Open gallbladder surgery for gallstones

	Surgery Overview
	What To Expect After Surgery
	Why It Is Done
	How Well It Works
	Risks
	What To Think About
	References
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In open gallbladder surgery (cholecystectomy), the surgeon removes the gallbladder through a single, large incision in the abdomen. You will need general anesthesia, and the surgery lasts 1 to 2 hours. The surgeon will make the incision either under the border of the right rib cage or in the middle of the upper part of the abdomen (between the belly button and the end of the breastbone).

Doctors do most open gallbladder surgeries after trying first to remove the gallbladder with laparoscopic surgery. A few people have conditions that require open gallbladder surgery. For more information, see the Why It Is Done section below.

After surgery to remove the gallbladder, bile flows from the liver (where it is produced) through the common bile duct and into the small intestine. Because the gallbladder is gone, bile no longer is stored between meals. In most people, this has little or no effect on digestion.

Surgery usually involves a hospital stay of 2 to 4 days or longer. Most people can return to their normal activities within 4 to 6 weeks. Open surgery involves more pain afterward and a longer recovery period than laparoscopic surgery.^{1, 2}

This surgery leaves a moderately large scar [4 in. (10.2 cm) to 8 in. (20.3 cm) long].

No special diets or other precautions are needed after surgery.

Several conditions may lead to surgery to remove the gallbladder. Conditions that may require open rather than laparoscopic surgery include:

• Severe inflammation of the bile duct or gallbladder.
• Inflammation of the abdominal lining (peritonitis).
• High pressure in blood vessels in the liver (portal hypertension). This is caused by cirrhosis of the liver.
• Being in the third trimester of pregnancy.
• A major bleeding disorder or use of medicines to prevent blood clotting (blood thinners or anticoagulants).
• Scar tissue from many previous abdominal surgeries.
• Abnormal anatomy in the abdomen.

In about 2 out of 10 laparoscopic gallbladder surgeries in the United States, the surgeon needs to switch to an open surgical method that requires a larger incision.² Examples of problems that can require open rather than laparoscopic surgery include unexpected inflammation, scar tissue, injury, or bleeding.

Surgery reduces the risk that gallstones will come back. But gallstones sometimes form in the bile ducts years after cholecystectomy, although this is not common.

The possible complications of open gallbladder surgery include:

• Injury to the common bile duct.
• Excessive bleeding.
• Infection of the surgical wound.
• Injuries to the liver, intestines, or major abdominal blood vessels.
• Blood clots or pneumonia related to the longer recovery period after open surgery.
• Risks of general anesthesia.

After gallbladder surgery, some people have ongoing abdominal symptoms, such as pain, bloating, gas, or diarrhea (postcholecystectomy syndrome).

Open gallbladder surgery has been done safely for many years.

In most cases, laparoscopic surgery has replaced open surgery to remove the gallbladder, because recovery is much faster and less painful than after traditional open surgery.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Citations

1. Zacks SL, et al. (2002). A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. American Journal of Gastroenterology, 97(2): 334–340.

2. Glasgow RE, Mulvihill SJ (2006). Treatment of gallstone disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 1, pp. 1419–1442. Philadelphia: Saunders Elsevier.