Open Cholecystectomy

WHAT YOU SHOULD KNOW:

• Open cholecystectomy (koe-le-sis-TEK-toe-mee) is surgery to treat gallbladder and bile duct diseases. These diseases include cholecystitis (swelling of the gallbladder) and cholelithiasis (stones in the gallbladder or bile ducts). The gallbladder is a pear-shaped organ found under your liver on the right side of your upper abdomen (stomach). It stores bile that comes from the liver and helps in the digestion of food. Bile is carried by the bile duct to the intestines. If left untreated, gallstones or biliary sludge may block the flow of bile. This can cause more swelling, infection, and abdominal pain.
  
  
• With open cholecystectomy, the gallbladder is removed through an incision (cut) in the abdomen. Sometimes, your caregiver will do open surgery after having problems during a laparoscopic cholecystectomy. Laparoscopic cholecystectomy is surgery that uses several small incisions and special instruments to remove your gallbladder. With open cholecystectomy, your symptoms may be relieved and further damage to other organs prevented.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• The bile duct, nerves, blood vessels, muscles, and other organs near the gallbladder may be damaged. You can get an infection or bleed too much. Your signs and symptoms may not go away. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• Without treatment, the symptoms of cholecystitis and cholelithiasis may get worse. The bile flow may get blocked or the gallbladder tissue may die. The gallbladder may burst and spill bile and blood inside the abdomen. This may lead to serious medical problems, such as peritonitis (infection of abdominal wall membrane) and sepsis (blood infection). Ask your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Enema: You may need to have an enema before your surgery. This is liquid put into your rectum to help empty your bowel.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.
  
  
• Nasogastric (NG) tube: An NG tube is put into your nose, and passes down your throat until it reaches your stomach. Food and medicine may be given through an NG tube if you cannot take anything by mouth. The tube may instead be attached to suction if caregivers need to keep your stomach empty.
  
  
• Tests:
  
  
  • Abdominal ultrasound: An abdominal ultrasound is a test to see inside your abdomen. Sound waves are used to show pictures of your gallbladder and abdomen on a TV-like screen. This allows your caregiver to check for stones and other problems.
    
    
  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
    
    
  • Computerized tomography scan: This is also called a CT or CAT scan. An x-ray machine uses a computer to take pictures of your abdomen to look for problems and abnormal changes.
    
    
  • ERCP: ERCP is also called endoscopic retrograde cholangiopancreatography. This test is done during an endoscopy to find stones, tumors, or other problems. Dye is put into the endoscopy tube. The dye helps your pancreas and bile ducts show up better on x-rays. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish, dyes, or any medicines. If you have stones, they may be removed during ERCP.
    
    
  • Gallbladder scintigraphy: This is also called a HIDA scan. This procedure uses a radioactive chemical or tracer to help the gallbladder show up clearly on a special screen. The tracer is injected into your IV.
    
    
  • Percutaneous bile aspiration: This procedure is used to remove bile from your gallbladder using a thin, long needle. The sample of bile will be sent to a lab for tests. This procedure can also be used to decrease your symptoms.
    
    
  • X-rays: Before surgery, caregivers may want to have an x-ray (picture) of your abdomen to see any other problems.

During your surgery:

After you go to sleep, your body will be moved into position for your surgery. Your skin is cleaned with soap and water and covered with sheets. An incision (cut) is made in your abdomen to reach the gallbladder. Once it is seen, the blood vessels attached to it are tied off and cut. It is removed carefully, making sure not to damage the liver. Your caregiver checks for bleeding and the other damage to organs nearby. Your caregiver may place a drain (small tube) to let fluid flow out from your abdomen. The incision is closed with sutures (stitches) and covered with a bandage.

After your surgery:

You may be taken to a recovery room, where you will stay until you are fully awake. Caregivers will watch you closely for problems. Do not attempt to get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages covering your incision keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your incision.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Deep breathing and coughing: This is an exercise to help decrease your risk for a lung infection after surgery. Do the following:
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breathes help open the airways that lead to your lungs. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
    
    
  • You may be given an incentive spirometer to help you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Let out your breath and cough. Repeat the steps 10 times every hour.
  
  
• Food and drink after surgery: You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.
  
  
• Medicines: You may need any of the following:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
    
    
  • Patient controlled analgesia: You may get pain medicine from a special pump. You can receive the pain medicine through an IV or an epidural line. This is called patient controlled analgesia (PCA) or patient controlled epidural analgesia (PCEA). Your caregivers set up the PCA pump to give you small amounts of pain medicine. The PCA pump has a cord coming from it, with a push button on the end. When you feel pain and push the button, you will give yourself pain medicine. To keep you from getting too much medicine, there is a limit on how often you can get the medicine. Do not let anyone else push the button for you. Your pump may give you a constant dose of pain medicine, as well as the medicine that you give yourself. If your pain is still bad even with using the PCA, let your caregivers know.
    
    
  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
  
  
• Monitoring: Caregivers may check for pulses on your arms or wrists. This helps caregivers learn if you have problems with blood flow after your surgery. You may also have any of the following:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
    
    
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.
  
  
• Tubes and drains:
  
  
  • Nasogastric (NG) tube: An NG tube is put into your nose, and passes down your throat until it reaches your stomach. Food and medicine may be given through an NG tube if you cannot take anything by mouth. The tube may instead be attached to suction if caregivers need to keep your stomach empty.
    
    
  • Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
    
    
  • T-Tube: A thin rubber tube may come out of your abdomen after surgery. This tube drains bile onto a bandage or into a small bag. The T-tube is removed when the amount of bile draining is already very little.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Open Cholecystectomy (Inpatient Care)