Cholecystectomy

Dr. med. Philipp Nicol is a freelance writer for the medical editorial team.

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Cholecystectomy is the surgical removal of the gallbladder. It is mainly performed in the event of complications caused by inflammation of the gallbladder (cholecystitis) and gallstones that cannot be treated otherwise. Read everything about the various surgical procedures, when they are performed and what you need to consider after the operation!

What is a cholecystectomy?

In a cholecystectomy, the gallbladder is removed by surgery. The operation is performed almost 200,000 times a year in Germany and nowadays mainly through a small incision in the abdominal wall (minimally invasive, laparoscopic cholecystectomy). In some cases, however, an open surgical procedure (conventional cholecystectomy) is still necessary.

The gallbladder

The gallbladder is a pear-shaped hollow organ located in the right upper abdomen just below the liver. It is used to store and thicken the bile that is produced in the liver and can hold between 40 and 200 ml of fluid, depending on the state of stretching. The bile is released into the small intestine during the digestive process and is essential for the absorption and processing of dietary fats. Inflammation of the gallbladder (cholecystitis) is caused in most cases by gallstones, which can form, for example, with high cholesterol levels.

When is a cholecystectomy done?

A cholecystectomy is mainly performed if the gallbladder is inflamed (cholecystitis), which is causing symptoms, especially if there are complications. The procedure usually leads to a lasting healing success. Other diseases that require gallbladder removal include:

Gallbladder perforation (e.g. as part of an accident)
Connecting ducts between the bile ducts and the gastrointestinal tract (so-called biliodigestive fistulas)
large stones in the bile ducts that cause bile to build up (cholestasis) and cannot be removed otherwise.
Gall bladder or bile duct tumors (they are usually removed as part of a major operation)

Asymptomatic (not causing discomfort) cholecystitis alone is not a reason to have the gallbladder removed. In this case, you can first treat it with medication and wait for an improvement.

What do you do with a cholecystectomy?

Basically, the gallbladder can be removed using two methods: conventional cholecystectomy (open surgical) and laparoscopic cholecystectomy (minimally invasive).

The conventional cholecystectomy

In conventional surgery, the surgical area is usually opened under general anesthesia through an incision below the right ribs. The supplying artery (arteria cystica) and the branching bile duct (ductus cysticus) are then tied off, severed and the gallbladder removed. The insertion of a wound drainage is usually not necessary. Before the operation, the risk of infection is reduced by giving an antibiotic. Thrombosis prevention (e.g. with heparin) may be necessary, but is not administered as standard. Most patients can leave the hospital after three to five days.

Laparoscopic cholecystectomy

The gold standard in treating gallbladder inflammation today is laparoscopic cholecystectomy. The gall bladder is removed in a minimally invasive manner using what is known as "keyhole surgery". The basic principle of all laparoscopic operations is the introduction of mostly three long instruments and flexible camera optics into the abdominal cavity through small incisions. The instruments can be controlled from the outside while the camera transmits a live image to a monitor.

The abdominal cavity is expanded by pumping in carbon dioxide, thereby ensuring better visibility and mobility for the operating doctors (so-called pneumoperitoneum). Then you can remove the gallbladder with the help of the instruments under visual inspection and transport it to the outside through one of the incisions.

Advantages of the laparoscopic gallbladder operation compared to the conventional procedure are above all less pain after the operation, smaller scars and thus a better cosmetic result as well as a shorter hospital stay. Complications are similarly common with both procedures. The latest methods now only use a single access route through which all instruments are introduced into the abdominal cavity (“single-site approach”) or natural body orifices, for example the gastrointestinal tract or the vagina (“NOTES” = “natural orifice transluminal endoscopic”) surgery ”). However, these surgical methods are still being tested.

Laparoscopic gallbladder removal should not be performed under the following circumstances:

if a gallbladder tumor is suspected, as the risk of tumor cells spreading into the abdomen is too great (e.g. due to accidental perforation of the gallbladder).
in the case of severe cardiovascular disease, because the air introduced increases the pressure in the abdomen and thus makes it difficult for blood to return to the heart.
in patients who have a bleeding disorder, as effective hemostasis is far more difficult with a laparoscopic cholecystectomy than with an open surgical technique.
in pregnant patients (especially in the last trimester of pregnancy), as the introduction of the instruments and the gas can be spatially difficult.
in patients who have already been operated on on the abdomen and for whom there is a risk of adhesions in the abdomen.

Change of surgical technique (conversion)

Sometimes it is necessary to switch to a conventionally open operation during a laparoscopic operation. This may be necessary, for example, if it turns out during the laparoscopic operation that the instruments pose an excessive risk of injury to adjacent organs or tissue (in approx. Nine percent of cases).

What are the risks of a cholecystectomy?

Cholecystectomy is a relatively safe procedure, but - as with any procedure - complications cannot be completely ruled out. These include bleeding, infection, or injury to adjacent organs but are rare. Studies have shown an increased rate of complications in patients with conventional gallbladder surgery. However, the reason for this is that especially seriously ill patients have to undergo conventional surgery, who anyway have a higher risk of developing complications. The risk of dying from gallbladder surgery is extremely low (less than 0.1 percent of cases).

What should I watch out for after a cholecystectomy?

In principle, there is no need to follow a special diet after a cholecystectomy. However, since the bile required for fat digestion is still produced in the liver, but can no longer be temporarily stored in the gallbladder and released into the intestine in large quantities, patients who have had their gallbladder removed can no longer tolerate foods that contain very fat. Diarrhea may increase after consumption.

Diet after gallbladder removal

Clear liquids can be drunk immediately after the gallbladder has been removed. Normal food intake (light food) can usually be started on the first day after the operation. In order to avoid the diarrhea described above, it is necessary to pay attention to various things in the long term:

Reduce the fat content of the food: In the early phase directly after the cholecystectomy, in particular, it makes sense to pay attention to a low-fat diet. If possible, patients should not consume more than three grams of fat per serving.
Increase the fiber content: Grains such as wheat and barley contain a lot of fiber and have a positive effect on bowel movements. The amount of fiber should initially be increased slowly over several weeks, otherwise it can lead to unpleasant gas and cramps.
Eat smaller meals throughout the day: This helps the gastrointestinal tract to use nutrients better.
Reduce foods that can cause diarrhea, such as coffee, dairy products, fatty foods, or foods that are very sweet.

Carrying out and aftercare of a cholecystectomy are now part of the medical routine and have therefore become a very safe therapy.

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