Infected gallbladder incision: Cholecystectomy | Johns Hopkins Medicine
Cholecystectomy | Johns Hopkins Medicine
What is a cholecystectomy?
A cholecystectomy is surgery to remove your gallbladder.
The gallbladder is a small organ under your liver. It is on the upper right side of your belly or abdomen. The gallbladder stores a digestive juice called bile which is made in the liver.
There are 2 types of surgery to remove the gallbladder:
Open (traditional) method. In this method, 1 cut (incision) about 4 to 6 inches long is made in the upper right-hand side of your belly. The surgeon finds the gallbladder and takes it out through the incision.
Laparoscopic method. This method uses 3 to 4 very small incisions. It uses a long, thin tube called a laparoscope. The tube has a tiny video camera and surgical tools. The tube, camera and tools are put in through the incisions. The surgeon does the surgery while looking at a TV monitor. The gallbladder is removed through 1 of the incisions.
A laparoscopic cholecystectomy is less invasive. That means it uses very small incisions in your belly. There is less bleeding. The recovery time is usually shorter than an open surgery.
In some cases the laparoscope may show that your gallbladder is very diseased. Or it may show other problems. Then the surgeon may have to use an open surgery method to remove your gallbladder safely.
Why might I need a cholecystectomy?
A cholecystectomy may be done if your gallbladder:
Has lumps of solid material (gallstones)
Is red or swollen (inflamed), or infected (cholecystitis)
Gallbladder problems may cause pain which:
Is usually on the right side or middle of your upper belly
May be constant or may get worse after a heavy meal
May sometimes feel more like fullness than pain
May be felt in your back and in the tip of your right shoulder blade
Other symptoms may include nausea, vomiting, fever, and chills.
The symptoms of gallbladder problems may look like other health problems. Always see your healthcare provider to be sure.
Your healthcare provider may have other reasons to recommend a cholecystectomy.
What are the risks of a cholecystectomy?
Some possible complications of a cholecystectomy may include:
Injury to the tube (the bile duct) that carries bile from the gallbladder to the small intestine
Scars and a numb feeling at the incision site
A bulging of organ or tissue (a hernia) at the incision site
During a laparoscopic procedure, surgical tools are put into your belly. This may hurt your intestines or blood vessels.
You may have other risks that are unique to you. Be sure to discuss any concerns with your healthcare provider before the procedure.
How do I get ready for a cholecystectomy?
Your healthcare provider will explain the procedure to you. Ask him or her any questions you have.
You may be asked to sign a consent form that gives permission for the procedure. Read the form carefully and ask questions if anything is not clear.
Your provider will ask questions about your past health. He or she may also give you a physical exam. This is to make sure you are in good health before the procedure. You may also need blood tests and other diagnostic tests.
You must not eat or drink for 8 hours before the procedure. This often means no food or drink after midnight.
Tell your provider if you are pregnant or think you may be pregnant.
Tell your provider if you are sensitive to or allergic to any medicines, latex, tape, and anesthesia medicines (local and general).
Tell your provider about all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.
Tell your provider if you have a history of bleeding disorders. Let your provider know if you are taking any blood-thinning medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.
If this is an outpatient procedure, you will need to have someone drive you home afterward. You won’t be able to drive because of the medicine given to relax you before and during the procedure.
Follow any other instructions your provider gives you to get ready.
What happens during a cholecystectomy?
You may have a cholecystectomy as an outpatient or as part of your stay in a hospital. The way the surgery is done may vary depending on your condition and your healthcare provider’s practices.
A cholecystectomy is generally done while you are given medicines to put you into a deep sleep (under general anesthesia).
Generally, a cholecystectomy follows this process:
You will be asked to take off any jewelry or other objects that might interfere during surgery.
You will be asked to remove clothing and be given a gown to wear.
An intravenous (IV) line will be put in your arm or hand.
You will be placed on your back on the operating table. The anesthesia will be started.
A tube will be put down your throat to help you breathe. The anesthesiologist will check your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
If there is a lot of hair at the surgical site, it may be clipped off.
