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Common questions

Cholecystectomy (Removal of the gall bladder)

This fact sheet is to help MBF members and their families be better prepared for the healthcare experience if they are having surgery to remove their gall bladder, a procedure known as cholecystectomy.

Not all of the information here will be applicable to everyone, so it is important to discuss your individual circumstances with your doctor and perhaps with other healthcare professionals in the team caring for you. Please, never hesitate to ask 'why' or to have something explained to you until you understand it. If, after you have been given an answer, you still feel as though there are unanswered questions, ask again or ask someone else. You can help the healthcare team to help you if you feel free to communicate your needs to them. Further research and reading (see 'Useful resources-where to find out more') will also help you make more informed decisions about your treatment.

 What is a cholecystectomy?

Cholecystectomy is the surgical removal of the gall bladder. The gall bladder is a muscular sack that stores a substance produced in the liver called bile. Bile assists in digestion. When the gall bladder is blocked or inflamed it swells and can be very painful and sometimes it is necessary to remove the gall bladder. This surgery will involve either laparoscopic (small incision) surgery or open (large incision) surgery.

During laparoscopic surgery, the surgeon makes four small incisions in the abdomen, usually less than 2.5cm each in length. The abdomen is then gently inflated with carbon dioxide, lifting the abdominal wall to enable clear viewing and freer movement for the surgeon, and then an instrument called a laparoscope is inserted. A laparoscope is a tube containing optical fibres attached to a video camera that enables the surgeon to see inside the abdomen and to remove the gall bladder with several thin instruments.

During an open cholecystectomy, the gall bladder is removed through a larger (around 10cm) incision just under the right side of the ribs. The surgeon can see the gall bladder directly. Open surgery generally requires a longer hospital stay and recovery time than the laparoscopic alternative but many surgeons prefer to be able to operate directly.

The type of surgery you have will depend on the nature and severity of your condition, what prior surgery you may have had, your general health, and the experiences of your surgeon with both procedures.

Cholecystectomy is highly effective at relieving troubling gall bladder symptoms. The risk of death is considered to be relatively low among major surgical procedures. However as with any surgical procedure, there are both general and specific risks. General risks apply to most surgery types, particularly where general anaesthesia is involved. Risks which are specific to gall bladder removal include excessive bleeding, leakage of the bile into the abdomen causing severe inflammation, loss or blockage of gallstones, damage to the bile duct or blood vessels, gas embolus (when a gas bubble from the carbon dioxide accidentally makes its way into the bloodstream), very occasionally injury to other organs in the abdomen, and more commonly wound infection and problems with wound healing. In a minority of cases, a laparoscopic procedure will be completed via open surgery due to complications that arise.

See 'Questions to ask your doctors' for more about this.

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 Why is it performed?

Generally, your doctor will recommend a cholecystectomy to treat:

  • gallstones that are causing symptoms such as pain, nausea and vomiting (the most common reason for cholecystectomy);
  • infection or inflammation of the gall bladder, medically known as cholecystitis;
  • gall bladder cancer (which is rare); or
  • abnormal gall bladder function, medically known as biliary dyskinesia.

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 Questions to ask your doctors

A cholecystectomy is a specialised procedure that is best performed by a surgeon who is highly experienced in cholecystectomy. A doctor who has performed many of these procedures with a very low complication rate is the best person for the job. If you are being advised to have the procedure by laparoscope, then ask whether the surgeon has specifically trained in doing the procedure and how many they have done by this method. The two approaches are very different.

Your GP will generally suggest the names of one or more surgeons, or you may be referred first to a gastroenterologist (a doctor that specialises in the stomach, intestines, and related organs of the body).

Some questions to ask your GP or referring doctor:

  • Why am I being referred for a cholecystectomy? What other options are there? There are a number of other options available to treat gallstones. Some of these may carry high complication rates and may not be as effective as removing the gall bladder altogether. Others generally rely on medications and some time to allow for symptoms to go away.
  • What surgeon(s) do you recommend?
  • Why have you recommended this particular doctor to perform the cholecystectomy? Do you know whether they have a preference for an open or a laparoscopic approach?
  • Do you know if this doctor has done many cholecystectomies?
  • Do you know if he or she charges a 'gap' that Medicare or my health fund won't cover? Or is there someone just as suitable that is more likely not to charge a 'gap' over the medical fee? Even so, we recommend you choose your doctor first based on their experience and expertise.

Some questions to ask the gastroenterologist or surgeon:

  • Will you explain, in simple terms, how a cholecystectomy is performed?
  • Which type of surgery do you recommend for me -- open or a laparoscopic? Why do you think this will be better for me?
  • What are the benefits and risks or different complications of each approach?
  • What are the possible complications and/or side effects associated with my surgery?
  • Is there anything I should or could do to reduce the risk for complications?
  • What percentage of your patients experience complications during or after this procedure?
  • How should I prepare for the procedure? Do you have any written material I can take home with me as a guide?
  • How long does it typically take to recover in hospital? Do I need someone to drive me home? How long before I can get back to my normal activities?
  • Will I have to follow a special dietary regime after surgery? If so, what will it be?
  • Will I be on any medications after my surgery? Can I continue to take my other medications?
  • Once I am discharged, when will I next see you? Typically this will be 7 to 10 days after discharge from the hospital.
  • Will I need any further treatment after leaving the hospital?
  • Who do I call afterwards if I experience any problems or complications?
  • How long after the procedure will it take to feel back to normal?
  • Do you charge a gap that Medicare or my health fund won't cover? Again, choose your doctor first based on their experience and expertise.
  • Does the anaesthetist or any other doctor who may assist with the procedure charge a gap? If so, how much should I expect that to be?

