Gallbladder surgery, also known as cholecystectomy, is a common surgical procedure performed to remove the gallbladder.


The gallbladder is a small organ located beneath the liver that stores bile produced by the liver.


Cholecystectomy is typically recommended for individuals with symptomatic gallstones, gallbladder inflammation (cholecystitis), or other gallbladder-related conditions that do not respond to non-surgical treatments.


Types of Gallbladder Surgery

Laparoscopic Cholecystectomy

This minimally invasive approach involves making several small incisions in the abdomen, through which a laparoscope and specialized surgical instruments are inserted to remove the gallbladder. Laparoscopic cholecystectomy generally results in less post-operative pain and a faster recovery compared to open surgery.

Robotic Cholecystectomy

This minimally invasive approach involves making small incisions and inserting a camera and instruments. These are then attached to a robot which the surgeon controls to perform surgery. The technology of the robot confers several advantages which can be especially helpful in difficult cholecystectomy cases.

Open Cholecystectomy

In certain cases, such as when laparoscopic surgery is not feasible or safe, an open cholecystectomy may be performed. This involves making a larger incision in the abdomen to directly access and remove the gallbladder.

The difficult cholecystectomy


A difficult cholecystectomy refers to the surgical removal of the gallbladder under challenging conditions, often due to anatomical variations, inflammation, scarring, or other complications.

Many of the determinants of a difficult cholecystectomy can be predicted before surgery and it is important that such operations be performed by a specialist HPB surgeon to ensure the best possible outcome.


Determinants of difficult cholecystectomy

  1. Anatomical variations: Anatomical anomalies or variations in the biliary tract can make the identification and dissection of structures more challenging during the surgery.
  2. Inflammation and scarring: In cases of severe inflammation or scarring, the gallbladder may adhere to surrounding tissues, making dissection and removal more difficult and increasing the risk of injury to nearby structures.
  3. Obesity: Increased adipose tissue in obese patients can obscure the surgical field and make access to the gallbladder more challenging.
  4. Previous abdominal surgery: Adhesions from prior abdominal surgery can complicate the dissection process and increase the risk of injury to nearby organs and structures.

Surgical Techniques and Considerations


Surgeons may employ various advanced techniques during a difficult cholecystectomy, including:

  • Careful dissection and identification of structures to minimize the risk of injury to the bile ducts, blood vessels, and surrounding organs.
  • Intraoperative cholangiography to visualize the biliary anatomy and ensure the absence of common bile duct stones or other complications.
  • Performing a robotic cholecystectomy for enhanced visualisation and precision
  • Performing a fenestrating cholecystectomy to avoid scarring
  • Conversion to an open cholecystectomy if the laparoscopic approach becomes technically challenging or risky.


Risks and Complications 


Whilst gallbladder surgery is considered safe, some risks and potential complications may include infection, bleeding and injury to other parts of the biliary system or nearby organs. A small proportion of patients may experience fat-intolerance and digestive disturbances after surgery.


Recovery after cholecystectomy 


Following gallbladder surgery, patients are typically monitored in the hospital for a brief period to ensure there are no immediate complications. Many patients go home the same day with some staying overnight. Pain management, intravenous fluids, and antibiotics may be administered as needed.

Patients are encouraged to resume light activities soon after surgery and gradually return to their regular routine over the following weeks. Most people report feeling back to normal within about a week. The only restriction after surgery is to avoid heavy lifting for 2-4 weeks to decrease the chance of a port site hernia. Many patients start with a light diet and build up to their normal diet over a few days to allow the digestive system to adjust to the absence of the gallbladder.

Recovery from a difficult cholecystectomy may be more prolonged compared to a routine procedure and patients may experience a longer hospital stay. Some patients may go home with a drain to prevent late infection.


Follow-Up Care 


Regular follow-up visits with a healthcare provider are essential after gallbladder surgery. These visits are important for monitoring the recovery process, ensuring the incision site is healing properly, and addressing any post-operative concerns. 

Go to Top