The skin over the surgical site will be cleaned with a sterile (antiseptic) solution.
Open method cholecystectomy
An incision will be made. The incision may slant under your ribs on the right side of your abdomen. Or it may be made in the upper part of your abdomen.
Your gallbladder is removed.
In some cases, 1 or more drains may be put into the incision. This allows drainage of fluids or pus.
Laparoscopic method cholecystectomy
About 3 or 4 small incisions will be made in your abdomen. Carbon dioxide gas will be put into your abdomen so that it swells up. This lets the gallbladder and nearby organs be easily seen.
The laparoscope will be put into an incision. Surgical tools will be put through the other incisions to remove your gallbladder.
When the surgery is done, the laparoscope and tools are removed. The carbon dioxide gas is let out through the incisions. Most of it will be reabsorbed by your body.
Procedure completion, both methods
The gallbladder will be sent to a lab for testing
The incisions will be closed with stitches or surgical staples
A sterile bandage or dressing or adhesive strips will be used to cover the wounds
What happens after a cholecystectomy?
In the hospital
After the procedure, you will be taken to the recovery room to be watched. Your recovery process will depend on the type of surgery and the type of anesthesia you had. Once your blood pressure, pulse, and breathing are stable and you are awake and alert, you will be taken to your hospital room.
A laparoscopic cholecystectomy may be done on an outpatient basis. In this case, you may be discharged home from the recovery room.
You will get pain medicine as needed. A nurse may give it to you. Or you may give it to yourself through a device connected to your IV (intravenous) line.
You may have a thin plastic tube that goes through your nose into your stomach. This is to remove air that you swallow. The tube will be taken out when your bowels are working normally. You won’t be able to eat or drink until the tube is removed.
You may have 1 or more drains in the incision if an open procedure was done. The drains will be removed in a day or so. You might be discharged with the drain still in and covered with a dressing. Follow your provider’s instructions for taking care of it.
You will be asked to get out of bed a few hours after a laparoscopic procedure or by the next day after an open procedure.
Depending on your situation, you may be given liquids to drink a few hours after surgery. You will slowly be able to eat more solid foods as tolerated.
Arrangements will be made for a follow-up visit with your provider. This is usually 2 to 3 weeks after surgery.
Once you are home, it’s important to keep the incision clean and dry. Your provider will give you specific bathing instructions. If stitches or surgical staples are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and usually will fall off within a few days.
The incision and your abdominal muscles may ache, especially after long periods of standing. If you had a laparoscopic surgery, you may feel pain from any carbon dioxide gas still in your belly. This pain may last for a few days. It should feel a bit better each day.
Take a pain reliever as recommended by your provider. Aspirin or other pain medicines may raise your risk of bleeding. Be sure to take only medicines your healthcare provider has approved.
Walking and limited movement are generally fine. But you should avoid strenuous activity. Your provider will tell you when you can return to work and go back to normal activities.
Call your provider if you have any of the following:
Fever or chills
Redness, swelling, bleeding, or other drainage from the incision site
More pain around the incision site
Yellowing of your skin or the whites of your eyes (jaundice)
Belly or abdominal pain, cramping, or swelling
No bowel movement or gas for 3 days
Pain behind your breastbone
Infections and bacteriological data after laparoscopic and open gallbladder surgery
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doi: 10. 1016/s0195-6701(98)90240-7.
P T den Hoed
, R U Boelhouwer, H F Veen, W C Hop, H A Bruining
- 1 Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands.
P T den Hoed et al.
J Hosp Infect.
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P T den Hoed
, R U Boelhouwer, H F Veen, W C Hop, H A Bruining
- 1 Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands.
