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. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• You may have trouble breathing, or get pneumonia or blood clots after having an open cholecystectomy. 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 symptoms may not disappear at once and may still continue.
  
  
• 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.

GETTING READY:

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Medications:
  
  
  • Ask your caregiver if you need to stop using any of your present medicines. These may include aspirin, ibuprofen, or blood thinners.
    
    
  • Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
    
    
  • Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Depending on your health status and results of the blood tests, you may need to donate your own blood no later than three days before surgery. Your own blood may be used when a possible blood transfusion during surgery is needed. You may also ask a family member or friend with the same blood type to donate their blood. Talk to your caregiver for more information on blood donations.
  
  
• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.
  
  
• Tell your caregiver if you know or think you might be pregnant.
  
  
• Dye may be used during your surgery to help caregivers see the gallbladder and bile duct better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
• You may need to have abdominal or chest x-rays, ultrasound, or blood, urine, or stool tests. Other tests may also be needed, such as a liver and gallbladder scan or endoscopic retrograde cholangiopancreatography (ERCP). Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• Your bowel may need to be emptied and cleaned out before the surgery. Caregivers may give you a liquid medicine called an enema. This will be put into your rectum to help empty your bowel. Your caregiver will teach you how to do this.
  
  
• You may be given medicine to help you sleep.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Do not wear contact lenses on the day of your surgery. You may wear glasses. Wear socks to help you stay warm.
  
  
• If you are staying in the hospital after your surgery, bring your personal belongings with you. These may include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Preparing you for surgery:
  
  
  • Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
    
    
  • An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
    
    
  • You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

TREATMENT:

What will happen:

• You will be asked to change into a hospital gown. You may be given antibiotic medicine through your IV to prevent infection. You may be given medicine to help you relax or make you drowsy. You will be taken on a stretcher to the room where the surgery will be done. A medicine called general anesthesia will be given to keep you asleep and free from pain during the surgery. You will be moved into position for the surgery when you are asleep. Your chest and abdomen will be cleaned and covered with sheets to keep the surgery area clean.
  
  
• An incision (cut) will be made on the abdomen (stomach) just below the right ribs. Your caregiver may also choose to do the incision right down the middle of your abdomen. He will carefully cut through or push aside muscles and other tissues until your gallbladder is seen. Your caregiver will remove the gallbladder, and tissues and blood vessels sticking to it. He will check for bleeding and look for other problems in the area. Your caregiver may place a small tube called a drain. This tube will drain fluid from your abdomen to the outside of your body. The incision will be 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 try to get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken to your hospital room. The bandages covering your incision will keep the area clean and dry to prevent infection. A caregiver may remove the bandages to check your incision.

Waiting room: This is a room where your family and friends can wait until you are ready for visitors. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

• You cannot make it to your surgery appointment on time.
  
  
• You have a fever (increased body temperature).
  
  
• Your skin is itchy, swollen, or has a rash.
  
  
• You have questions or concerns about your surgery.

SEEK CARE IMMEDIATELY IF:

• You are not able to eat or drink, or are urinating less or not at all.
  
  
• You have trouble breathing or chest pain all of a sudden.
  
  
• You get bad pain in your abdomen, or feel faint or weak.
  
  
• Your abdomen becomes tender and hard.
  
  
• Your vomit (throw up) has blood or bile in it.
  
  
• Your signs and symptoms are getting worse.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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.

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