How Long Does Gallbladder Removal Surgery Take?

Gallstones: How Long the Operation Takes, the Symptoms, and When Removal Is Necessary

Laparoscopic gallbladder removal takes 45 to 60 minutes in the operating theatre in an uncomplicated case, and it is surgery under general anaesthesia. It is carried out through a few small incisions in the abdomen rather than through one long cut.

What a patient actually lives through, and counts as “the length of the operation”, is longer than the surgery itself, because it also takes in the preparation and the anaesthetic, then the recovery room and the stay in hospital before discharge. Those stages are set out in detail below.

One point here causes a great deal of confusion. Many people look for a way to have gallstones taken out through a laparoscope while keeping the gallbladder itself. In reality, gallstones that cause symptoms are treated by removing the gallbladder together with the stones inside it, not by extracting the stones and leaving the gallbladder in place. There is no method that takes the stones out and keeps the gallbladder. The word “laparoscopic” describes how the surgeon reaches the gallbladder, through small openings instead of one large wound. It describes the surgical approach; it does not mean there is no surgery.

How long laparoscopic gallbladder removal takes, from the anaesthetic to going home

In uncomplicated cases the gallbladder operation does not run for hours; the surgery itself is measured in minutes. Below is a breakdown of the stages a patient goes through, from arriving at the hospital to getting back to normal activity:

Time in the operating theatre: 45 to 60 minutes in a routine case, and it may run longer if the gallbladder is inflamed or there are extensive adhesions.
Preparation and anaesthetic: the patient is asked to stop eating and drinking for a period set by the anaesthetist, usually from the night before the operation, and to arrive at the hospital early enough for the tests and the anaesthetist's assessment to be completed. Setting up the general anaesthetic then takes several minutes before the surgery begins, which is why the time spent inside the surgical department is longer than the operating time on its own.
Recovery room: usually one to two hours under observation, until the anaesthetic wears off and the patient is fully awake and able to drink fluids.
Hospital stay: many patients go home on the same day or after a single night. The decision rests with the surgeon, according to how the operation went and the patient's condition.
Return to normal activity: patients are encouraged to get up and walk on the same day. Desk work and ordinary daily life usually resume within about a week, while heavy lifting and strenuous effort are put off for several weeks, according to the surgeon's instructions.

What makes the operation take longer

The duration is not a fixed number for every patient, and a longer operation does not mean that something has gone wrong. More often it means the surgeon is taking the time needed to work safely. The commonest things that lengthen an operation are:

Acute inflammation of the gallbladder, or repeated attacks of inflammation, because the gallbladder wall becomes swollen and harder to handle.
Adhesions left by previous abdominal surgery.
Variation in the anatomy of the bile ducts from one person to another, which calls for extra time to confirm the landmarks before any step is taken.
A stone that has passed out of the gallbladder into the bile duct. This may call for imaging of the duct during the operation, which lengthens the surgery itself, or for a separate endoscopic procedure on the duct before or after the removal, which lengthens the overall treatment journey rather than the operation alone.
Conversion to open surgery in some cases, when the laparoscopic view is not clear enough to work safely. This is not a failure of the operation and not a complication. It is a safety decision the surgeon takes during the surgery to protect the bile ducts, and the possibility of it happening is explained to the patient beforehand.

Why the treatment is removing the gallbladder, not taking the stones out of it

The problem is not the stone on its own; it is the gallbladder that produced it. If the stones were taken out and the gallbladder left in place, stones would form all over again. That is why the established treatment for gallstones that cause symptoms or complications is removal of the whole gallbladder, and this is most often done by laparoscopic surgery.

Laparoscopic gallbladder removal is a surgical operation in every sense of the word. It is performed under general anaesthesia, through several small openings in the abdominal wall; a laparoscope fitted with a camera and fine instruments is passed through them, and the gallbladder is separated and brought out through one of those openings. What differs from open surgery is the size of the wound and the speed of recovery, not the nature of the procedure itself. In both cases it is surgery under general anaesthesia.

The body carries on working after the gallbladder is removed, and life afterwards is normal for most people, because bile continues to reach the intestine directly from the liver instead of being stored in the gallbladder first. In the first few weeks some patients notice looser stools or discomfort after rich meals, which improves gradually with time and does not call for a permanently restricted diet.