In two hospitals 637 patients undergoing cholecystectomy between June 1989 and June 1993 were entered into a prospective audit. The aim of this study was to determine the incidence of postoperative infections, especially wound infections, after open and laparoscopic biliary surgery and to assess the bacteriological data on these patients. The incidence of minor wound infection was 10.4% (66/637), of major wound infection 3.6% (23/637) and the overall incidence was 14% (89/637). The incidence of wound infection after laparoscopic cholecystectomy was 5.3% (10/189) and all were minor. Significant specific risk factors for developing a wound infection after laparoscopic cholecystectomy were emergency of the operation (P = 0. 046) and acute cholecystitis (P = 0.014). Overall, bile cultures were positive in 22%. There were 85 patients (13.3%) with positive bile from the gallbladder. From the laparoscopically operated patients 2.8% had a positive bile culture. The predominant micro-organisms from gallbladder bile were Escherichia coli (56 isolates), Klebsiella spp. (20 isolates) and Streptococcus spp. (16 isolates). There was no relationship between positive gallbladder cultures and wound infection. The consequences of wound infections can be serious and this study showed a morbidity rate comparable with the literature. The incisions used in laparoscopic gallbladder surgery are less susceptible to major problems. This combined with the significantly lower incidence of wound infections after laparoscopic cholecystectomy suggests that routine antibiotic prophylaxis as recommended for biliary surgery in general is now questionable.
Surgical infections after laparoscopic cholecystectomy: ceftriaxone vs ceftazidime antibiotic prophylaxis. A prospective study.
Colizza S, Rossi S, Picardi B, Carnuccio P, Pollicita S, Rodio F, Cucchiara G.
Colizza S, et al.
Chir Ital. 2004 May-Jun;56(3):397-402.
Chir Ital. 2004.
Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections.
Sarkut P, Kilicturgay S, Aktas H, Ozen Y, Kaya E.
Sarkut P, et al.
Surg Infect (Larchmt). 2017 Jul;18(5):603-609. doi: 10.1089/sur.2016.265. Epub 2017 Apr 4.
Surg Infect (Larchmt). 2017.
The need for antibiotic prophylaxis in elective laparoscopic cholecystectomy: a prospective randomized study.
Tocchi A, Lepre L, Costa G, Liotta G, Mazzoni G, Maggiolini F.
Tocchi A, et al.
Arch Surg. 2000 Jan;135(1):67-70; discussion 70. doi: 10.1001/archsurg.135.1.67.
Arch Surg. 2000.
Safety and efficacy of antibiotic prophylaxis in patients undergoing elective laparoscopic cholecystectomy: A systematic review and meta-analysis.
Liang B, Dai M, Zou Z.
Liang B, et al.
J Gastroenterol Hepatol. 2016 May;31(5):921-8. doi: 10.1111/jgh.13246.
J Gastroenterol Hepatol. 2016.
Use of retrieval bag in the prevention of wound infection in elective laparoscopic cholecystectomy: is it evidence-based? A meta-analysis.
La Regina D, Mongelli F, Cafarotti S, Saporito A, Ceppi M, Di Giuseppe M, Ferrario di Tor Vajana A.
La Regina D, et al.
BMC Surg. 2018 Nov 19;18(1):102. doi: 10.1186/s12893-018-0442-z.
BMC Surg. 2018.
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Comparison Between Closed and Open Methods for Creating Pneumoperitoneum in Laparoscopic Cholecystectomy.
Agarwal PK, Golmei J, Goyal R, Maurya AP.
Agarwal PK, et al.
Cureus. 2023 Mar 10;15(3):e35991. doi: 10.7759/cureus.35991. eCollection 2023 Mar.
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Incidence of bactibilia and related factors in patients who undergo cholecystectomy.
Moon DK, Kang JS, Byun Y, Choi YJ, Lee HW, Jang JY, Lim CS.
Moon DK, et al.
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A cross sectional study of risk factors for surgical site infections after laparoscopic and open cholecystectomy in a tertiary care hospital in North East India.
Hajong R, Dhal MR, Newme K, Moirangthem T, Boruah MP.
Hajong R, et al.
J Family Med Prim Care. 2021 Jan;10(1):339-342. doi: 10.4103/jfmpc.jfmpc_1245_20. Epub 2021 Jan 30.
J Family Med Prim Care. 2021.
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Re-examining causes of surgical site infections following elective surgery in the era of asepsis.
Alverdy JC, Hyman N, Gilbert J.
Alverdy JC, et al.