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 How to prepare and what to expect

Your doctor should provide you with instructions about the appropriate preparation for surgery. Be sure to follow them carefully. It is also advisable to limit alcohol and stop smoking for as long as possible prior to any surgery.

You will usually be admitted to hospital either the night before or on the morning of surgery.

Both types of cholecystectomy occur under general anaesthetia. On average, laparoscopic surgery takes up to a couple of hours to perform and open surgery lasts a little less.

Afterwards, you may feel some abdominal pain and pain in the shoulder. You may also experience nausea and vomiting from the general anaesthetia. You may be offered pain killing drugs and anti-nausea medication if required.

It is likely that the hospital staff will encourage you to get up and walk around as soon as you feel able. Your hospital stay may vary from overnight for laparoscopic surgery, up to a week or so for open surgery.

Make sure you ask for written instructions as to what you should be doing when you are discharged. These should tell you when you should see your doctor again, what medications to take or avoid, who to call if you are experiencing difficulties and alert you to signs and symptoms of complications.

Signs of complication or infection may include excessive bloody discharge from the wounds, high temperature, extreme pain even after taking painkillers, swelling in the abdomen, redness, heat or swelling of the wounds, jaundice (yellowing) of the eyes and skin. If any of these occur, call the hospital or your doctor immediately.

Depending on your general health, the type of procedure performed and how you feel, some of your daily activities may be restricted for one to two weeks, including driving and lifting.

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 What MBF pays toward the procedure

Understanding how the healthcare system works can be confusing. This brief summary outlines what you can expect in terms of your health cover, hospital and medical costs. Always check with MBF before you go to hospital.

 Your hospital costs

MBF hospital cover helps pay for a cholecystectomy provided that:

  • It is provided to you while you have been formally admitted to a hospital;
  • It is a procedure for which Medicare pays a benefit;
  • It is not an Excluded Service on your level of cover; and
  • you have met all the standard conditions of your membership (like serving the relevant waiting periods).

Selected MBF hospital cover will pay for the following treatments and services so long as you are formally admitted to the hospital:

  • shared accommodation (or private room if available);
  • surgery- related expenses including operating theatre and intensive care if needed;
  • certain therapies such as physiotherapy when provided by the hospital and associated with your hospital treatment; and
  • certain drugs supplied as part of your inpatient hospital treatment.

Remember, if you are not in an MBF Network Hospital and/or public hospital, you may incur substantial out-of-pocket expenses for your hospital charges.

Please note that doctors' charges will be part of your medical costs.

 Your medical (doctors') costs

Ask your surgeon to explain the costs of your surgery including their own fees, any fees that other doctors involved in the surgery might charge and any other expenses involved. If there are any gaps for you to pay, ask for a written cost estimate. This is known as informed financial consent. Obtaining this information is extremely important before any planned hospital admission.

Remember, there may be more than one doctor involved in the procedure. These may include the surgeon, an anaesthetist and a pathologist. You may not meet them all in person.

Key things for you to know about medical costs and your health cover are:

  • MBF will pay benefits toward your doctors' charges for the service you receive:
    • when formally admitted as an in-patient in hospital or day surgery, and
    • when the service relates to treatment included under your level of cover, and
    • when you are entitled to a Medicare benefit for the treatment.
  • The Medicare Benefits Schedule Fee ('MBS') is the amount determined by the Commonwealth Government for the purpose of paying Medicare Benefits. For eligible in-patient services, Medicare pays for 75% of the MBS; MBF pays the remaining 25%.
  • Many doctors charge above the MBS, creating a 'gap' - an amount the patient has to pay.
  • MBF does not pay any amount charged by your doctor above the MBS unless there is an agreement in place between your doctor and MBF. This agreement is known as the MBF Medical Gap Cover Scheme.
  • MBF has created the MBF Medical Gap Cover Scheme to help reduce gaps paid by members. Doctors who participate in this scheme have agreed to accept the MBF benefit as full payment for your treatment. If a doctor has agreed to treat you under the MBF Medical Gap Cover Scheme there will be no 'gap' to pay for that doctor's charge.
  • It may be that not all doctors involved in your hospital treatment are 'no gap' doctors. So you may have to pay a gap for some doctors' services, but not others.

Remember, doctors are independent of MBF and can decide whether or not to treat you under the MBF Medical Gap Cover Scheme.

Click here for a list of 'no gap' doctors or call MBF.

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 More about cholecystectomy and related conditions

 More about going to hospital, MBF Network hospitals, no-gap doctors, and MBF MemberCare providers

As well as calling MBF, you can find plenty of useful information about your health cover and what to expect when you go to hospital right here on this website.

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Last updated: 06-06-07

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