The gallbladder is a pouch-like structure located on the underside of the right lobe of the liver. This condition involves the surgical removal of the gallbladder, referred to as cholecystectomy.

The surgery is the treatment procedure associated with cholecystitis or cholelithiasis or both. The procedure is used when conditions are unresponsive to diet therapy, drugs, or treatments.

The signs and symptoms indicating the need for the removal of the gallbladder are noted in Diagnostic Code: 7314 Cholecystitis, chronic; Diagnostic Code: 7315 Cholelithiasis, chronic; and Diagnostic Code: 7316 Cholangitis, chronic. Postoperative signs and symptoms of gallbladder removal will vary according to the procedure performed. If an abdominal approach is used, there will be a scar on the upper right abdomen, and a possible healed or healing puncture site from a drainage tube. Some patients continue to have symptoms of fatty food intolerance, right upper quadrant pain, and gas following surgical removal of the gallbladder. The persistence of these symptoms may require investigation. A laparoscopic approach to gallbladder removal results in two very small abdominal incisions for the scope and instrumentation. After recovery, in either approach, later complaints (post-cholecystectomy syndrome) of postoperative complications might include: pain; fever; distention; jaundice; clay-colored stools; generalized itching; dark urine; or wound drainage. These symptoms will require medical attention.

Diagnostic measures that were performed prior to surgery are noted in Diagnostic Code: 7314 Cholecystitis, chronic, and Diagnostic Code: 7315 Cholelithiasis, chronic. Complaints related to possible complications listed above (post-cholecystectomy syndrome) may require laboratory examinations including: liver function tests; amylase levels; serum bilirubin; serum alkaline phosphatase; prothrombin time; abdominal ultrasonography; endoscopic retrograde cholangiopancreatography (ERCP); and computed tomography (CT) scan.

Gallbladder removal is a treatment (see Diagnostic Code: 7314 Cholecystitis, chronic). The complete recovery time is usually 4 to 6 weeks for abdominal surgery, and 2 to 3 weeks for a laparoscopic removal. Following a successful recovery period, patients may resume usual activities related to diet, exercise, lifting, work, and motor vehicle operation.

Following normal recovery time from gallbladder removal, if complaints and symptoms arise or persist, then there is a possibility of a common duct stricture or common duct stone (choledocholithiasis). The symptoms listed for post-cholecystectomy syndrome will be present. Endoscopic retrograde cholangiopancreatography (ERCP) is useful in demonstrating biliary problems. An endoscopic procedure (rather than open surgery) may be used to remove the stone or relieve the stricture.

• None.

• See Hemic and Lymphatic Systems.

• Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. [38 CR 4.114]

• There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Diseases of the Digestive System,” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 CFR 4.14.  [38 CFR 4.113]