Lancet Infect Dis. 2020 Mar;20(3):e38-e43. doi: 10.1016/S1473-3099(19)30756-X. Epub 2020 Jan 29.
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treatment, symptoms, diagnostics – LISOD clinic in Kyiv, Ukraine
Gallbladder cancer (GBC) is a rare disease that develops with cholelithiasis, chronic cholecystitis. Among malignant tumors of the gastrointestinal tract, gallbladder cancer is in fifth place. The tumor process is detected in most cases in women after 50 years. In 70% of cases, gallbladder cancer is represented by adenocarcinoma, in other cases – by papillary or squamous cell carcinoma.
The tumor is located on the neck and bottom of the bladder. The disease must be diagnosed and treated as early as possible, because the tumor can quickly progress and affect other organs. The peculiarity of RZHP is precisely in its pronounced malignancy and local spread to the liver. Metastasis occurs along the paths of lymphatic drainage to the nearest tissues, the parietal peritoneum, pancreas, and para-aortic tissue. The prognosis in such cases is usually unfavorable. In order not to start the disease, you need to contact an oncologist at the first alarming signs. LISOD specialists know the latest methods of gallbladder cancer treatment.
LISOD uses world medical standards to diagnose gallbladder cancer.
- Laboratory research is carried out in a clinical laboratory equipped with modern equipment. For diagnostics, a special spectral system is used, which allows obtaining results with high accuracy. An increase in bilirubin levels indicates the presence of liver or gallbladder disease, including gallbladder cancer. Also, the study of the levels of alkaline phosphatase and aspartate aminotransferase helps to identify gallbladder disease.
- Ultrasound allows not only to detect a tumor, but also its spread to the walls of the gallbladder and liver. This method is especially effective when used during endoscopy or laparoscopy. This technique makes it possible to examine the gallbladder at close range.
- Computed tomography (CT) is used for both initial diagnosis and tumor staging. In addition, the state of the pancreas and liver is specified. This allows LISOD specialists to properly plan surgical treatment.
- Cholangiography (contrast examination of the bile ducts) also helps in the diagnosis of gallbladder tumors.
- Laparoscopy. Through a small incision in the anterior abdominal wall, a laparoscope is inserted into the abdominal cavity to examine the internal organs, including the gallbladder. During this study, a biopsy is taken (taking a suspicious piece of tissue for microscopic examination) and the stage (prevalence) of the tumor is specified.
In LISOD, when performing such operations, modern endoscopic and laparoscopic equipment is used, which employs leading specialists – endoscopic surgeons who are proficient in these techniques (both diagnostics and performing surgical interventions in full). The laparoscopic method allows you to make an accurate and correct diagnosis, determine the volume and stage of the process, and also choose the tactics of treatment.
The Comprehensive Examination allows LISOD specialists to confirm or refute the diagnosis of gallbladder cancer.
Surgery is the main method in the treatment of gallbladder cancer.
Cholecystectomy is the surgical removal of the gallbladder and its surrounding tissues for cancer of the gallbladder. It is also possible to remove regional (neighboring) lymph nodes. For gallbladder surgery, LISOD uses the laparoscopic method. Laparoscopy of the gallbladder consists in the fact that through small incisions (0.5 – 1.5 cm) with a special optical device, a laparoscope (a telescopic tube containing a lens system and attached to a video camera) penetrates into the abdominal cavity. Thus, the surgeon sees the surgical field on the monitor screen and has the opportunity to excise the neoplasm with very thin special instruments. Then the excised tissues are placed in special bags-containers and removed. Laparoscopy of the gallbladder is a low-traumatic method, easier tolerated by patients, and there are fewer adverse reactions.
For inoperable cases, chemotherapeutic treatment is carried out, and sometimes, if indicated, radiotherapy is prescribed.
Common signs of gallbladder cancer are pain , liver enlargement , palpable tumor-like mass in the abdomen . Sometimes there is gastric dyspepsia , pain in the gallbladder . The pain is localized in the right hypochondrium and epigastric region, gives to the right shoulder. Similar pains occur with stone and tubeless cholecystitis. In most cases, gallbladder cancer is combined with cholelithiasis and cholecystitis.