Stones that pass out of the gallbladder into the bile duct are a different problem in a different place, and they have a procedure of their own: an endoscope is passed through the mouth to reach the bile duct and clear the stones out of it. That procedure is very often an addition to gallbladder removal rather than a substitute for it, because the gallbladder itself remains the source of the stones. It is explained in detail later on this page.

Breaking up gallstones with a laser: why gallstones are not treated the way kidney stones are

One of the most frequently asked questions is whether gallstones can be broken up with a laser or with shock waves, the way it is done with kidney stones. The question is a fair one, because the idea genuinely did work for kidney stones. But the situation in the gallbladder is different, for clear reasons:

Once a kidney stone has been broken up, the fragments pass out in the urine and the kidney stays sound and carries on working. The gallbladder, by contrast, stays where it is after the stones are broken up, and it is the very organ that formed them, so the problem happens all over again.
The fragments left by breaking up a stone can move and become wedged in the bile duct, causing obstruction, yellowing of the skin and eyes, or inflammation of the pancreas, all of which are more serious than the original stone.
There are stone-dissolving medicines of the bile acid class, but their use is very limited: they act slowly, they suit only particular kinds of small stone, the stones often come back once the medicine is stopped, and they are prescribed only in selected cases, at the decision of the treating doctor.

For these reasons, breaking up gallstones is not an established treatment in everyday practice, and the alternative is removal of the gallbladder by laparoscopic surgery. Breaking up a stone keeps one narrow role: a large stone wedged inside the bile duct may be broken up during the endoscopic procedure on the duct so that it can be brought out, and that concerns the bile duct, not the gallbladder itself.

What gallstones are and why they form

Gallstones are hard deposits that form inside the gallbladder, a small sac that sits beneath the liver, stores the bile the liver produces and then empties it into the intestine to help digest fat. They range from grains as fine as sand to large stones, and there may be a single stone or several of them at the same time. The commonest type is cholesterol stones, followed by pigment stones.

Stones form when the balance of the components of bile is upset, so that cholesterol or pigments rise beyond what the bile is able to keep dissolved, or when the gallbladder does not empty its contents regularly and material settles inside it. Several factors make them more likely:

Older age.
Being female, particularly with repeated pregnancies.
Excess weight, and equally the opposite: losing weight very rapidly, or going for long stretches without food.
A diet high in fat and low in fibre.
A family history of gallstones.
Diabetes and disorders of blood lipids.
Some blood disorders in which red blood cells break down more than usual, which are linked to pigment stones.
Certain hormonal medicines containing oestrogen, as assessed by the doctor following the case.

Having stones does not necessarily mean having symptoms. Many stones are found by chance on a scan carried out for another reason and stay silent, with no complaint at all. In that situation the decision rests on the doctor's assessment, not on the presence of a stone alone.

Gallstone symptoms and the biliary colic attack

The best-known symptom is an attack of biliary colic. The pain usually begins after a rich meal or in the evening, and it follows a distinctive pattern that anyone who has been through an attack will recognise:

Pain in the upper abdomen on the right side, or in the middle just below the rib cage, coming on as an attack and building gradually.
Pain spreading to the right shoulder, or to the upper back between the shoulder blades.
An attack lasting from half an hour to a few hours and then easing off, sometimes returning at widely spaced intervals.
Nausea or vomiting along with the pain.
Bloating, indigestion and a feeling of fullness, particularly after rich and fried food.

These symptoms resemble those of other conditions that cause pain in the upper abdomen, which is why the diagnosis is not made on symptoms alone but by clinical examination and an ultrasound scan of the abdomen.

Signs that mean going to the emergency department straight away

Some symptoms are different from the usual colic attack and point to a blockage in the bile duct or inflammation of the gallbladder. These signs will not wait for a clinic appointment or for the next day; they call for going to the emergency department as soon as they appear:

Fever, or shaking chills, along with the abdominal pain.
Yellowing of the whites of the eyes or of the skin.
Dark urine together with pale stools.
Repeated vomiting that will not settle and makes it impossible to keep fluids down.
Severe pain that lasts more than a few hours and does not ease with rest.
Severe pain with a racing heartbeat, or a sudden and obvious collapse in general condition.

