Before and During Gallbladder Surgery

Gallbladder surgery typically takes place in a hospital. Patients should follow any preparatory steps recommended by their physician prior to surgery. These may include changes to diet or medication regimen.
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If gallstones are present in the common bile duct, a procedure called endoscopic retrograde cholangiopancreatography (ERCP) may be used to reduce or eliminate these stones either prior to or during the surgery to remove the gallbladder. During ERCP a long, flexible tube called an endoscope is passed through the mouth into the first part of the small intestine (duodenum) to the bile ducts. A catheter is inserted into the tube to scoop up the stone and remove it from the body. In some instances gallstones may pass spontaneously from the bile ducts.
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Before gallbladder surgery, patients are placed under general anesthesia, meaning they are unconscious and do not experience pain during the procedure.
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Gallbladder surgery is most often performed as a laparoscopic procedure. As part of this technique, the surgeon makes several small incisions in the abdomen. Carbon dioxide is used to inflate the abdomen, which increases the space in which the surgeon is able to work.
A thin, tube-like instrument called a laparoscope is inserted through a hollow instrument (cannula) into the incisions in the abdomen. A camera and light attached to the laparoscope provide images of the gallbladder that are transmitted to a monitor. The surgeon watches the monitor while inserting medical instruments into the laparoscope and separating the gallbladder from the liver, ducts and other structures. The cystic duct (duct that conveys bile from the gallbladder to the common bile duct) is cut and the gallbladder is removed through the incisions, which are then closed.

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Open surgery is either planned in advance or improvised if the surgeon finds that a procedure that started as laparoscopy cannot be completed using that technique. In open surgery, an incision 5 inches to 8 inches long (12.7 to 20.32 centimeters) is made on the right side of the abdomen just below the ribs and the gallbladder is removed. When gallbladder surgery is performed to remove advanced cancer, the surgeon may use a technique known as extended cholecystectomy. Liver tissue and nearby lymph nodes are removed in addition to the gallbladder during this procedure.
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