Due to obstruction of the common bile duct, jaundice appears , which, unlike blockage of the duct by a stone, develops without previous hepatic colic and fever. Anemia is rare, there is no noticeable weight loss.
Several risk factors are now known to increase the risk of gallbladder cancer. However, the presence of one or even several of these factors does not necessarily mean the development of cancer.
- Gallbladder stones and inflammation. 75-90% of patients with gallbladder tumors had stones or signs of chronic inflammation of this organ. People with large gallbladder stones were more likely to develop a tumor than those with multiple small gallstones. However, keep in mind that most people with gallstones will never develop cancer.
- “Porcelain” gallbladder. In patients with severe inflammation of the gallbladder, the walls of the gallbladder may be covered with calcium overlays, which significantly increases the risk of developing cancer. Therefore, we recommend the removal of such a gallbladder.
- Typhoid fever. People infected with the bacterium Salmonella, which causes typhoid fever, have a 6-fold increased risk of developing gallbladder cancer. However, typhoid fever is a rare disease.
- Common bile duct cysts contain bile, may increase in size and contain areas of precancerous changes, which increase the risk of developing gallbladder cancer.
- Cigarette smoking also increases the risk of gallbladder cancer.
- Professional hazards. Workers in the rubber and steel industries have an increased risk of developing gallbladder cancer as a result of exposure to a number of chemicals, such as nitrosamines.
- Malformations of the pancreatobiliary zone at the confluence of the ducts of the liver, gallbladder, and pancreas increase the risk of developing gallbladder cancer.
- Age. Most patients with gallbladder cancer are over 70 years of age.
- Gallbladder polyps of 1 cm or more often turn into a malignant tumor. Therefore, we recommend removal of the gallbladder in this category of people.
- Obesity is also a risk factor for gallbladder cancer.
- Diet. The high carbohydrate and low fiber content increases the likelihood of gallbladder tumors.
- Helicobacter pylori. The presence of such an infection increases the risk of developing both stomach and duodenal ulcers, as well as the occurrence of stones and gallbladder cancer.
In most cases, gallbladder cancer cannot be prevented. However, some risk factors can be avoided.
- Maintaining a normal weight is one of the ways to reduce the risk of both cancer of this localization and other tumors (colon, prostate, uterus, kidney, breast).
- Adequate consumption of fruits and vegetables and limiting animal fat intake may reduce the risk of developing gallbladder cancer.
- Daily physical activity is another way to reduce the risk of gallbladder cancer.
- Smoking cessation also reduces the risk of developing gallbladder cancer.
- Treatment of gallbladder stones reduces the likelihood of chronic inflammation and the risk of cancer.
Questions and Answers
Questions from patients and answers from our specialists are published in this section. Each person’s question concerns a specific problem related to their disease. Israeli clinical oncologists and the head doctor of LISOD, MD, Professor Alla Vinnitskaya answer the patients.
The answers of specialists are based on knowledge of the principles of evidence-based medicine and professional experience. The answers correspond solely to the information provided, are for informational purposes only and do not constitute medical advice.
The main purpose of section is to provide information to the patient and family so that they can decide with their doctor about the type of treatment. The tactics of treatment offered to you may differ from the principles set forth in the answers of our specialists. Feel free to ask your doctor about the reasons for the differences. You must be sure that you are receiving the correct treatment.
Ask your doctor
August 13, 2012
Why laparoscopy? Question price.
Gallbladder removal – EMC
In our medical center, gallbladder removal is carried out in different ways. An operation to remove the gallbladder is called a cholecystectomy.
Main types of surgeries performed at the Yekaterinburg Medical Center:
- Laparoscopic cholecystectomy
- Mini-approach cholecystectomy
- Cholecystectomy with choledochotomy, intraoperative ultrasound, removal of stones from the choledochus and drainage of the choledochus according to Kehr and Pikovsky
Laparoscopic cholecystectomy is most often used by the surgeons of the medical center as the newest and most promising method of removing the gallbladder. This method is more difficult to implement than the classic open cholecystectomy method, but has several advantages.
