Gallbladder and Bile Duct Procedures

Having Laparoscopic Cholecystectomy

Gallbladder and Bile Duct Surgery

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What Are Gallstones?

The gallbladder stores bile, a fluid made by the liver. Bile helps digest fats in the foods you eat. Gallstones form when certain substances in the bile crystallize and become solid. In some cases, the stones don’t cause any symptoms. In others, they irritate the walls of the gallbladder. More serious problems can occur if stones move into nearby ducts—such as the common bile duct—and cause blockages. This stops the flow of bile and can lead to pain, nausea, and infection.

Common Symptoms

Gallbladder problems can cause painful attacks, often after a meal. Some people have only one attack. Others have many. Common symptoms include:

Severe pain or aching in the upper abdomen, back, or right shoulder blade
A dull ache beneath the ribs or breastbone
Nausea, upset stomach, or vomiting
Jaundice (a buildup of bile chemicals in the blood), which causes yellowing of the skin and eyes, dark urine, and itching

Treating Gallstones

If your stones are not causing symptoms, you may choose to delay treatment. But if you’ve had one or more painful attacks, your doctor will likely recommend removing your gallbladder. This prevents more stones from forming and causing attacks. It also helps prevent complications, such as stones passing into the ducts and causing infection or pancreatitis. After the gallbladder is removed, your liver will still make bile to aid digestion.

If You’re Pregnant

Hormone changes during pregnancy can make bile more likely to form stones. If your gallbladder needs to be removed, your doctor will talk with you about the timing for surgery. In some cases, it can be delayed until after childbirth. In others, you may have surgery during pregnancy. This helps protect you and your baby’s health.

Treating Gallstones

Gallstones are treated only if you have symptoms. Sometimes your doctor may simply want to monitor your condition. If treatment is done, it may include medication, ERCP, or surgery.

Medication

Medication can be given by mouth to dissolve some kinds of small stones. But it takes time for the medication to take effect. Stones may return. Medication is most useful for people who cannot have surgery.

ERCP

ERCP (endoscopic retrograde cholangiopancreatography) uses a thin tube with video and x-rays to locate stones and remove them from the common bile duct. ERCP may be done alone. Or it may be followed by surgery to remove the gallbladder.

Surgery

Surgery is done to remove gallstones and the gallbladder.

Laparoscopic cholecystectomy uses small incisions to locate and remove the gallbladder.
Cholecystectomy uses a larger incision to remove the gallbladder.

Prevent Future Symptoms

Once gallstones are dissolved or removed from the ducts, you may be able to prevent them from returning. How? By eating a low-fat diet. This means limiting your use of high-fat meat and dairy products and vegetable oils. Read food labels to be sure they’re low in fat.

Having Cholecystectomy

Clips are used to close off the bile duct and blood vessels so the gallbladder can be removed.

If you have painful attacks caused by gallstones, your doctor may recommend removing your gallbladder. This surgery is called cholecystectomy. This surgery eliminates pain and prevents future attacks. Best of all, you’ll be able to live a full, healthy life even without your gallbladder. This includes eating the foods you enjoyed before your gallbladder problems started.

Before Your Surgery

Stop taking aspirin and any NSAID’s one week before surgery. Ask your doctor what to do if you take prescription blood thinners such as Coumadin (warfarin).
You may need lab tests, an EKG and Chest X-Ray.
Don’t eat or drink anything after midnight, the night before your surgery. This includes water and coffee.

During Surgery

There are two methods for removing the gallbladder. Your doctor will choose which method is safer for you.

Laparoscopic cholecystectomy is used for most gallbladder problems. During surgery, a thin, lighted device called a laparoscope sends images to a video monitor. The magnified view lets your surgeon view and remove the gallbladder using only small incisions in the abdomen.
Open cholecystectomy removes the gallbladder through a single, larger incision. It is most often used when scarring or other factors make this a safer procedure for you. There is also a chance that your doctor may need to convert from laparoscopic to open surgery during the operation.

