Cholecystectomy (Gallbladder Removal)

Cholecystectomy is a surgical operation to remove the gallbladder, a small pear-shaped organ that sits just beneath the liver on the right side of the abdomen.

The gallbladder stores bile, a digestive fluid made by the liver. When the gallbladder becomes diseased — most often because hard deposits called gallstones form inside it — it can cause serious pain and other problems. Removing the gallbladder stops those problems at their source. After removal, bile flows directly from the liver into the small intestine, and most people digest food normally without their gallbladder.

Cholecystectomy is recommended when the gallbladder is causing symptoms or has become dangerous to leave in place. The most common reason is gallstones (hard crystal-like lumps that form from bile), but there are several other indications.

• Symptomatic gallstones — gallstones that cause recurring pain, especially after eating fatty food.
• Biliary colic — sudden, severe cramping pain in the upper right abdomen caused by a gallstone temporarily blocking the bile duct (the tube that carries bile).
• Acute cholecystitis — sudden, severe inflammation (swelling and irritation) of the gallbladder, often triggered by a blocked bile duct.
• Chronic cholecystitis — long-lasting inflammation of the gallbladder that causes repeated episodes of pain and indigestion.
• Choledocholithiasis — gallstones that have moved into the common bile duct, potentially blocking it.
• Gallstone pancreatitis — inflammation of the pancreas (a digestive gland behind the stomach) caused by a gallstone escaping into the shared duct.
• Gallbladder polyps — small growths inside the gallbladder that may become cancerous if they reach a certain size.
• Gallbladder cancer — in selected cases, early-stage cancer of the gallbladder.

Cholecystectomy is usually not suitable in certain situations. Your surgical team will assess all of these carefully before recommending the operation.

• Patients who are too medically unwell to safely undergo general anaesthesia (the deep sleep used during surgery).
• Patients with severe, uncontrolled bleeding disorders that cannot be corrected beforehand.
• Cases where the anatomy inside the abdomen is too distorted — for example, from many previous abdominal operations — making safe access difficult.
• Asymptomatic gallstones (gallstones that cause no symptoms at all) in most patients, as the risks of surgery may outweigh the benefits.

Cholecystectomy is one of the most commonly performed operations and is generally considered safe, but like all surgery it carries recognised risks.

• Wound infection — redness, swelling, or discharge at the cut site, more common in open surgery than in keyhole (laparoscopic) surgery.
• Shoulder or abdominal bloating — caused by the carbon dioxide gas used to inflate the abdomen during laparoscopic (keyhole) surgery; usually settles within a day or two.
• Bile leak — bile escaping from a small cut or clip site inside the abdomen, which may need further treatment.
• Bile duct injury — accidental damage to the common bile duct during surgery; rare but the most serious complication, potentially requiring further surgery.
• Bleeding — usually controlled during the operation, but occasionally requires a blood transfusion.
• Injury to nearby structures — such as the bowel, liver, or major blood vessels, which may need immediate repair.
• Post-cholecystectomy syndrome — ongoing digestive discomfort such as bloating or loose stools in a small number of patients after removal.
• Deep vein thrombosis (DVT) — a blood clot forming in a leg vein, a general risk of any abdominal surgery.
• Anaesthetic reactions — rare adverse responses to the medications used to keep the patient asleep during surgery.
• Conversion to open surgery — in laparoscopic procedures, the surgeon may need to switch to a larger abdominal cut if complications arise; this is a decision, not a failure.

Good preparation helps the surgical team work safely and helps you recover faster. Your team will give you personalised instructions, but the following is what is typically expected.

Before the day of surgery, your doctor will usually ask you to fast — stop eating solid food for a number of hours and stop drinking even clear fluids for a shorter period beforehand (your team will give you exact times). Smoking should be stopped as far in advance as possible, as it slows healing and increases breathing risks during anaesthesia. Alcohol should be avoided in the days before surgery. If you take blood thinners, aspirin, or anti-inflammatory medicines, your surgical team will advise whether and when to pause them — do not stop any medication without their guidance. Diabetes medicines and blood pressure medicines may also need timing adjustments on the day.

