Gallbladder surgery: what to expect before, during, and after

Gallbladder surgery — laparoscopic cholecystectomy — is one of the commonest operations performed in South Africa. It is well tolerated, done through four small keyhole incisions, and most patients are home the next morning. This guide covers what actually happens before, during and after, and answers the questions patients most often ask in the days leading up to theatre.

Why the gallbladder is removed

The gallbladder is a small pear-shaped reservoir on the underside of the liver. It stores and concentrates bile, but it is not essential — the liver drains bile directly into the bowel once the gallbladder is gone. The commonest reason for removal is gallstones: hard deposits that form inside the gallbladder and cause pain, inflammation (cholecystitis), blockage of the bile duct, or pancreatitis.

Typical symptoms are a right-upper or upper-central pain that comes on after fatty meals, often radiates through to the back or right shoulder blade, lasts an hour or two, and is severe enough to make you sit still. Nausea and bloating are common. Once symptoms have started, they tend to recur, and each attack carries a small risk of a serious complication — which is why the standard advice is to remove the gallbladder rather than wait.

Before the operation

At the consultation you will be examined, results of your ultrasound and blood tests reviewed, and any additional imaging (MRCP, HIDA) ordered if needed. The practice provides a written quotation with all procedure and ICD-10 codes for you to submit to your medical aid to secure pre-authorisation before booking. We gladly assist with any quotation queries.

Prepare for theatre:

• Nothing to eat for six hours before your admission time; clear fluids up to two hours before.
• Take routine medications with a small sip of water unless the anaesthetist specifically asked you to stop them.
• Blood thinners (aspirin, clopidogrel, warfarin, DOACs) usually need to be paused — Dr Marais will confirm the exact schedule.
• Bring a comfortable loose-waisted outfit for going home.
• Arrange a lift home. You cannot drive after a general anaesthetic.

What happens in theatre

A laparoscopic cholecystectomy takes 45 to 60 minutes of operating time. Under general anaesthetic, four small incisions are made — one at the belly button and three across the upper abdomen. The abdomen is gently inflated with carbon dioxide, a camera and instruments are passed through the ports, and the gallbladder is separated from the liver, the cystic duct and artery are clipped and divided, and the gallbladder is removed through the umbilical port.

In a small percentage of cases — usually because of severe inflammation or unusual anatomy — the operation needs to be completed through a small conventional incision. This is not a complication; it is a safety decision and the outcome is still excellent.

Immediately after

You wake up in recovery, are moved to the ward, and are usually eating light food within four to six hours. The shoulder-tip discomfort many patients notice is referred pain from residual carbon dioxide under the diaphragm — it settles over 24 to 48 hours and is helped by gentle walking. Most patients are discharged the following morning; some straightforward cases go home the same evening.

The first week at home

• Pain — mild to moderate for three to five days, well controlled with paracetamol and an anti-inflammatory. Strong opioids are rarely needed after day two.
• Sleep — most patients are more comfortable propped up on two or three pillows for the first week, sleeping on their back or the left side. Keeps pressure off the small incisions on the upper right abdomen.
• Bloating — some abdominal bloating for one to two weeks is normal, a combination of residual carbon dioxide and mildly slowed gut motility. It settles.
• Wound care — waterproof dressings stay on for 48 hours; short showers after that. No baths, swimming pools or hot tubs for two weeks.
• Diet — start with plain, low-fat food for the first three to four days, then reintroduce foods as tolerated. There is no permanent gallbladder diet; most patients eat completely normally within a fortnight.

When you can drive, work, exercise

• Driving — usually five to seven days, once you can perform an emergency stop without hesitation and are off strong painkillers. Check your car insurance requirements.
• Desk work — one to two weeks.
• Manual work or heavy lifting — four to six weeks. Straining the abdominal wall too early risks an incisional hernia at the umbilical port.
• Gym / running — light walking from day one; graded return to full exercise at four weeks.

Warning signs — call the practice

Contact the rooms (or after hours, the hospital) if you develop any of the following:

• Fever above 38 °C.
• Progressive abdominal distension, severe pain, or pain not settling with prescribed analgesia.
• Persistent vomiting or inability to keep fluids down.
• Yellow tinge to the skin or eyes, or dark tea-coloured urine (possible retained stone in the bile duct).
• A wound that becomes hot, red, or leaks anything other than a small amount of clear fluid.

Life without a gallbladder

The liver adapts within weeks. Most patients eat and drink normally, including fatty food, with no lasting restrictions. A minority notice looser or more frequent stools in the first few months as bile drainage rebalances; this usually settles, and simple measures (smaller meals, less fried food, occasional bile-acid binder if needed) manage it. There is no long-term increase in risk of any illness after gallbladder removal — patients who have had symptomatic gallstones do far better once the gallbladder is out.

To discuss gallbladder removal with Dr Marais, please send an enquiry or read the gallbladder surgery service page.