What is a laparoscope?
The laparoscope is used for laparoscopic operations, being, in fact, an endoscope for manipulations in the abdominal cavity. It consists of a tube equipped with a lens system, an optical cable and a halogen lamp. To perform laparoscopic cholecystectomy, the surgeon, along with the laparoscope, uses a set of endoscopic equipment: an endovideo system, an illuminator, an aspirator, an electrosurgical apparatus, and a monitor. Laparoscopic instruments are also needed – trocars, clamps, grippers, forceps, scissors, electrocoagulators.
Benefits of laparoscopic surgery
- low trauma and fast recovery
- less blood loss
- no need for analgesics after surgery
- discreet postoperative scars
Indications for surgery
- acute cholecystitis not amenable to medical treatment
- chronic cholecystitis
- gallbladder blocked with stones
Contraindications for laparoscopic cholecystectomy
- abdominal adhesive disease
- diseases of the abdominal organs
- chronic diseases of organs and systems in the stage of decompensation
The course of the operation to remove the gallbladder
The surgeon during laparoscopic cholecystectomy first of all makes punctures in four places:
- in the epigastric region below the xiphoid process up to 5 mm in size
- in the right hypochondrium size 5 mm
- two punctures in the umbilical region – for inserting a video camera and extracting the gallbladder up to 10 mm in size
Through the punctures, the surgeon passes special instruments – trocars, through the trocars you can enter the instruments necessary for manipulation. It is necessary to introduce carbon dioxide into the abdominal cavity so that the surgeon can clearly see all the organs on the monitor.
The surgeon dissects the gallbladder neck, duct and cystic artery, which he crosses with the instrument. Then the gallbladder is cut off from the liver with the help of an electrocoagulator, which makes the operation bloodless. After excision of the gallbladder, its bed is examined, bleeding stops, and the bladder itself is removed by the surgeon through an incision in the umbilical region. Seams are applied. Sometimes it becomes necessary to apply drainage, which is removed on the second or third day after the operation. The whole operation lasts about 40-50 minutes and takes place under general anesthesia.
Consequences of gallbladder removal
Complications after laparoscopic cholecystectomy are rare, but possible. These include:
- accidental injury to abdominal organs
- damage to the biliary tract
- outflow of bile from bile ducts
- minor bleeding of the removed bladder bed
The surgeons of our medical center are taking measures to prevent the development of postoperative complications, the main of which, of course, is the operation with strict adherence to the methodology and technique.
Many patients of our center can be discharged from the hospital on the third day after the operation, having the strength to return to their daily activities. The stitches are removed on the seventh day after the operation, cosmetic stitches dissolve on their own. After two weeks, the patient can start work.
In the multidisciplinary Medical Center, our surgeons perform gallbladder removal using other surgical techniques.
In this technique, a retractor-manipulator is used, the use of which allows to reduce the depth of the surgical approach and increase the angle of the surgical action by almost four times. The surgeon makes a 4 cm long incision in the region of the right hypochondrium and inserts a retractor-manipulator into the wound, then spreads the instruments and fixes them with a screw. Then the retractor-manipulator moves to the bottom of the gallbladder to its body and neck. The surgeon performs cholecystectomy with simultaneous suturing of the bed and insertion of a drainage tube, which significantly reduces the time of the operation.
This technique does not use carbon dioxide, and the operation is performed through a micro-incision, which significantly expands the indications for cholecystectomy for patients suffering from chronic respiratory and cardiovascular diseases.
Cholecystectomy with choledochotomy
Surgeons of our medical center often have to operate on patients with acute cholecystitis and obstructive jaundice. In this case, the operation of choledochotomy is used, in which the surgeon removes the holedoch. Bile is removed from it by suction, stones are groped and pushed to the opening in the duct. If possible, they are removed by the tool. At the end of the operation, the patency of the excretory ducts is checked.
Cholecystectomy with choledochotomy and removal of stones from the choledochus, intraoperative ultrasound, drainage of the choledochus according to Kerr, Pikovsky