Cholecystectomy (Gallbladder Removal)

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Preoperative Care

Because gallbladder surgery is performed under general anesthesia, the stomach must be completely empty. This precaution is taken to avoid vomiting during and after surgery. Nothing may be taken by mouth after midnight, and smoking is prohibited.

Blood "thinning" medication, including aspirin, must be discontinued several days before the operation to avoid excessive bleeding during the procedure. The discontinuation of any medication must be discussed with the doctor when the surgery is scheduled.

Preoperative tests are usually ordered and completed a few days before the surgery. Depending on the patient's health, these may include blood tests, a chest x-ray, an EKG, and a urinalysis. If these were done during the initial workup and diagnosis, they usually are not repeated.

Patients check in to the hospital the day of the surgery. Inpatients are checked into a regular hospital room. Most patients undergoing the laparoscopic procedure are not checked into a room; instead they go to the outpatient surgery area.

On admission to the hospital, an informed consent form acknowledging that the patient understands the procedure, the risks, and that they will be receiving anesthesia and possibly other medications must be signed.

The anesthesiologist (doctor who administers the anesthesia) speaks with the patient prior to surgery and performs a brief physical assessment. The anesthesiologist must be aware of all drugs that the patient uses on a regular basis, any history of allergies, and previous adverse reactions to anesthesia. This is to assess possible conditions or problems that may influence the choice and dosage of anesthesia and to determine what, if any, special precautions need to be taken.

The patient is then taken to the preoperative or holding area and remains in bed except to use the bathroom. An intravenous (IV) is started for fluids and medication. Patients may have had the IV started in their room. Sedation is given through the IV or by injection. The anesthesia is administered in the operating room.

Postoperative Care

Patients are taken to the postanesthesia care unit (PACU) to recover from the anesthesia. They are closely monitored by the PACU nursing staff and remain there until the anesthesia wears off.

Laparoscopic Surgery
Recovery from the laparoscopic procedure is quicker than from the open procedure. As the anesthesia wears off, and once vital signs stabilize, the nurse offers the patient ice chips. If ice is tolerated, water and other clear liquids are offered. Once liquids are tolerated, patients can eat a light meal and the IV is removed.

Sometimes patients are nauseated after waking from the anesthesia. This sensation usually passes. If it does not, medication can be given to relieve it.

Postoperative pain can usually be controlled with over-the-counter pain relievers. Some patients may need a stronger, prescription analgesic.

The incisions are covered by small adhesive bandages that can be removed in about 5 days. The stitches dissolve over time. The area must be kept dry until the wound begins to heal and sponge baths are recommended for the first day or two. Scarring is minimal.

Most outpatients go home the same day, usually within 5 hours after surgery. Even though the anesthesia has worn off, most patients remain groggy for the rest of the day. Patients must arrange for a family member or friend to be with them upon discharge. Most inpatients are discharged the next day.

Patients usually resume normal daily activities within 24 hours and may return to work within a week. Heavy lifting and strenuous exertion should be avoided for a few weeks longer.

Open Surgery
Recovery from open surgery is not as rapid. Patients experience pain at the incision site and a narcotic pain reliever is usually required for the first day or two. The patient may not be able to eat until the morning after surgery. The intravenous is left in until food and fluids are taken and tolerated.

Patients are usually able to get out of bed by the next morning. It is important to get up and walk as soon as possible to help blood circulation return to normal and to avoid complications such as blood clots.

The hospital stay generally lasts 3 to 7 days and it usually takes about 3 weeks to fully recover. This procedure leaves a large abdominal scar, which may fade over time.

Postoperative Complications

Cholecystectomies are safe, but complications can develop. The main disadvantage of laparoscopic surgery is a higher risk for injury to the bile duct, which connects the gallbladder and the liver. This rare complication can cause serious liver damage and requires additional, extensive surgery. Injury to the bile duct can occur during open surgery as well but is more prevalent with the laparoscopic procedure.

Other potential complications, for both procedures, include:

• Bleeding
• Complications from general anesthesia
• Injury to other abdominal organs
• Leakage of bile from the bile ducts into the abdomen
• Wound infection

If there is drainage, bleeding, or swelling at any incision site; pain that worsens or is not relieved by medication and comfort measures; or a sudden fever, the surgeon should be contacted immediately. These symptoms may indicate a postsurgical complication.

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