The following tests are commonly run before cholecystectomy to make sure the operation is safe and to plan the approach:

• Blood tests — to check for infection, anaemia (low red blood cells), liver function, and how well blood clots.
• Abdominal ultrasound (USG perut) — the main imaging test to confirm gallstones and assess the gallbladder.
• CT scan or MRI of the abdomen — sometimes used for a more detailed view of the bile ducts and surrounding anatomy.
• MRCP (magnetic resonance cholangiopancreatography — a special MRI of the bile and pancreatic ducts) — ordered if stones in the common bile duct are suspected.
• Electrocardiogram (EKG) and chest X-ray — to assess heart and lung fitness for anaesthesia, especially in older patients.
• Anaesthesia review — a consultation with the anaesthesiologist (the doctor who manages your sleep and pain during surgery).

On the day of surgery, a cholecystectomy typically follows these steps:

• 1. Admission and preparation — you change into a hospital gown, a nurse checks your vital signs, and a small intravenous (IV) line is placed in your arm for fluids and medicines.
• 2. Anaesthesia — the anaesthesiologist gives general anaesthesia so you are fully asleep and feel nothing during the operation.
• 3. Positioning — you are placed on your back on the operating table, and the abdomen is cleaned with antiseptic.
• 4. Access — in laparoscopic surgery (the most common approach), the surgeon makes several small cuts — usually three to four — in the abdomen. In open surgery, one longer cut is made.
• 5. Inflation — in laparoscopic surgery, carbon dioxide gas is pumped in to create space to work. A thin camera called a laparoscope is inserted through one cut so the surgeon can see inside on a screen.
• 6. Identification and clipping — the surgeon carefully identifies the cystic duct (the tube connecting the gallbladder to the main bile duct) and the cystic artery (the blood vessel feeding the gallbladder), then clips and cuts them to safely detach the gallbladder.
• 7. Removal — the gallbladder is gently freed from its attachment to the underside of the liver and removed through one of the small cuts (or the larger cut in open surgery).
• 8. Check and close — the surgeon inspects the area for any bleeding or bile leaks, then removes the gas and closes the cuts with stitches, staples, or surgical glue.
• 9. Recovery room — you are moved to a recovery area where nurses monitor you as the anaesthesia wears off.

Recovery after cholecystectomy depends on whether laparoscopic or open surgery was performed. Laparoscopic patients often go home the same day or the following day; open surgery usually requires a longer hospital stay. In both cases, your medical team will monitor your vital signs, pain level, and wound condition before you are discharged.

• Pain management — some soreness at the wound sites and shoulder discomfort from the gas are normal after laparoscopic surgery. Your team will prescribe appropriate pain relief; do not take anti-inflammatory medicines without checking with them first.
• Diet — start with light, low-fat foods and fluids in the first days. Rich or fatty meals may temporarily cause loose stools or bloating while your digestive system adjusts to the absence of the gallbladder.
• Wound care — keep incision sites clean and dry. Your team will tell you when it is safe to shower and how to care for stitches or staples. Watch for signs of infection: increasing redness, warmth, swelling, or unusual discharge.
• Activity restrictions — gentle walking is usually encouraged from day one to reduce the risk of blood clots. Heavy lifting and strenuous exercise are typically restricted for several weeks; your surgeon will advise the exact timeframe based on your recovery.
• Driving — usually not permitted until you are off strong pain medicines and can react quickly. Your team will confirm when it is safe.
• Return to work — many patients with desk jobs return within one to two weeks after laparoscopic surgery; physical jobs may require longer. Your doctor will advise based on your individual progress.
• Follow-up appointments — a post-operative review is usually scheduled within two to four weeks to check the wound and assess recovery. If a bile duct stone was also treated, additional follow-up may be needed.
• When to seek urgent care — go to an emergency department if you develop a high fever, severe abdominal pain, yellowing of the skin or eyes (jaundice), dark urine, persistent vomiting, or any wound that looks seriously infected.