Repeated attacks of pain in the upper right abdomen after rich meals are a different matter. Even when they settle on their own, they are reason enough for a non-urgent medical assessment at a general surgery or gastroenterology clinic, because it is the recurrence of attacks in the presence of stones that determines the need for removal before complications develop.

Laparoscopic gallbladder removal: surgery through small incisions

The established treatment for gallstones that are causing symptoms is removal of the gallbladder itself, not taking the stones out and leaving the organ where it is. In most cases the operation is done laparoscopically, meaning through small incisions in the abdominal wall instead of one long surgical cut. One point should be clear to the patient from the outset: laparoscopy is a less invasive surgical approach, not a substitute for an operation. It is carried out in an operating theatre, under general anaesthesia, by a surgeon, and what separates it from open surgery is the size of the incisions and how much the tissues are disturbed.

How laparoscopic gallbladder removal is done

The main steps of the operation run as follows:

The patient is given a general anaesthetic, so is fully asleep and feels nothing during the operation, with the anaesthetist monitoring breathing and vital signs throughout.
The surgeon makes several small incisions in the abdominal wall, one of them usually at the navel.
A medical gas (carbon dioxide) is passed into the abdominal cavity to lift the abdominal wall and create a safe working space and a clear view between the organs.
The laparoscope camera goes in through one of the incisions and sends a magnified, clear picture of the gallbladder and the structures around it to a screen in front of the surgeon, while the fine instruments pass through the other incisions.
The surgeon identifies the anatomy precisely before any cutting step, working to the rule that nothing is divided until there is complete certainty about what it is.
Once that certainty is established, the artery supplying the gallbladder and the cystic duct connecting it to the bile duct are sealed and then divided.
The gallbladder is separated from its bed against the liver and lifted out whole, with the stones still inside it, through one of the small incisions; it is then sent for histopathology as routine practice.
The gas is released, the incisions are closed with fine stitches or surgical glue, and in some cases a thin drain is left in place and removed later.

During the operation the surgeon may also use X-ray imaging of the bile duct to confirm that it is clear of stones before finishing.

Why the gallbladder is removed instead of just taking the stones out

The question is a fair one, and the answer goes to the heart of the treatment: the stone is not the whole problem, the gallbladder that produced it is. If the stones are taken out and the gallbladder is left behind, the conditions that formed them are still there, new stones usually form, and the attacks come back.

After repeated attacks the gallbladder wall is often scarred, inflamed or contracting poorly, so it is no longer doing its job in any case.
Leaving a diseased gallbladder in place means the risk of further biliary colic and acute inflammation of the gallbladder continues.
A stone may slip out of the gallbladder into the bile duct and cause obstruction and jaundice, infection of the bile duct, or inflammation of the pancreas.
Removing the gallbladder treats the source rather than the result: there is no gallbladder left behind to form new stones.

This is also why gallstones are not shattered or lasered the way kidney stones are. Once a kidney stone has been broken up, the fragments leave in the urine by a natural route; the gallbladder, by contrast, stays where it is and remains the organ that makes the stones, so new stones simply form and the symptoms come back. Fragments can also drop into the narrow bile duct and block it, causing jaundice or inflammation of the pancreas. Shock-wave fragmentation, and dissolving agents of the bile acid class, are therefore not standard treatment for gallstones; they are considered only in very limited cases, decided by the doctor, when surgery is not a suitable option for that patient. Laser has a quite different role: it may be used to break up a stubborn stone inside the bile duct during endoscopy, not to clear stones out of the gallbladder.

None of this means that every stone calls for an operation straight away. The decision rests on whether there are symptoms or complications, and on the surgeon's assessment of the case after examination and imaging.

When the surgeon converts to open surgery

In some cases the surgeon decides during the operation to complete it through a wider surgical incision rather than continue with the laparoscope. This is a decision taken to protect the patient, not a failure of the operation, and it is normally explained as part of informed consent before going into theatre, as a possibility in any gallbladder operation. The commonest reasons for it are:

Severe inflammation or scarring around the gallbladder that blurs the boundaries between the tissues.
Adhesions from previous abdominal operations or from repeated attacks of inflammation.
Unusual anatomy of the bile duct or of the blood vessels that cannot be told apart safely through the laparoscope.
Bleeding during the operation that needs direct control.
An unexpected anatomical or disease finding that calls for wider access.

