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Cholecystitis, acute - Treating acute cholecystitis

NHS Choices Medical Reference

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If your GP suspects you have acute cholecystitis, you will probably be admitted to hospital for treatment.

Antibiotics

You will first be given an injection of antibiotics into a vein. Broad-spectrum antibiotics are used, which can kill a wide range of different bacteria. 

Once your symptoms have stabilised, you may be sent home and given an appointment to return for surgical treatment (see below).

Alternatively, if your symptoms are particularly severe or you have a high risk of complications, you may be referred for surgery a few days after antibiotic treatment.

A cholecystectomy is the most widely used type of surgery for cases of acute cholecystitis.

Surgery

A cholecystectomy is the surgical removal of the gallbladder. There are two types of cholecystectomy:

  • laparoscopic cholecystectomy
  • open cholecystectomy

These are described below.

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is a type of 'keyhole' surgery. It is the most widely used type of cholecystectomy. A laparoscopic cholecystectomy is carried out under a general anaesthetic, which means you will be asleep during the operation and will not feel any pain.

During a laparoscopic cholecystectomy, the surgeon makes four small cuts, each about 1cm or smaller, in your abdomen (tummy) wall. One incision is made near your belly button and the other three made across your upper abdomen.

Your abdomen is inflated with carbon dioxide gas passed through the cuts. Inflating your abdomen gives the surgeon a better view of your organs and more room in which to work.

The surgeon passes an instrument called a laparoscope through one of the incisions. A laparoscope is a small, rigid tube that has a light source and a camera at one end. The camera transmits images of the inside of your abdomen to a television monitor.

The surgeon then passes small instruments down the other incisions to remove your gallbladder and any gallstones. After your gallbladder has been removed, the incisions are closed.

As this technique only involves making small cuts in your abdomen, you will not experience much pain afterwards. You should also recover quickly from the effects of the operation. Most people are able to return home either on the day of the surgery or the day after.

Read about laparoscopic cholecystectomy for more information about the procedure.

Open cholecystectomy

A laparoscopic cholecystectomy is not recommended if you:

  • are in the third trimester (the last three months) of pregnancy
  • for some people with cirrhosis (scarring of the liver)

In these circumstances, an open cholecystectomy may be recommended.

An open cholecystectomy may also be carried out if a planned laparoscopic cholecystectomy is not successful.

As with a laparoscopic cholecystectomy, an open cholecystectomy will be carried out under general anaesthetic so you will not feel any pain during the procedure. The surgeon will make a large cut in your abdomen to remove your gallbladder.

An open cholecystectomy is an effective method of treating acute cholecystitis, but has a longer recovery time than laparoscopic cholecystectomy. Most people take about six weeks to recover from an open cholecystectomy.

Percutaneous cholecystostomy

If your symptoms are severe or you are in poor health, your care team may decide immediate surgery is too dangerous.

In such circumstances, a temporary measure known as a percutaneous cholecystostomy may be carried out. A percutaneous cholecystostomy may be performed under a local anaesthetic, which numbs your abdomen. This means you will be awake during the procedure.

The surgeon will use an ultrasound scan to guide a needle to the site of your gallbladder. The needle is then used to drain bile out of the gallbladder, which should help relieve inflammation (swelling). Once your symptoms improve, your gallbladder can be surgically removed.

Living without a gallbladder

You can lead a perfectly normal life without a gallbladder. The organ can be useful but it's not essential. Your liver will still produce bile to digest food.

However, some people who have had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating fatty or spicy food. If certain foods do trigger symptoms, you may wish to avoid them in the future.

Read more about making changes to your diet after gallbladder surgery.

Medical Review: July 28, 2012
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