Open Cholecystectomy: Causes, Symptoms, Treatment and Cost

An open cholecystectomy is a surgical technique that removes the gallbladder. The gallbladder is a small organ found in the upper right side of the abdomen that stores bile released by the liver. Open cholecystectomy is usually performed when other treatments, such as medications or lifestyle changes, have not been successful in relieving symptoms caused by gallstones or inflammation of the gallbladder (cholecystitis).

• Laparoscopic cholecystectomy: This is the most common type of open cholecystectomy, and involves making several small incisions in the abdomen to access the gallbladder. The gallbladder is subsequently removed by the surgeon using a camera and specialised equipments.
• Open cholecystectomy: This kind of open cholecystectomy necessitates a wider incision in order to get direct access to the gallbladder. The surgeon will next create an incision in the abdomen and use specialised equipment to remove the gallbladder.
• Hand-assisted laparoscopic cholecystectomy: This type of open cholecystectomy combines laparoscopy with traditional open surgery techniques by utilising a hand-assist device that is inserted through one of the small incisions made during laparoscopy. The device allows for more direct manipulation of tissue, allowing for more precise removal of the gallbladder and surrounding structures if necessary.
• Robotic-assisted laparoscopic cholecystectomy: This type of open cholecystectomy utilises robotic technology to help guide surgeons during their procedure and provide them with enhanced visualisation and precision when removing the gallbladder and surrounding structures if necessary.

The primary benefit of open cholecystectomy is that it allows for direct visualisation and manipulation of the abdominal organs, which can make it easier to identify and remove stones, tumours, or other abnormalities.Open cholecystectomy also offers a lower risk of complications than laparoscopic cholecystectomy (surgery performed with a tiny camera inserted through small incisions).

Other benefits of open cholecystectomy include shorter recovery time compared to laparoscopic procedures; less pain during recovery; and fewer risks associated with general anaesthesia.Additionally, open cholecystectomy may be more cost-effective than laparoscopic surgery due to reduced operating time and fewer medical supplies needed for the procedure.

Gallstones, which are hard deposits of digestive fluid that may develop in the gallbladder, are commonly treated by an open cholecystectomy. The procedure may also be used to treat other diseases, including gallbladder inflammation and infection, or bile duct obstruction.

• Bleeding: The most common risk associated with open cholecystectomy is bleeding. This can occur during or after the procedure due to injury to a blood vessel or from cutting into the gallbladder itself.
• Infection: As with any surgery, there is a risk of infection at the incision site or in the abdominal cavity. This can be treated with antibiotics and may require additional surgery if it becomes severe.
• Injury to surrounding organs: There is a chance of unintentionally damaging other abdominal organs, such as the intestines, liver, or pancreas, during an open cholecystectomy.
• Adverse reactions to anaesthesia: Any time general anaesthesia is used, there is a risk of an adverse reaction such as nausea, vomiting, dizziness, confusion, or even death in rare cases.
• Bile duct injury: This occurs when the bile ducts are damaged during surgery and can lead to leakage of bile into the abdomen which can cause serious complications such as infection and sepsis (a life-threatening condition).

Before undergoing an open cholecystectomy, it is important to prepare both physically and mentally.

Physically, you should:

• Follow your doctor’s instructions for any pre-operative tests or exams.
• Stop taking any drugs that might make you more prone to bleeding during surgery.
• To make sure you are in excellent health for surgery, maintain a nutritious diet and exercise routine.
• Smoking should be avoided both before and after the treatment since it might delay recovery.
• Make arrangements for someone to drive you home following the surgery since the effects of the anaesthesia will prevent you from doing so.

Mentally, you should:

• Learn about what will happen during the procedure so that you can feel more comfortable when it comes time for surgery day.
• Talk with your doctor about any fears or anxieties that you may have regarding the procedure so that they can provide reassurance and support throughout the process if necessary.
• Make sure to get plenty of rest prior to your surgery so that your body is well rested and ready for recovery afterwards!

The surgery involves the removal of the gallbladder through an incision in the abdomen. To locate and excise the gallbladder, the surgeon will typically create a small incision on the right side of your belly. Usually taking between one and two hours, this treatment is done while the patient is under general anaesthesia.

• Obtain informed consent from the patient.
• Perform preoperative tests such as blood work, urine analysis, and imaging studies as indicated by the patient’s medical history and condition.
• Administer preoperative medication as prescribed by the physician, such as antibiotics or antispasmodics for pain relief or nausea prevention.
• Place an intravenous line for fluid administration during surgery and administer medications as needed throughout the procedure if necessary.
• Assemble all necessary surgical instruments and supplies in a sterile field prior to beginning the procedure.
• Position the patient on the operating table with arms tucked at their sides and legs spread apart slightly to provide access to the surgical site while maintaining comfort for the patient throughout surgery.