In some cases of severe inflammation the surgeon may choose a middle course that is safer in that situation, such as removing part of the gallbladder and leaving the portion stuck to vital structures, or placing a temporary drain and postponing removal until things settle. The rule the surgeon works to is a simple one: the safety of the bile duct comes first, and if the view is not safe, converting to open surgery is the right choice rather than the last resort.

Recovery after the operation, day by day

The pace of recovery differs from one patient to another, but the general course runs like this:

The day of the operation: the patient wakes up in the recovery room and may have a sore throat from the anaesthetic breathing tube, pain around the incisions, and sometimes pain in the shoulder from gas remaining after the operation, which is temporary and settles gradually. Sips of water come first, then light food according to the team's instructions, and the patient is encouraged to get up and walk early, because moving about helps recovery and reduces problems after surgery.
Leaving hospital: the timing depends on how stable the patient is once the anaesthetic has worn off. Many patients go home the same day, while some spend a night under observation if the inflammation was severe, if there are other medical conditions, or if a drain was left in. The medical team assesses the patient before discharge, and the patient goes home with clear instructions for the wounds, the medicines and the follow-up appointment.
The first days at home: the pain is usually manageable and is controlled with painkillers the doctor prescribes. The wounds are kept clean and dry according to the team's instructions, heavy lifting and strenuous effort are avoided, and it is best to start with small, frequent, low-fat meals and widen the diet gradually, along with walking around indoors at intervals and doing deep-breathing exercises.
The first weeks: everyday activities and desk work come back first, then driving, once the patient can press the brake hard and suddenly without pain and is no longer taking a painkiller that causes drowsiness, and then physical effort, sport and lifting, with the surgeon's agreement at the follow-up visit.

Warning signs after the operation that need prompt action

Recovery passes without trouble in most cases, but there are signs that should not be left until the follow-up appointment:

A raised temperature with shivering or chills, or abdominal pain that increases instead of easing: urgent medical assessment straight away, at the nearest emergency department.
Yellowing of the whites of the eyes or of the skin, or dark urine with pale stools: medical assessment the same day, as these signs may point to a blockage or a leak in the biliary tract.
Persistent vomiting that prevents the patient from keeping fluids down, or a swollen abdomen with no wind being passed: contact the treating team the same day.
Redness, swelling or discharge around one of the incisions, or one of them opening up: the wound should be seen by a doctor the same day, and no medicine should be started without medical advice, since the decision to treat any infection belongs to the doctor after examination.
Shortness of breath, chest pain, or a swollen, painful leg: emergency department immediately.

ERCP, the bile duct endoscopy: a different procedure for a different problem

This is where the commonest confusion lies, and it deserves a decisive answer. Endoscopic retrograde cholangiopancreatography, known as ERCP, is not an alternative to removing the gallbladder. It does not treat the stones sitting inside the gallbladder, and it does not treat the gallbladder at all. It is aimed at a different place altogether: the bile duct.

The route is different: the endoscope is passed through the mouth, then down the oesophagus and the stomach as far as the duodenum. No incision is made in the abdominal wall, and it is carried out under sedation or anaesthesia.
The purpose is different: it deals with a stone that has dropped down into the bile duct and blocked it, causing jaundice, infection of the bile duct or inflammation of the pancreas, or with a blockage of the duct from other causes.
What the doctor does: reaches the opening of the bile duct in the duodenum, injects a dye that shows up on X-ray to pinpoint the blockage, then widens the opening by cutting the sphincter muscle or with a balloon, extracts the stone with a basket or a balloon, and may place a stent to secure the drainage of bile if that is needed.
What it does not do: it does not take the gallbladder out, and it does not put an end to the reason the stones are forming, because the gallbladder is still in place once it is over and can still send another stone down into the duct.

