Open Cholecystectomy

Open cholecystectomy surgery

The removal of the gallbladder by means of a single large incision in the upper right abdomen is called open cholecystectomy. It is generally performed when the laparoscopic (keyhole) surgery cannot be done or is not safe.

What is it for?

This surgery is recommended for the patient who has the following: 

• Passive or large gallstones.
• With severe inflammation or infection of the gallbladder (acute cholecystitis).
• Perforated or gangrenous gallbladder.
• Advanced thick bowel adhesions from previous surgeries. 
• Known gallbladder cancer.
• Laparoscopic cholecystectomy failure or complications (converted) 

Open cholecystectomy procedure

Open cholecystectomy means that the gallbladder is taken out through a single cut in the right upper part of the belly. The procedure is clearly and calmly described as applied to a standard surgical practice below.

Preparation before Surgery

• Patient evaluation: blood analyses, ultrasound/CT, liver function test. 
• Fasting for 6–8 hours
• Antibiotics intravenously administered prior to incision.
• General anaesthesia was given.

Patient Positioning

• Patient in the supine position.
• Slightly elevated on right side.
• Refrained and draped abdomen on sterile grounds.

Surgical Incision

• The right subcostal (Kochers) incision is created and tends to be 10-15 cm.

Incision passes through:

• Skin
• Subcutaneous tissue
• Muscle layers
• Peritoneum

Exposure of the Gallbladder

• Liver retracted upward
• Gallbladder observed under the liver.
• Careful dissection of adhesions (when they exist) is done.

Recognition of the Triangle of Calot

Structures identified:

• Cystic duct
• Cystic artery
• Common bile duct
• Essential anatomy verified to prevent injury of the bile ducts.

Cystic Duct and Artery ligation

Cystic artery is:

• Clamped
• Ligated
• Divided

Cystic duct is:

• Clamped
• Ligated
• Cut close to the gallbladder

Removal of the Gallbladder

• Gallbladder issues: disconnected.
• Hemostasis ensured
• Gallbladder resected to the last.

Inspection and Hemostasis

• Liver bed observed to check whether there is bleeding or bile leakage.
• Saline wash (peritoneal lavage) done where necessary.

Drain Placement (If Required)

A subhepatic drain can be inserted in:

• Acute inflammation
• Suspected bile leak
• Difficult dissection

Closure of the Wound

• Layers of peritoneum and muscle closed.
• Closure of the skin with a suture or a staple.
• Sterile dressing applied

Time

• 60-120 minutes

Post-operative Care

• Treatment with drugs to manage pain.
• Premature mobilization was encouraged.
• The liquids began in less than a day.
• Removal of drain after 2-4 days when placed.
• Sutures removed after 7–10 days

Open gallbladder removal recovery

The number of days to recover following open removal of the gallbladder is more than that of laparoscopic surgery due to the high incision. The recovery timeline and a care plan are very patient-friendly and are shown below.

First 24-48 hours/Immediate Recovery

• Recovery room/ ward hospital monitoring.
• Surgical pain (treated with IV analgesics)
• IV fluids and antibiotics
• Pulmonary exercises promoted to avoid pulmonary infection.
• There may be drain (as in case of surgery).

Hospital Stay

• 3 to 7 days (could be more in case of complications)

During hospital stay:

• The slow transition to soft diet: liquids.
• Ambulation began during 24 hours.
• De-bride in 2-4 days when the output is low.
• Wound monitored and vital signs monitored on a daily basis.

First 2 Weeks After Surgery

• Middle level pain and stiffness in the area of incision.
• Stitches or staples taken off 7-10 days.

Avoid:

• Heavy lifting
• Bending or straining
• Keep on deeply breathing and walking every day.

Weeks 3–6 (Healing Phase)

• Pain significantly reduces
• Staged re-entry of normal functioning.
• Capable of doing light household jobs.
• Generally, driving permits within 3-4 weeks (pain-free)

Complete Recovery

4–6 weeks

• Incision fully healed
• The energy levels are restored to normal.
• Ready to work and exercise (doctor-dependent)
• Post-Open Gallbladder Removal Diet.

First few weeks:

• Low fat and digestible foods.
• Small, frequent meals
• Plenty of fluids

Avoid initially:

• Fried and oily foods
• Spicy foods
• Alcohol

Later:

• The majority of the patients can handle regular diet in a month.

Pain and Wound Care

• Use patient-prescribed pain medication.
• Keep wound clean and dry

Watch for:

• Redness
• Swelling
• Discharge
• Fever

Best hospital for open cholecystectomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Open gallbladder surgery (open cholecystectomy) is an effective, safe and time-proven surgical operation particularly where the complex conditions related to the gallbladder or when laparoscopy surgery is not possible. Despite the long healing process because of the bigger incision, majority of the patients are fully cured in 4-6 weeks under right care given after the operation. Strict compliance with wound care, restrictions of activities, pain management, breathing exercises as well as dietary recommendations are important in avoiding complications and facilitating the healing process. Patients are able to resume a normal healthy life once they have recovered without any major digestive problems in the long-run.

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FAQ

Why they do open gallbladder surgery instead of doing laparoscopic? 

• Open procedures are reserved for complicated situations such as intense infection, inaccessible previous operations by reason of thick adhesions, perforated gallbladder, hemorrhaging, suspicious tumor, or when laparoscopic attempts have failed or are not safe. 

Should I expect any digestive problems after my gallbladder is out? 

• The long-term digestive problems are not common in most patients. Mild diarrhea or bloating can be experienced at the beginning but most of the time clear after a few weeks.

Is a drain post-surgically necessary?

• No. A drain will only be applied in specific situations, where inflammation, risk of bile leaks or challenging dissection is involved.

Will it leave the scar permanently?

• Yes, it will still be there but most of the time it will fade and become less noticeable. 

Can gallstones come back after my gallbladder has been taken out? 

• No. Once the gallbladder is removed, the gallstones cannot form in the gallbladder.