According to the Mayo
Clinic, you’ll typically spend up to three days in the hospital while you
begin to recover. A full recovery from open gallbladder surgery takes about
four to six weeks.
Some ways you can prevent complications after surgery
- walking around frequently to prevent blood clots
- drinking plenty of fluids to prevent dehydration
- not lifting more than 10 pounds for four to six
- washing your hands before and after touching the
area around your incision site
- changing your bandages as directed
- avoiding wearing tight clothing that could rub
against the incision
While you can expect some mild to moderate pain after
surgery, it should not be severe. Pain medication taken after surgery can cause
constipation. Your doctor may prescribe a stool softener to reduce straining.
You may also wish to eat a high-fiber diet that includes fruits and vegetables.
This will help you pass your stools easier.
The risk of complications after surgery is low. However, you
should call your doctor if you have the following symptoms because they could
indicate an infection:
- pain that gets worse, not better
higher than 101°F
- vomiting that won’t subside
- foul-smelling or bloody drainage from the
- significant redness and swelling of the incision
- not passing a bowel movement for two to three
days after surgery