For this reason, in suitable cases the bile duct endoscopy is carried out alongside removal of the gallbladder rather than instead of it: the bile duct is cleared of the stone that blocked it, and the gallbladder that sent the stone there is removed as well, so that the problem does not repeat itself. The ERCP may come before the operation, after it, or in the same session, and in some cases the surgeon is able to clear the bile duct during the laparoscopic operation itself; the order is decided by the treating team according to the patient's condition. Nor is ERCP a minor procedure to be used as a way around the operation, since it carries complications of its own, the best known being inflammation of the pancreas afterwards, and so it is only done when there is a clear reason for it. And if the stones are sitting inside the gallbladder alone, the bile duct endoscopy is not a treatment for them in the first place.

Does the body need a gallbladder? Life after it is removed

The gallbladder is not an indispensable organ. Its job is to store the bile that the liver produces, concentrate it, and push it out when a fatty meal is eaten. After it is removed the liver carries on producing bile as usual, but the bile flows into the intestine continuously instead of being stored and released in one go, and the digestion of food and of fats continues normally.

Most people do not need a permanent diet or lifelong food restrictions after the operation, and going back to a normal way of eating is the rule rather than the exception.
Some patients notice looser stools, needing to open their bowels sooner after eating, or discomfort after very rich meals, and this usually improves gradually as the body adjusts.
What helps during this period is spreading food across smaller and more frequent meals, cutting down temporarily on fried food and saturated fat, then bringing foods back gradually according to what each person tolerates.
If the digestive symptoms persist or are troublesome, they should be discussed with the treating doctor so that they can be assessed and a suitable plan put in place; persistent diarrhoea after gallbladder removal has recognised causes, and there is a medicine for it from the class of bile acid binding agents, which the doctor decides on after examination.

Choosing where to have laparoscopic gallbladder removal, and preparing for it

Laparoscopic gallbladder removal (laparoscopic cholecystectomy) is a surgical operation, carried out under general anaesthesia through small incisions in the abdominal wall. The word "keyhole" here describes the route to the gallbladder — small incisions instead of one long cut — and the procedure remains full surgery, with preparation before it, anaesthesia during it and follow-up after it. The right place to have it done is therefore one that brings the pre-operative assessment, the anaesthesia and the after-care together, and one you leave understanding what is going to happen to you and why. At Town Hospital in New Cairo (Fifth Settlement) these cases are followed in the general surgery clinics and the gastroenterology (digestive diseases) clinics, where the investigations are carried out, the diagnosis is made, and a treatment plan is then set for each individual case.

Questions worth asking your surgeon before you consent

Consenting to any operation is a clearer decision when you have asked your questions and understood the answers before you sign. These are practical things to raise in the clinic:

Does my case really need the gallbladder removed now, or does it need follow-up and periodic assessment instead?
Is there any suspicion of a stone in the bile duct that would call for an additional procedure before or after the operation?
How likely is it that my operation would be converted to open surgery, and what would that mean for my recovery and my stay in hospital?
Who will actually perform the operation, and who will follow me up afterwards?
What type of anaesthesia will be used, and who will assess whether I am fit for it beforehand?
What are the possible complications in my particular case, and which warning signs should I watch for after I go home?
Will I need to stay overnight, and what might make the stay longer?
Which of my medicines have to be stopped before the operation — anti-clotting and other blood-thinning medicines in particular — and when do I go back to my usual medicines?
When can I go back to work, drive, and lift heavy things?
What are the dietary instructions after the operation, and when does eating go back to normal?

It helps to come out of that conversation clear on two things. The first is that conversion to open surgery is not a failure and not a complication: it is a safety decision the surgeon takes during the operation when the view is not clear enough because of inflammation or adhesions, and finishing the operation safely matters more than insisting on the keyhole route. The second is that bile-duct endoscopy (ERCP) — in which an endoscope is passed down through the mouth to retrieve a stone that has dropped into the bile duct — is a different procedure treating a different problem; where it is needed it is done alongside gallbladder removal rather than instead of it, because the gallbladder that formed the stones is still there.