• Make an incision in the abdomen just below the rib cage, typically on the right side of the body near gallbladder location.
• Identify anatomical structures including gallbladder, liver, common bile duct (CBD), cystic duct, cystic artery.
• Dissect down to isolate gallbladder from surrounding tissue.
• Clamp off the cystic artery and cut off the cystic duct.
• Expose gallbladder from behind the liver using blunt dissection technique.
• Divide connective tissue around the gallbladder neck with scissors or electrocautery devices.
• Remove the entire gallbladder including any stones present within it.

• Close incision using sutures or staples depending on size of incision made during the procedure.
• Apply sterile dressing over the wound site.
• Monitor vital signs including heart rate, blood pressure, respiratory rate regularly after surgery until stable.
• The incision site should be checked for proper healing and for any signs of infection.
• The patient should also be encouraged to move around as soon as possible to help prevent postoperative complications such as blood clots and pneumonia.
• Additionally, the patient may need to take antibiotics or other medications prescribed by their doctor in order to prevent infection.

Generally, the cost of an open cholecystectomy in India can range from anywhere between Rs. 25,000 to Rs. 1,50,000.

After an open cholecystectomy, it is important to follow a healthy diet that is low in fat and high in fibre. Examples of foods to eat after an open cholecystectomy include:

• Lean proteins such as fish, chicken, beans, and eggs.
• Whole grains like oats, quinoa, brown rice, and whole wheat bread.
• Fruits and vegetables such as apples, bananas, carrots, and spinach.
• Low-fat dairy foods like milk and yoghurt.
• Good fats derived from nuts and seeds.
• Water to stay hydrated.

Yes, an open cholecystectomy is a technique that is typically safe to undergo. The risks associated with open cholecystectomy are relatively low, and complications are rare. However, you may lower your exposure to these risks by carefully following your surgeon's pre- and post-operative instructions.

Because an open cholecystectomy is normally performed under general anaesthesia, the patient does not experience any pain during the treatment itself.

However, there may be some discomfort and pain after the procedure due to incision site pain, gas pains, and bile duct spasms. Pain medicine may be given by the doctor to help with the pain after surgery.

Recovery from open cholecystectomy typically takes 4-6 weeks. The amount of time it takes to fully recover varies from person to person, and depends on factors such as age, overall health, and the type of surgery performed. Patients may feel pain, sickness, and tiredness in the first few days after surgery. Following the first phase of recovery, patients are often able to return to their regular activities within a few weeks at the most.

The most typical effects of an open cholecystectomy include:

• Abdominal ache and discomfort.
• Temporary numbness or tingling in the skin around the surgical area.
• Wound infection or bleeding at the site of incision.
• Nausea and vomiting due to anaesthesia or pain medications used during surgery.
• Damage to surrounding organs such as the bowel, bile ducts, or blood vessels during surgery, which can cause abdominal pain, fever, jaundice, and other symptoms that require additional treatment and monitoring by a healthcare provider.
• Gallbladder stones can form after surgery if any gallstones remain in the gallbladder after removal of the organ itself; these may need to be removed with another procedure depending on their size and location within the body.

• After an open cholecystectomy, it is important to follow the instructions given by your doctor for proper aftercare.
• Inspect the location of your incision for indications of infection, such as redness, swelling, and discharge. If you see any of these symptoms, consult your physician promptly.
• Take all prescription drugs as directed to alleviate pain and promote recovery.
• For at least six weeks following surgery, avoid intense activity and heavy lifting to enable the wound to heal properly.
• Consume a diet high in nutritious foods to accelerate your recovery and provide enough nutrients. Steer clear of meals that are fatty or oily, since they might irritate the digestive tract and cause nausea.
• Drink plenty of fluids to stay hydrated and help flush toxins from the body during the recovery period.
• Follow-up with your doctor as recommended for post-operative checkups and tests such as abdominal ultrasounds or blood tests if needed to monitor progress of recovery after surgery.

The open cholecystectomy is a safe and effective operation for treating gallbladder disease. It is associated with a low risk of complications, and most patients experience good outcomes.

In addition, open cholecystectomy can be performed laparoscopically, which reduces the risk of complications and helps speed up recovery time. With proper care and follow-up, open cholecystectomy can provide relief from gallbladder disease symptoms and help restore quality of life.