Laparoscopic Cholecystectomy (Gallbladder Removal)

Medically reviewed by Dr Murlidhar Boob, MS, FAIS, DLS, FMAS — Laparoscopic Surgeon & Surgical Gastroenterologist

What it is

Laparoscopic cholecystectomy is the removal of the gallbladder through three or four small cuts, using a telescope and fine instruments instead of a long incision. It is the standard treatment for symptomatic gallstones anywhere in the world today.

The gallbladder is a small pear-shaped bag tucked under the liver on the right side. Its only job is to store bile and squeeze it out when a fatty meal arrives. When stones form inside it, they block that outflow — and the squeezing against a blocked exit is what produces the classic gallstone attack: a hard, gripping pain under the right ribs, often after dinner, sometimes travelling to the back or the right shoulder blade.

An important point that surprises many patients: we remove the whole gallbladder, not just the stones. That is deliberate. A gallbladder that has made stones once will make them again, so taking out only the stones simply guarantees a second operation later.

Who needs it

Gallstones themselves are extremely common. Surgery is for the ones causing trouble.

• Repeated attacks of biliary colic — that severe upper abdominal pain, with or without vomiting, that sends people to casualty at night.
• Acute cholecystitis, where the gallbladder becomes inflamed and infected, with fever and constant pain rather than colic.
• Stones that have slipped into the bile duct and caused jaundice or pancreatitis. Here the duct is cleared first, usually by ERCP, and the gallbladder removed afterwards.
• Gallstone pancreatitis — once the attack settles, the gallbladder must come out, otherwise it happens again.
• A thickened, contracted or non-functioning gallbladder on ultrasound.
• Gallbladder polyps above about a centimetre, or growing on follow-up scans.
• Silent stones in specific situations — long-standing diabetes, a porcelain (calcified) gallbladder, or very large stones.

“Why can’t I just wait and see? The pain does settle down each time.” It does settle, and that is exactly what makes gallstones deceptive. Every attack leaves a little more scarring around the gallbladder, and each episode makes the next operation slightly harder and slightly riskier. Worse, the stone that gives you a two-hour pain today can slip into the bile duct tomorrow and cause jaundice or pancreatitis — and that is a far bigger illness than a planned keyhole operation. Waiting has a cost; it just does not send you a bill straight away.

How it is done

You are under general anaesthesia, fully asleep.

A small cut is made near the navel and the abdomen is gently inflated with carbon dioxide to create working space. The telescope goes in through that opening, and two or three more slim ports are placed along the right upper abdomen.

The liver edge is lifted and the gallbladder is grasped and pulled upward so that the triangle of tissue at its neck comes into view. This next step is the heart of the operation. The tissue around the neck is carefully dissected until two structures — the cystic duct and the cystic artery — are seen clearly and unmistakably, with no other tube or vessel in question. Surgeons call this the critical view of safety, and it is the discipline that protects the main bile duct. Nothing is clipped or cut until that view is achieved.

The cystic artery and duct are then clipped and divided, and the gallbladder is peeled off the liver bed with a hook or diathermy. Any small bleeding points on the liver surface are sealed. The gallbladder, stones and all, is placed in a retrieval bag and drawn out through the navel port.

Where the bile duct is suspected to contain a stone, an on-table cholangiogram or ultrasound may be done, or the duct may be cleared separately by ERCP either before or after surgery. A small drain is left only occasionally, when the dissection has been difficult or the gallbladder badly inflamed. Finally the gas is released and the port sites closed — usually with absorbable stitches under the skin, so there is nothing to remove later.

Anaesthesia, duration and hospital stay

General anaesthesia in every case.

For a straightforward gallbladder, the operation takes 30 to 60 minutes. An inflamed or repeatedly attacked gallbladder, where the planes are stuck together, takes 60 to 90 minutes or occasionally longer — and that extra time is time well spent, not a problem.

Most patients are admitted on the morning of surgery and go home the next morning, so a single night in hospital is typical. Acute cholecystitis, an elderly patient, or someone who needed ERCP as well will usually stay two to four days. You will be sipping fluids a few hours after waking, eating a light meal the same evening, and walking to the bathroom on your own.

Recovery

Day 1. Sore around the port sites, particularly the navel one. Many patients feel an odd ache in the right shoulder — that is referred pain from the gas, not a heart or lung problem, and it goes away within a day or two. Walking helps it clear faster than lying still. Light food, oral painkillers, home by morning.

The first week. Tiredness is the main complaint, more than pain. Keep the dressings dry for two to three days, then shower normally. Eat what you feel like, but keep it light and low in oil. Bowel habit can be a little loose or a little slow for a few days. Most people stop painkillers by day four.

Weeks 2 to 4. Back to office work, driving and normal household routine. Walking is good and encouraged. Avoid lifting anything heavy, and avoid abdominal exercises. This is also when your diet can quietly go back to normal.