What the pre-operative work-up usually involves

The assessment differs from one patient to another according to age, chronic illnesses and the findings on clinical examination, but it usually covers the same ground:

A clinical examination and a review of your medical history, your previous operations and any drug allergies.
Basic blood tests, usually including a blood count, liver function, clotting, kidney function and blood sugar, and commonly screening for hepatitis viruses as part of routine preparation for surgery.
An abdominal ultrasound scan to assess the gallbladder, its wall and the bile duct.
Further imaging in some cases, such as magnetic resonance imaging of the bile duct (MRCP), when the doctor suspects there is a stone inside it.
An assessment by the anaesthetist to confirm that you are fit for general anaesthesia; an ECG, a chest X-ray or a specialist opinion may be requested depending on the case.
A full review of the medicines you take regularly, to decide which to continue and which to stop before the operation, with written instructions from your doctor.

What to bring and arrange before the day of the operation

Good preparation shortens the formalities on the day and makes a postponement less likely:

Bring your national ID card, and your insurance papers if you have them.
Bring your reports and test results, and any earlier scan images or discs if they are available.
Bring a written list of every medicine you take regularly, exactly as your doctor prescribed it.
Pack loose, comfortable clothes and shoes that are easy to put on, plus toiletries if there is any chance of staying overnight.
Follow the fasting instructions for the period the medical team specifies, with nothing to eat or drink throughout that time.
Arrange for someone to come with you and take you home; you must not drive yourself after a general anaesthetic, and you should avoid driving until your doctor tells you it is safe.
Arrange some simple help at home for the first few days, especially with anything that involves effort or lifting.
Remove jewellery, nail polish and contact lenses before you come in, and tell the medical team about any loose teeth or dental work.
Stop smoking before the operation for the period your doctor advises, because it affects breathing and wound healing.

What happens on the day of the operation

The steps usually run as follows, with small differences depending on the case and on your medical team's instructions:

Arriving at the time you were given and completing the admission formalities, then a final review of your file and test results.
Meeting the surgeon and the anaesthetist, and signing the consent form once the operation, its alternatives, its possible complications and the possibility of conversion to open surgery have been explained to you.
Having a cannula placed in a vein, and possibly being given some preparatory medicines before you go into the operating theatre.
The operation itself, carried out under general anaesthesia through small incisions in the abdominal wall, with you fully asleep and feeling nothing.
Waking up in the recovery room under nursing observation, with your vital signs and any nausea monitored, and pain controlled with the painkillers the doctor prescribes.
Starting on fluids and then light food, and getting out of bed to walk short distances as the medical team instructs.
Going home, most often on the same day or after one night, although the stay may be longer if the gallbladder was inflamed or the case needed an additional procedure.
Receiving written instructions on discharge covering wound care, medicines, diet and the follow-up appointment.

After you go home: what to expect and when to contact the hospital

Recovery after laparoscopic gallbladder removal is usually uneventful: mild pain around the small wounds, a bloated feeling and shoulder pain that both settle within a few days, and a gradual return to moving about and to eating. Most people go back to an ordinary diet once they have recovered, and some notice looser stools or find that they cannot tolerate rich meals for a while; this improves gradually, and it does not mean a permanent diet or giving up fat for good. Some symptoms, though, should not be left to settle on their own.

Go to the nearest emergency department immediately, at any hour, if any of the following appears:

Abdominal pain that increases with time instead of easing, or severe pain that the prescribed painkillers do not relieve.
A raised temperature with shivering and chills, especially if it comes with yellowing of the eyes or skin, or with severe abdominal pain.
Yellowing of the whites of the eyes or of the skin, or dark urine with pale stools.
Repeated vomiting that stops you drinking fluids or keeping them down at all.
Severe swelling of the abdomen, with no wind or stool passing at all.
Shortness of breath or chest pain; or pain, swelling and warmth in the leg.

Contact the hospital the same day, without waiting for your follow-up appointment, if any of the following appears:

A slightly raised temperature with no other symptoms.
Redness, swelling or warmth around the wounds, discharge or pus coming from them, or any of them opening up.
Yellow or greenish fluid leaking from one of the wounds.
Nausea or vomiting that carries on for more than a day, or a clear drop in your ability to eat and drink.
Pain that is not improving gradually in the way you were told to expect when you were discharged.

The earlier you get in touch, the simpler the cause is to deal with, so there is no need to wait for your follow-up appointment if you feel that something is not right.

