Cholecystectomy (Gall Bladder Removal)

What is a cholecystectomy (gall bladder removal)?

Illustration of gallbladder removal (cholecystectomy) surgery.

Cholecystectomy, or gall bladder removal surgery, is the surgical removal of the gall bladder.

It is performed when the recurring formation of gallstones on the wall of the gall bladder:

Leads to severe symptoms such as abdominal pain, nausea, vomiting and digestive problems.
Results in complications such as infections.

How it works

Laparoscopic cholecystectomy is the recommended treatment for patients with symptomatic gallstones. It uses keyhole surgery to remove diseased or inflamed gall bladders.

During the procedure, fine instruments and a video camera are inserted into the abdomen through small incisions. These small incisions enable faster recovery and lower infection risk.

Why do you need a cholecystectomy?

Cholecystectomy or gall bladder removal may be recommended if you experience recurring gallstone formation or severe symptoms such as:

Abdominal pain (usually on the right side, just under the ribs, or in the upper middle part of the stomach)
Pain in the back or right shoulder
Bloating or indigestion
Nausea or vomiting

If left untreated, gallstones can result in complications such as:

Cholecystitis (infection of the gall bladder)
Cholangitis (blockage of the bile duct resulting in pain, fever and jaundice)
Pancreatitis (inflammation of the pancreas)

What are the risks and complications of a cholecystectomy?

Cholecystectomy is a safe procedure, with a low risk of complications. However, like any other surgery, it carries a small risk.

Risks and complications of cholecystectomy include:

Reaction to anaesthesia or other drugs
Bleeding and injury of the bile ducts, intestines and other organs
Deep vein thrombosis and blood clots
Abdominal and wound infection

How do you prepare for a cholecystectomy?

You will undergo a comprehensive pre-op consultation. Your doctor will also review your blood test and scan results.

Your doctor will advise you on the preparations required before your surgery. This may include:

Not consuming any food and drinks for 4 hours or more before surgery
Using a special antibacterial soap in the shower before coming to the hospital for your surgery
Arranging a ride home
Arranging for someone to stay with you after your surgery

Note: It is important to inform your doctor if you are currently taking any medication. Certain medications can interfere with the surgical procedure.

You will need to inform your doctor if you are pregnant or could possibly be pregnant.

What can you expect in a cholecystectomy?

Gall bladder surgery can be done through:

Laparoscopic (keyhole) surgery
Conventional open surgery

Laparoscopic surgery is usually preferred as the smaller incisions mean faster recovery and a lower risk of infection.

You will be asleep throughout the procedure as cholecystectomy is performed using general anaesthesia.

Conventional laparoscopic surgery

Your surgeon will make 4 incisions through the abdominal wall. He or she will insert a small camera through one incision and remove the gall bladder through the other incisions.

You may receive 3 – 4 visible scars on the upper abdomen.

Single-incision laparoscopic surgery (SILS)

Your surgeon will make a single cut through the umbilicus, your body’s ‘natural orifice’. The camera and instruments used for the surgery pass through this single incision.

The resultant scar is invisible when healed as it is embedded deep inside the umbilicus.

“Open” cholecystectomy

This procedure is also known as open gall bladder removal. During the procedure, your surgeon will remove the diseased or inflamed gall bladder via a single, large cut in the abdomen.

This approach is sometimes required if laparoscopic surgery is not possible. You may need to undergo this procedure if you have the following conditions:

Severe infection
Complicated anatomy
Scar tissue from previous abdominal surgery

After the procedure

Common cholecystectomy side-effects include:

Difficulty digesting fats
Diarrhoea
Flatulence

Care and recovery after cholecystectomy

If you underwent:

Laparoscopic (keyhole) surgery, you will have to stay in the hospital for 1 night after laparoscopic gall bladder removal surgery. Recovery after laparoscopic surgery is quite fast. You may resume normal activities the next day after surgery.
Open surgery, you will have to stay in the hospital for 3 – 5 nights if you had open surgery.

After 1 – 2 weeks, you can start with some gentle exercise.

Your doctor will give you instructions on how to care for your incision wounds. You should be able to get your stitches removed at your follow-up appointment.

While you may return to a normal diet the day after your surgery, it is best to avoid fatty and oily food for a period of time. Do take food with more fibre content, like fruits and vegetables, to aid digestion after surgery.

Frequently asked questions

A: Most gallstones do not cause any symptoms at all. These gallstones are known as silent stones and require no treatment. But sometimes the gallstones may cause symptoms like severe pain, nausea and vomiting or jaundice.

Gallstones can also cause acute cholecystitis, a more serious condition where the gall bladder is inflamed. This is generally treated by surgical removal of the gall bladder.

A: No, once your gall bladder is removed, you should not develop gallstones again.

However, you may develop primary ductal stones due to bile duct disorders.

A: Although you can try to dissolve gallstones with certain medications, this treatment approach is rarely successful.

A: Your body can still function well without your gall bladder.

Without your gall bladder, bile flows directly into the small intestine. This may cause loose stools for 3 – 6 months. If this happens, stay on a low-fat diet to help with the loose motion.

A: There may be a few possible causes of pain after cholecystectomy, such as:

Infection
Difficulty in digesting high-fat and certain high-fibre foods
Bile leakage. In very rare cases, bile fluid can occasionally leak out into the abdomen, causing tummy pain.

Although it is normal to have some side effects after surgery, if you have pain that doesn’t get better with time, new abdominal pain, or pain that gets worse, contact your doctor right away.

A: If you have had laparoscopic (keyhole) cholecystectomy, although you may be able to go home on the same day as your surgery, a one-night stay in the hospital is usually required.

A: Your body needs to adjust to having no gall bladder. In the months after your operation, you can test your limits to work out what kind of food work best for you.

You can try:

A low-fat diet. Avoid high-fat, fried and greasy foods.
Increasing the fibre in your diet slowly over a few weeks to help normalise bowel movements.
Eating smaller, more-frequent meals that should include small amounts of lean protein, such as poultry, fish or fat-free dairy, along with vegetables, fruits and whole grains.
Limiting caffeine, dairy products or very sweet foods that tend to worsen diarrhoea.

A: There are no scientific studies proving definite weight gain after gall bladder surgery. However, there are people who report a gain in weight post-surgery.

Possible causes of weight gain after gall bladder surgery include:

Poor diet
Inflammation
Insulin resistance
Hormone imbalance
Faulty fat digestion and metabolism
Metabolic changes

A: Your doctor should be able to advise:

Dietary improvements to help you lose or maintain your weight. These improvements should help to reduce your risk of conditions such as high blood pressure, heart disease and diabetes too.
When you may return to or begin an exercise regimen after surgery. Living an active lifestyle is essential for weight management after gall bladder removal.

Note: Refrain from attempting fad diets (popular short term diets) after gall bladder removal. These diets may not work and can be dangerous.

A: Here are some dietary tips:

Take frequent but smaller portions throughout the day
Limit your fat intake. Choose boiled or grilled food over fried and opt for low-fat choices.
Record your food intake, breaking down each ingredient and how much you eat, and note the side effects that come up. Look for patterns so you can moderate your diet accordingly.
Reduce your fibre consumption after surgery, as they may cause bloating, pain and diarrhoea. You can re-introduce them slowly back into your diet one at a time.
Reduce your caffeine intake

A: Yes, you can drink alcohol after you have had a cholecystectomy. However, you might want to avoid alcohol shortly after your surgery as it can worsen diarrhoea.

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