In most cases, surgery means removing the gallbladder. But there may be other alternatives in certain situations, and there’s more than one way to perform gallbladder removal surgery. Here are three surgical options that your doctor may discuss with you, and what to expect from each procedure.
Cholecystectomy (Gallbladder Removal)
Cholecystectomy is the medical term for surgery to completely remove the gallbladder. In the United States, cholecystectomy is a very common operation. Most gallbladder removal surgeries are performed because of gallstones. Specific reasons for the surgery include:
Gallstones in the gallbladder that cause painGallstones in the bile ducts that cause painGallbladder inflammation, usually due to obstructed bile ducts from gallstonesPancreas inflammation (pancreatitis) due to gallstones
There are two main methods of performing gallbladder removal: laparoscopic and open. Both methods are performed under general anesthesia, so you’ll be completely “out” during the procedure. (1)
Laparoscopic Method
Using this method, surgeons remove the gallbladder through a series of small incisions in the abdomen. Laparoscopy “is a ‘Band-Aid’ surgery, and the recovery is much easier,” says Harold Berenzweig, MD, a gastroenterologist based in Fort Worth, Texas. Most patients can go home the same day, Dr. Berenzweig adds. Others may need to spend one night in the hospital. (1) In this surgery, three to four small incisions are made in the abdominal wall. Your surgeon inserts a laparoscope — a flexible tube containing a light and tiny video camera — into one incision, and surgical instruments into the others. Your surgeon performs the procedure while looking at a video monitor, and then the gallbladder is pulled out through one of the incisions. Before finishing the surgery, the surgeon may perform an X-ray or ultrasound to look for retained gallstones, leaks, or other problems in the bile ducts that weren’t visible at the start. If everything looks fine, your incisions will be sutured and you’ll be taken to a recovery area. The entire procedure takes 1 to 2 hours. (1,2)
Open Method
It’s possible that your surgeon won’t be able to reach your gallbladder using the laparoscopic method, potentially due to scar tissue from previous surgeries or a serious infection of the gallbladder that would make a larger incision necessary. If this happens, or if other complications occur, your surgeon may opt for an open surgery. This method involves making an incision measuring roughly 6 inches (15 centimeters) on the upper right side of your abdomen. This larger incision cuts through muscles, which results in more pain and discomfort later. These muscles and other tissue are pulled back to expose your liver and gallbladder, which your surgeon then removes. Your incision will then be sutured, and one or more drains may be placed in it to allow fluid or pus to flow out. While an open cholecystectomy takes about the same amount of time to perform as the laparoscopic version, it results in a longer recovery time due to the larger incision. You can expect to spend two to three days in the hospital, after which you’ll need four to six weeks to recover from the surgery. After either type of surgery, a dressing or adhesive strips will be applied to your sutured incisions. Your gallbladder will be sent to a lab for analysis. (1,2)
Endoscopic Retrograde Cholangiopancreatography (ERCP)
This procedure is used to view and treat a bile duct that has become blocked or narrowed. A blockage can happen when one or more gallstones migrate out of the gallbladder and into the common bile duct, which carries bile to the small intestine. During ERCP, an endoscope — a flexible tube with a light and tiny camera on it — is guided down your throat into your stomach and small intestine. A thin tube called a catheter is inserted through the endoscope and into the opening of the bile ducts, where a special dye is injected to make the ducts more visible on an X-ray. If blockages or narrowed areas are then seen on an X-ray, surgical tools can be inserted through the endoscope to fix the problem. You will be given a sedative to help you relax during ERCP, but you may not require general anesthesia ERCP is often performed in conjunction with gallbladder removal. (3)
Cholecystostomy (Gallbladder Draining)
Draining the gallbladder is usually done only as a temporary measure to relieve swelling when surgery to remove the gallbladder can’t be performed right away. It’s sometimes a good option for people with severe gallbladder problems who have other conditions that would make gallbladder removal a risky procedure. During this minimally invasive procedure, your doctor will insert a needle through your abdomen into the gallbladder. A tiny tube called a catheter will be inserted through the needle to drain the gallbladder of bile and decompress it. A drainage bag or bulb will be attached to the end of the catheter to collect excess bile. The catheter and bag will be attached for a few days to several weeks. With cholecystostomy, “you’re still left with a gallbladder full of gallstones,” Berenzweig notes. That’s why it’s almost always done with an eye toward future gallbladder removal. (4)
A Nonsurgical Option
A rarely used method for treating gallstones is lithotripsy, which uses high-energy sound waves to break the stones into tiny pieces so they can drain out of the gallbladder. This procedure is sometimes used in combination with oral drugs that can help dissolve or break up gallstones. (5) But it’s unlikely that your surgeon will recommend lithotripsy for your gallstones. “I don’t know of anyone who’s had that done lately,” Berenzweig says. Additional reporting by Quinn Phillips