General surgery and gastroenterology clinics at Town Hospital

The general surgery clinics and the gastroenterology clinics at Town Hospital in New Cairo (Fifth Settlement) provide diagnostic and treatment services for problems of the digestive system, the gallbladder and the bile duct, delivered by a specialist medical team. That covers clinical examination, laboratory tests and imaging, then setting the treatment plan and following you up after the operation. Assessment in the clinic remains the basis of all of it: gallstones need examination, review and imaging before any decision is taken.

The same is true of any recurring stomach or digestive complaint, since similar symptoms can have different causes behind them, and it is early diagnosis that keeps complications away.

On a related digestive topic, read more about how H. pylori leaves the body.

Frequently asked questions about gallstones and gallbladder removal

How long does the operation take?

Laparoscopic (keyhole) removal of the gallbladder takes roughly 45 to 60 minutes in the operating theatre in an uncomplicated case, and you are fully asleep under general anaesthesia throughout, so you feel nothing. On top of that there is the preparation and anaesthetic time beforehand, then about one to two hours in the recovery room afterwards, so you spend several hours in hospital even though the surgery itself is much shorter than that. Most patients go home the same day or after a single night, and are back to their usual activity within about one to two weeks. The operation can take longer if the gallbladder is acutely inflamed, if there are adhesions from an earlier infection or an earlier operation, if there are stones in the bile duct that have to be dealt with, or if the surgeon judges that safety calls for converting to open surgery.

Is gallbladder removal open surgery or keyhole surgery?

Gallstones that cause symptoms are treated by removing the gallbladder, and that is an operation whether it is done by keyhole or by open surgery; the difference between the two is how the surgeon reaches the gallbladder, not whether the procedure counts as surgery. In the keyhole approach the surgeon works through small openings in the abdominal wall, usually three or four, under general anaesthesia, which means less pain, a faster recovery and smaller scars. Open surgery is done through a single larger incision, and is used when severe inflammation, adhesions or a poor view make it unsafe to finish the operation by keyhole. Converting from keyhole to open during the operation is a safety decision the surgeon takes to protect the bile ducts; it is not a complication and not a failure, and it is explained to you beforehand as one of the possibilities. There is no method that takes the stones out and leaves the gallbladder itself in place, because the diseased gallbladder is where the stones form.

Can gallstones be broken up with a laser like kidney stones?

Gallstones are not usually shattered or lasered the way kidney stones are, because the two situations are completely different. A kidney stone, once broken up, leaves the body in the urine through a natural passage, whereas the gallbladder is the organ that produced the stones in the first place; if the gallbladder stays where it is, the stones form again months or years later. The fragments can also drop into the bile duct and block it, causing jaundice or inflammation of the pancreas, which are more dangerous than the stone itself. There are medicines in the bile acid class that can dissolve one very limited type of stone (small, non-calcified stones in a gallbladder that still works). They work slowly, over months or years, and the stones come back once the medicine is stopped, so they are not a standard treatment and are only considered for carefully selected cases, on a doctor's decision. Breaking up a large stone inside the bile duct during an endoscopy passed through the mouth (ERCP), so that the stone can be extracted, is something entirely different from breaking up the stones in the gallbladder itself. The established treatment for stones that cause symptoms is removal of the gallbladder, usually by keyhole surgery.

What is the difference between a stone in the gallbladder and a stone in the bile duct?

A gallbladder stone sits inside the gallbladder itself, while a bile duct stone is one that has moved out of the gallbladder into the duct that carries bile from the liver to the intestine, and telling the two apart matters because the treatment is different. A stone inside the gallbladder causes biliary colic and pain in the upper right side of the abdomen, particularly after rich meals, and if it causes symptoms the treatment is keyhole removal of the gallbladder. A stone that has passed into the bile duct blocks the flow of bile and causes yellowing of the whites of the eyes and the skin, dark urine and pale stools, and it can lead to infection of the bile duct, with fever alongside the pain and the jaundice, or to inflammation of the pancreas, which is more serious still and needs the stone cleared from the duct first. A duct stone is usually removed with an endoscope passed through the mouth down to the duodenum (ERCP), which is a different procedure from keyhole abdominal surgery and is not a substitute for it; the gallbladder is generally removed afterwards so that new stones do not drop into the duct.