Having Laparoscopic Cholecystectomy

If you have painful attacks caused by gallstones, your doctor may recommend removing your gallbladder. This can be done using a type of surgery called laparoscopic cholecystectomy. People who have this procedure usually recover more quickly and have less pain than with open surgery.

Small abdominal incisions are made to insert the laparoscope and other instruments.

Your doctor views your gallbladder on a video monitor.

Before Surgery

Stop taking aspirin, ibuprofen, and naproxen as directed. Ask your doctor what to do if you take prescription blood thinners such as Coumadin (warfarin).
Have any tests, such as blood tests, that your doctor recommends.
Don’t eat or drink anything after midnight, the night before your surgery

The Day of Surgery

Arrive at the hospital or surgery center on time. You will be given an IV to provide fluids and medication.
An anesthesiologist will talk with you about the medications used to prevent pain during surgery. Laparoscopic cholecystectomy is done using general anesthesia. This lets you sleep during the procedure.

During Laparoscopic Surgery

Small incisions are made in the abdomen. A harmless gas is then used to lift the abdominal wall away from your internal organs. This helps your doctor see and move instruments inside your body.
A laparoscope (a thin, telescope-like device) is inserted through one incision. It sends images of the gallbladder to a video monitor. Surgical instruments are inserted through the other incisions to remove the gallbladder.
Small clips are used to close off the bile duct and blood vessels. The gallbladder is then detached from the liver and removed through one of the incisions. Bile will now flow directly from the liver to the small intestine.

After Gallbladder Surgery

You can usually go home the same day as your surgery. In some cases, you may need to stay overnight. Once you’re at home, be sure to follow all your doctor’s instructions.

In the Hospital

Bandages will cover your incisions and you may have special boots on your legs to prevent blood clots. To aid recovery, you’ll be asked to get up and move as soon as possible. You may also be asked to use a device that helps keep your lungs clear.

Regular exercise helps speed your recovery.

At Home

You can get back to your normal routine as soon as you feel able. To speed healing:

Take any prescribed pain medications as directed.
Follow our instructions about bathing and caring for your incisions.
Walk and move around as often as possible.
Ask Dr. Costa about driving and going back to work. This is often about 2-3 days after surgery.

Eating Normally Again

Removing the gallbladder doesn’t mean you have to be on a special diet. But you may want to start with light meals. It can also take a few weeks for your digestion to adjust. You may have indigestion, loose stools, or diarrhea. This is normal and should go away in time.

Following Up

Keep follow-up appointments during your recovery. These allow Dr. Costa to check your progress and answer any questions. Be sure to mention if you have any new symptoms. Also mention if you have diarrhea that doesn’t go away.

Call our office if you have any of the following:

Fever over 101°F or chills
Increasing pain, redness, or drainage at an incision site
Vomiting or nausea that lasts more than 12 hours
Prolonged Diarrhea

Incision Care: Abdomen

Dressing your incision helps keep it clean, dry, and infection-free. That way it will heal faster. Follow the steps below.

1. Wash Your Hands and Set Up

Use liquid soap. Lather for 1–2 minutes. Scrub between your fingers and under your nails.
Rinse with warm water, keeping fingers pointing down. Use a clean paper towel to dry your hands and turn off the faucet.
Put all your supplies on a clean cloth or paper towel. Open a plastic trash bag.
Peel back the edges of the dressing packages. Pour any irrigation solutions into solution cups.
Clean the scissors with soap and water. Cut each piece of tape 4 inches longer than the dressing.

2. Remove the Old Dressing

Put on disposable gloves.
Loosen the tape by pulling gently toward the incision. Remove the dressing one layer at a time. Put it right into the plastic bag.
Remove your gloves and put them in the plastic bag. Wash your hands. Then put on new gloves.

3. Clean and Dress the Incision

Clean the incision and apply a new dressing as directed.
Put all used supplies in the plastic bag. Remove your gloves last and put them in the bag. Seal the bag and put it in the trash. Be sure to wash your hands again.

Call Your Doctor If You Have:

Bleeding from the incision, or an increase in its size.
Increased redness, swelling, or drainage.
Pain in or around the incision.
Change in the color of the incision.
Fever over 101.0°F, or chills.