This topic is about a person with a permanent ileostomy who is preparing for an open gallbladder removal surgery. Due to previous surgeries, they have extensive adhesions, making laparoscopic surgery not an option. They are seeking advice and experiences from others who have undergone similar procedures. Here are some insights and advice shared by others:

1. Surgical Approach
- Open surgery is often safer for those with multiple adhesions, as it allows the surgeon to see and manage the adhesions directly.
- It's important to ensure the surgeon has experience with complex open gallbladder removals, especially in patients with extensive scar tissue and ostomies.

2. Adhesions and Intra-operative Risks
- Adhesions can cause organs to stick together, making surgery more challenging. Open surgery allows for careful management of these adhesions.
- This approach reduces the risk of accidental injuries during the procedure.

3. Post-operative Complications to Watch
- Be aware of the risk of acute pancreatitis and fluid-electrolyte imbalances, such as low potassium or magnesium, after surgery.
- There is a risk of blood clots, like deep-vein thrombosis and pulmonary embolism, which can occur up to a year after surgery. Discuss clot surveillance and anticoagulation plans with your doctor.
- Large volumes of "Lactated Ringers" may be used; understand why and monitor for any signs of over-hydration.

4. In-hospital and Home Monitoring
- Familiarize yourself with normal vital signs and lab results, and question anything that seems off.
- Having a knowledgeable advocate with you in the hospital can help ensure your needs and concerns are addressed.

5. Second Opinions
- Since surgical recommendations can vary, consider getting at least one additional opinion before deciding on the surgical approach.

6. General Recovery Tips for Ileostomates
- Start hydration protocols early to manage high ostomy output after anesthesia.
- Gradually reintroduce low-fat, easily digestible foods and monitor changes in output.
- Keep emergency supplies, like antidiarrheals and stoma accessories, handy in case of increased output after surgery.