By six weeks. Gym, cycling, farm and factory work, everything. The scars have faded into three or four small marks that most people stop noticing within a year.

You will be reviewed at around a week, and again when the histopathology report on the gallbladder is available.

Why keyhole rather than open surgery

Open cholecystectomy meant a 15-centimetre cut below the right ribs, five to seven days in hospital, and six weeks off work. Some of you will remember a father or uncle who went through exactly that.

Keyhole surgery removes the same organ through openings you can cover with a fingertip. The wall of muscle is not divided, and almost everything that made the old operation hard was about that wall — the pain, the chest complications from not breathing deeply, the wound infections, the hernias years later. Blood loss is minimal. Hospital stay drops from most of a week to a single night. People go back to work in seven to ten days instead of a month and a half.

There is one honest caveat. In a small number of cases — dense inflammation, thick adhesions from years of attacks, an unclear anatomy, or bleeding that will not settle — the safest thing a surgeon can do is convert to an open operation. That decision is made in the interest of your bile duct, and any surgeon who is unwilling to make it when needed is the wrong surgeon.

Risks and complications

Gallbladder surgery is safe and routine, but no operation is risk-free, and you deserve the list plainly.

• Bile duct injury — the most serious complication, and the reason for the meticulous dissection described above. It is uncommon but not impossible.
• Bile leak from the cystic duct stump or the liver bed, sometimes needing an ERCP or a drain.
• Bleeding, usually from the cystic artery or liver bed.
• Retained stone in the bile duct, which may show up as jaundice or pain afterwards and is dealt with by ERCP.
• Infection, at a port site or as a collection inside the abdomen.
• Conversion to open surgery, as discussed.
• Injury to bowel, stomach or blood vessels during port insertion — rare.
• Port site hernia, mostly at the navel, and more likely in the overweight.
• Post-cholecystectomy diarrhoea or loose stools, usually mild and self-limiting.
• Ongoing upper abdominal pain in a minority, where the gallstones were not in fact the cause of the symptoms — one reason we assess carefully before recommending surgery.
• Anaesthetic risks, which the anaesthetist will go through with you separately.

Alternatives

Watchful waiting is genuinely reasonable for silent stones found incidentally, provided you know the warning signs.

Dietary modification — cutting down fried and fatty food — reduces how often attacks occur in some people. It does not remove the stones and it does not prevent a stone slipping into the duct.

Oral dissolution therapy with ursodeoxycholic acid works only for small, non-calcified cholesterol stones in a functioning gallbladder, takes many months, and has a high recurrence rate once stopped. Its role today is narrow.

ERCP alone clears stones from the bile duct but does nothing about the gallbladder, which is where the stones are being manufactured. It is a step in treatment, not a substitute for it.

Open cholecystectomy, for the situations described above.

If you are still deciding whether an operation is right for you, our article on whether gallbladder stones always need surgery works through that question in more detail, and the general surgery and gastroenterology department page explains the wider range of work our surgical team handles.

What it costs

Laparoscopic cholecystectomy at Shubham Hi-Tech Hospital: ₹44,000 – ₹72,000. This is an all-inclusive figure covering the surgeon’s fee, operation theatre, anaesthesia, room rent for a typical stay, medicines and routine investigations.

Please note: The figures above are indicative estimates for a typical case. The final cost depends on your individual condition, the complexity of the surgery, the room category you choose, how long you stay, and any complications that arise. Deluxe and super-deluxe rooms are charged higher. Emergency admissions and night or holiday surgery attract additional charges. These charges are subject to change without prior intimation. Please call us on +91-8668954915 for a written estimate for your own case before you decide anything.

Preparing for your surgery

• Bring your ultrasound report and any previous scans, along with discharge papers from earlier attacks or admissions.
• List all your medicines. Blood thinners such as aspirin, clopidogrel and warfarin need planning — never stop them on your own.
• Tell us about diabetes, heart disease, asthma, thyroid problems and any previous abdominal surgery.
• Routine blood tests, liver function tests, an ECG and a chest X-ray are usually asked for before admission.
• Nothing to eat for six hours and nothing to drink for two hours before surgery, unless we tell you otherwise.
• Remove jewellery, nail polish and contact lenses on the morning of surgery.
• Arrange for an attendant overnight and someone to take you home the next day.
• Keep about a week free from work, and three to four weeks free from heavy lifting.
• If you develop fever, severe pain or yellowing of the eyes before your surgery date, call us — do not simply wait for the appointment.

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Gallstones rarely need to be an emergency, but they do need a decision. If you have had one attack or ten, bring your reports to the surgical team at Shubham Hi-Tech Hospital, Amravati, and we will tell you honestly whether you need an operation now, later, or not at all. Call +91-8668954915, get in touch here, or see all the procedures we perform.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.