What is an Open Cholecystectomy?

Open cholecystectomy, also known as open gall bladder removal, is a surgical procedure which involves removal of the gallbladder through creation of a large opening in the abdomen. The main aim of this surgical operation is to provide relief to people suffering from gallstones and other complications of the gallbladder.

Gallbladder is a tiny organ which is found under, but attached to the liver. The key task of the gallbladder is to store bile which is made in the liver. Bile is a substance whose main function is breakdown of fats into smaller fat droplets to increase the surface area of enzyme digestion. This process of breakdown of fats into smaller droplets by bile is known as emulsification.

Although bile storage is very important, your digestion can still continue without the gallbladder. The bile production in the liver can continue independent of the gallbladder. The bile can also reach the duodenum and ileum without being stored in the gallbladder first.

According to current scientific study, laparoscopic cholecystectomy is the major type of surgery used in the removal of gallbladder. However, open cholecystectomy is still used in many patients, especially the ones who have a scar tissue and other abdominal complications resulting from previous abdominal surgery.

Why is Cholecystectomy done?

Unfortunately, your gallbladder is not an efficient organ in the gut. Sometimes, your bile can be very thick creating blockages along the way of openings where it empties. Your gallbladder can also be prone to develop a complication known as gallstones. Gallstones are stone-like deposits of substances which can develop in the bile and then get stuck inside your gallbladder. Gallstones exist in different sizes ranging from a size of a grain to a size of a golf ball.

Cholelithiasis is a disease which develops as a result of accumulation of gallstones in the gallbladder. This disease can cause mild or severe and lasting pains in your abdomen. Gallstones can also become a source of gallbladder infections which can cause vomiting, constipation, nausea and further abdominal pains. In case gallstones cause pain and other abdominal complications, your surgeon is likely to remove the gallbladder.

Other complications or conditions which can make your surgeon remove the gallbladder include:

• Pancreatitis - It is a complication which is characterized by pancreas inflammation.
• Biliary dyskinesia - It is a condition where your gallbladder cannot fill or empty correctly. Can be caused by any defect in your gallbladder.
• Cholecystitis- It is characterized by gallbladder inflammation.
• Choledocholithiasis- This is a condition where the gallstones move to the common bile duct causing blockage. This may prevent bile drainage from the gallbladder.

Your doctor or surgeon may also recommend the removal of your gallbladder in case it is causing acute or severe problems or has become a chronic concern.

Some other symptoms which can signal your doctor to remove the gallbladder are:

• Jaundice - Is characterized by yellowing of your skin, eyes and the tongue. It indicates blockage of the bile duct.
• Abnormal bloating
• Nausea
• Fever
• Severe and sharp pain of the abdominal upper portion. This pain also extends to the right shoulder, middle stomach and the back of your stomach.

Sometimes, your doctor may recommend a watchful period to see if your gallbladder-related symptoms may reduce. You may be recommended a change in diet; maybe reduction of fat intake can help lessen the symptoms. If your symptoms do not reduce, your doctor will go for open cholecystectomy.

Open cholecystectomy is usually the better choice over the laparoscopic cholecystectomy in cases where your gallbladder is severely diseased. A gallbladder at that point can be difficult to remove since it has affected the neighboring areas and laparoscopic removal cannot work well.

Preparation for Open Cholecystectomy

Before open gallbladder removal surgery, you are required to undergo some tests to make sure that you are healthy enough for the surgical process. Some of these tests include imaging tests and blood tests for your gallbladder. Apart from these tests, a complete physical examination of your body and a record of your medical history is required.

If you go to see your doctor during these appointments, you should tell him or her about any drugs you are using including over-the-counter medications and nutritional supplements. Some of these medications are likely to alter the whole surgical procedure. Therefore, you should stop taking them prior to your surgery. You should also tell your doctor if you are pregnant or preparing to be pregnant.

Otherwise, your doctor will give you complete instructions on your appointments to prepare for cholecystectomy.

The instructions you are to receive from your doctor include:

• Taking your bath using a special soap called an antibacterial soap.
• Planning to be admitted in hospital in case complications develop.
• Not drinking or eating anything for 6 hours or more prior to surgery.
• Taking a certain prescription which is aimed to flush out or clear your bowels.
• Making arrangements to have someone to take care of you immediately after surgery.

How is the Cholecystectomy procedure performed?

When in surgery center or hospital, you will change your dressing to hospital gown and have an intravenous anesthesia inserted into your arm vein to reduce pain during surgery. Cholecystectomy procedure is always done under general anesthesia to keep you into a painless sleep before surgery starts.  

Your stomach will also be cleansed with use of an antiseptic solution to prevent infection. The surgeon will then make an incision in your stomach. There are 2 types of incision your doctor may choose. They include:

• A slanted incision that is made directly below the rib cage to the right of the abdomen
• An up-and-down incision that is made on the upper part of the abdomen

After the incision, muscle, skin and other tissues are pulled back to help expose your gallbladder. Once the gallbladder is exposed, the surgeon will remove it and then close the wound with stitches and then bandage the wound. The time taken during open cholecystectomy depends on the severity of your gallbladder disease.

After the surgery, you are taken back to the hospital room where your vital signs are monitored. If they aren’t any vital signs, you are released to go home.

What to Expect after Open Cholecystectomy

The doctor is likely to release you for home if your body is stable and you show clinical signs of recovery with no complications. The stay in hospital will be long compared to laparoscopic procedure since this procedure is more invasive. Your health professionals will also monitor your signs of fever, infection and any drainage at the surgical area. Your doctor will also make sure you have less pain and bleeding.

A full recovery after an open surgery to remove your gallbladder may take 4 to 6 weeks.

Some of the ways you can prevent complication and quicken recovery after open cholecystectomy include:

• Changing your bandages time after time.
• Frequent walks to prevent blood clots.
• Not wear tight clothing.
• Drinking enough fluids to prevent dehydration.
• Avoid lifting heavy loads more than 10 pounds.
• Washing your hand with a disinfectant before touching the surgical site.

Risks of Open Cholecystectomy

This is considered to be a safe operation with fewer complications. However, just like any other type of surgery, it carries some risks.

The risks of open cholecystectomy include:

• Infection
• Blood clots
• Pancreatitis
• Damage of your blood vessels
• Excessive bleeding
• Allergic reactions due to anesthesia and usage of other drugs 
• Injury to the intestines and bile duct
• Heart complications such as increased pulse rate

Your doctor will explain to you some of these risks before performing the open cholecystectomy procedure.

Bottom Line

Open cholecystectomy is a surgical procedure for removal of your gallbladder. This procedure involves making an incision on your stomach to expose the gallbladder after which it is permanently removed. The gallbladder is removed following an infection caused by gallstones and other complications.