Introduction

Gallbladder surgery, also known as cholecystectomy, is a common procedure used to remove the gallbladder when it becomes inflamed, infected, or blocked by gallstones. The most commonly performed type today is laparoscopic cholecystectomy, which is minimally invasive and offers a quicker recovery time than traditional open surgery. Below is a detailed, step-by-step explanation of the procedure in gallbladder surgery.

Procedure in Gallbladder Surgery

Preoperative Evaluation :- Before undergoing laparoscopic cholecystectomy, patients must undergo a complete clinical evaluation. This includes a thorough physical examination to check for signs of gallbladder inflammation or tenderness, as well as blood tests to assess liver function and detect infection. Imaging tests such as ultrasound or CT scans are done to confirm the presence of gallstones, gallbladder inflammation, or bile duct obstruction. This comprehensive assessment ensures that surgery is both necessary and safe for the patient.
Anesthesia Administration :- The procedure is performed under general anesthesia, meaning the patient is entirely unconscious and does not feel pain during surgery. An anesthesiologist is present throughout the procedure to administer medications and monitor vital parameters such as heart rate, oxygen levels, and blood pressure. This ensures the patient’s comfort and safety during the operation.
Patient Positioning :- The patient is positioned flat on the back (supine position) on the operating table. The abdominal area is cleaned with an antiseptic solution to prevent infection. Sterile drapes are placed around the surgical field to maintain a hygienic environment and reduce the risk of contamination during the procedure.
Creating Entry Ports (Laparoscopic Access) :- The surgeon makes 3 to 4 small incisions (usually less than 1 cm each) in the abdomen. Through each incision, a device called a trocar is inserted to serve as an access point for laparoscopic instruments. These small entry ports are key to performing the surgery with minimal trauma to the body.
Insufflation of the Abdomen :- To create a clear working space, carbon dioxide (CO₂) gas is pumped into the abdominal cavity. This process inflates the area, allowing the surgeon to view and maneuver around the internal organs easily. The gas lifts the abdominal wall away from the organs, improving visibility and precision.
Inserting the Laparoscope :- A laparoscope a thin tube with a high-resolution camera and light source is inserted through one of the trocars. The camera projects a real-time video of the internal structures onto a monitor in the operating room. This visual guidance allows the surgeon to navigate with high accuracy.
Identifying the Gallbladder :- The surgeon carefully locates the gallbladder, which may appear inflamed, distended, or filled with stones. Its appearance and condition are examined to ensure it is safe for removal. This step is critical in planning the dissection and removal process without causing damage to surrounding structures.
Dissecting the Cystic Artery and Duct :- Specialized laparoscopic instruments are used to separate and clip the cystic artery and cystic duct. These two structures supply blood to the gallbladder and transport bile from it, respectively. Once clipped, they are carefully divided to allow safe removal of the gallbladder.
Detaching the Gallbladder :- Using tools such as electrocautery, the gallbladder is gently separated from its attachment to the liver bed. This step requires delicate handling to prevent injury to vital structures like the common bile duct or the liver. Any bleeding is cauterized immediately.
Removing the Gallbladder :- The gallbladder is extracted through one of the incisions, typically the one near the navel (umbilicus). If the organ is too large or contains many stones, it may be broken into smaller pieces and removed using a retrieval bag. The goal is to extract it without contaminating the abdominal cavity.
Inspecting for Bile Leakage or Bleeding :- After gallbladder removal, the surgeon inspects the area for signs of bile leakage or bleeding. Any abnormalities are managed promptly. This is a crucial step to avoid complications like infection, abscess, or bile duct injury.
Flushing and Cleaning the Area :- The surgical site is flushed with sterile saline to remove any leftover blood, bile, or tissue fragments. This reduces the risk of infection, irritation, or inflammation post-surgery. The fluid is then suctioned out completely before closing.
Removing Instruments and Closing Incisions :- All laparoscopic tools and the camera are carefully withdrawn. The carbon dioxide gas is released from the abdomen to deflate it. The small incisions are then closed with stitches, surgical glue, or sterile strips. Finally, bandages are applied to protect the wound sites.
Transferring to Recovery Room :- Once the surgery is complete, the patient is transferred to the post-anesthesia care unit (PACU). Here, the patient is closely monitored for heart rate, oxygen levels, and blood pressure as they gradually awaken from anesthesia. Some nausea, drowsiness, or shoulder pain from the CO₂ gas is common
Postoperative Observation :- Patients are generally observed for 2 to 6 hours post-surgery. If there are no complications, they can often return home the same day. However, in cases of open surgery, conversion during laparoscopic surgery, or any complications, an overnight or extended hospital stay may be necessary.

What Happens After Gallbladder Removal?

Without the gallbladder, bile flows directly from the liver into the small intestine. While the body adjusts over a few weeks, some people may temporarily experience bloating, diarrhea, or indigestion, especially after fatty meals. These issues usually resolve with time and dietary adjustments.

When Is Open Gallbladder Surgery Needed?

In some complex cases, laparoscopic surgery might not be suitable due to scar tissue, severe inflammation, or anatomical variations. The surgeon may opt for an open cholecystectomy, which involves a larger incision and a longer recovery period.

Conclusion

Gallbladder surgery is a safe and effective solution for individuals suffering from gallstones and gallbladder inflammation. Thanks to modern laparoscopic techniques, the procedure has become faster, less invasive, and associated with minimal downtime. Understanding each step of the process helps patients feel more informed and confident before undergoing surgery.