Do I have to have my gallbladder removed if the stones are not hurting me?

Not every stone calls for removal. Silent stones, the ones found by chance on an ultrasound scan and causing no symptoms, are usually kept under review rather than removed, because many of them never cause a problem. Removal is still advised in some situations even without symptoms, among them polyps inside the gallbladder, calcification of its wall and large stones, as well as some cases where the patient's own health circumstances raise the chance of complications. Anyone who chooses to watch and wait should know the signs that mean the stones are no longer silent: an attack of pain under the right ribs lasting hours, a fever, or yellowing. Ask to be assessed as soon as any of them appears. What settles the question here is the surgeon's assessment after examination, ultrasound and liver function tests, not the size of the stone on its own.

Can I delay the gallbladder operation if my colic attacks are mild?

Repeated attacks of colic, even mild ones, mean this is not a case of silent stones: a stone is moving and blocking the outlet of the gallbladder, and waiting then carries a real risk. Someone who has had one attack is likely to have another, and it can progress to acute inflammation of the gallbladder, to blockage of the bile duct, or to inflammation of the pancreas. An operation done at a settled time, after full preparation, is also easier than one done during an acute attack, because inflammation makes the tissues fragile, raises the likelihood of converting to open surgery and lengthens the hospital stay. It is usually better, then, to have the operation once an attack has settled and before the problem repeats itself, rather than waiting for a complication to happen, and the right timing is for the surgeon to decide after assessment. An attack that is actually under way, meaning pain that lasts for hours, a fever or yellowing, is not something to postpone and needs immediate assessment.

How long will I stay in hospital and when can I go back to work?

Most patients go home the same day or after a single night following keyhole removal of the gallbladder, provided their general condition is stable and they can walk, drink fluids and keep the pain under control. People in desk jobs usually go back to work within one to two weeks, while anyone whose work is physical or involves lifting heavy weights needs longer, up to about four weeks, for the muscles of the abdominal wall to heal. Light walking from the first day is advised, because it lowers the risk of clots and helps trapped gas pass. If the operation is converted to open surgery, or if the gallbladder was acutely inflamed, both the hospital stay and the recovery period are longer, and the surgeon decides that according to the case.

What should I eat after my gallbladder is removed?

You do not need a special diet for the rest of your life after your gallbladder is removed, because the liver carries on producing bile and it now reaches the intestine directly instead of being stored first. In the first few weeks, though, it is better to go gradually: several small meals rather than one large one, less fat, less fried food and less very rich food, then bring items back one at a time while noticing what causes you discomfort. Bloating or loose stools after a rich meal are common in this period and usually improve over weeks to months, helped by plenty of fibre and fluids. If diarrhoea or pain after eating carries on for a long time, see a doctor so the cause can be assessed; there is treatment that can be prescribed after an examination, and it does not mean giving up foods permanently.

What symptoms after the operation mean I should contact the hospital the same day?

Some signs after the operation cannot wait for your follow-up appointment and mean going to the nearest emergency department straight away: a fever, or shivering and chills; severe abdominal pain that is getting worse rather than easing; yellowing of the whites of the eyes or the skin; dark urine with pale stools; repeated vomiting that stops you drinking; severe bloating of the abdomen with no gas passing; or breathlessness, chest pain or painful swelling in the leg. Contact the hospital the same day, rather than waiting for the following week, if redness, swelling or discharge appears at any of the small incisions, if you are struggling to eat and drink, or if you have pain that your prescribed painkillers do not control. Mild pain around the wounds and shoulder pain caused by the gas used during keyhole surgery are both common and settle gradually over a few days.

Can I live normally after having my gallbladder removed?

Yes, life after gallbladder removal is normal for most people, because the gallbladder is a sac that stores bile rather than the source of it; the liver is what produces bile, and it still reaches the intestine once the gallbladder is gone, so digestion and the absorption of fat carry on. Most patients need neither permanent medication nor a permanently restricted diet once the recovery period is over. Some people do notice looser stools or discomfort after rich meals in the first few months, and the body then adjusts gradually. Pain that continues exactly as it was before the gallbladder was removed is a reason to go back and be checked, because it may point to another cause for the symptoms or to a stone left behind in the bile duct.