Laparoscopic Gall Bladder Surgery
Laparoscopic Cholecystectomy: Information for patients
What does the gall bladder do?
The gall bladder is a pear shaped sac which is attached to the under surface of the liver in the right upper part of the abdomen. Bile ducts (small tubes) carry bile from the liver to the bowel where it aids in the digestion of food.
The gall bladder stores this bile in between meals, but is not essential for good health.
Why remove your gall bladder?
Your doctor may refer you for an operation to remove your gall bladder for a number of reasons. The most common are:
- Pain that is thought to be caused by gallstones or an abnormal gall bladder.
- Past episodes of inflammation of the gall bladder or pancreas.
What is a Cholecystectomy?
Cholecystectomy is a commonly performed operation to remove the gall bladder. This has, in the past, been performed through an open operation (involving a large cut on the stomach wall), that leaves a scar several inches long on the tummy.
In the last few years it has become usual practice to remove the gall bladder by "key-hole" surgery - called Gall Bladder Surgery .
Instead of one big cut, 4 small cuts are made.
The surgeon does the operation with the aid of a small camera inserted into the abdomen near the belly button and small instruments put into the abdomen through the other small cuts.
In less than one in ten operations it is necessary for safety to convert a laparoscopic into an open operation. This would mean a larger cut on the abdomen and a longer hospital stay.
ERCP - (endoscopic retrograde cholangio-pancreatogram)
This is a procedure performed though the stomach using a telescope passed by mouth. It is used to remove gallstones that have become lodged in the bile duct. These stones may be predicted before operation if you have had abnormal liver blood tests, an episode of yellow jaundice or pancreatitis before your gallbladder operation. Occasionally these stones are found unexpectedly during a cholecystectomy or soon afterward and ERCP needs to be performed.
Alternative treatments
There are two alternatives to cholecystectomy
A low fat diet can be tried in an attempt to reduce the number of episodes of pain. Even with a low fat diet, episodes of pain can still occur and there may be complications from the stones such as inflammation of the pancreas (pancreatitis).
Oral dissolution therapy is when a particular medication is taken to try and dissolve the gallstone. These tablets can cause unpleasant side effects and even if the stones dissolve they recur in 50% of people within 5 years. This treatment is only feasible for a small percentage of patients and is only advised in those who have a very high risk from surgery because of their general health.
Gall Bladder Surgery : Information for patients
What problems can arise after operation
The risk |
What happens |
What can be done about it |
Infection |
A wound may become infected causing pain, redness and possibly discharge. The rate of risk is less than 1 in 10. |
Infections are usually minor and are treated successfully with dressings and/or antibiotics |
Excessive bleeding |
Damage to a blood vessel occurs in about 1 in 300 operations. |
This problem may need a blood transfusion and you may need a second operation to stop the bleeding. |
Need for open surgery |
Keyhole surgery may not work and open surgery is needed - less than 1 in 10 |
Open surgery needs a bigger cut in the abdomen and a longer stay in hospital |
Hernia |
A small hernia may form through one of the small cuts, this is rare - occurring in less than one in fifty operations |
Hernias usually need to be repaired by further surgery. |
Stones in the bile duct |
These may be found during operation or cause symptoms such as yellow jaundice after operation. |
These stones can usually be removed by an ERCP , but may require a further operation. |
Bile leak |
Bile can leak from the bile tube or the liver and form a collection. |
The collection of bile may need to be drained through the skin and/or an ERCP may be needed |
Bile duct injury |
Damage to the main bile duct during operation - this is rare, but the most serious complication of Gall Bladder Surgery . It only occurs in one in 500 operations |
This problem can need complex surgery for repair and can be life threatening |
Surgery does not help |
Not all the symptoms are relieved by operation in about 1 in 10 people. |
There may be another problem as well as gall stones such as irritable bowel or a hiatus hernia |
On the day of operation
If your admission is at 8.00am in the morning you must not eat anything for 6 hours before. You may drink a non-milky drink up until 6.00am.
If you are coming in at 12.30pm you may have a light breakfast (tea and toast for example) at 6.30am, and a non-milky drink up until 10.30am.
It is advisable not to smoke or drink alcohol on the day before your operation.
When you arrive in hospital you will be shown to a bed and asked to change into a hospital gown. The surgeon doing your operation will visit and introduce themselves. They will ask you some questions and examine you. If you and they then agree to proceed with the operation you will be asked to sign a consent form and the operation will take place.
If you or the surgeon decides that the operation as planned should not occur, then it would need to be cancelled or postponed. This would happen very rarely and you will obviously be fully involved and informed in this discussion.
Laparoscopic Cholecystectomy: Information for patients
Care after the operation
Patients who have an uncomplicated Gall Bladder Surgery can usually go home within 48 hours of the operation.
Most of the patients who have their operation performed in the day surgery unit will go home on the same day.
When you wake up after the surgery we would expect that you would have some pain. We will give you tablets to control any pain that you have.
Discharge from hospital
Please remember to hand in your discharge letter to your General Practitioner within the next few days.
You do not need to make an appointment to see your Doctor. The letter will be of help should you have any problems after the operation.
We will give you some pain killing medication. Please use these up to the recommended dose if you have any pain.
Normal wound care after Discharge
The stitches used to close your small abdominal wounds will not require removal. You can remove the small protective dressings after about 48 hours.
You may take a shallow bath or shower as you wish, but please avoid soaking in the bath until the wounds are fully healed (usually about a week after operation), as this may delay normal healing.
If you have any concerns about your wounds because they are red, hot, swollen or painful you should seek advise.
Your recovery and return to normal activity
Over the next few days gently mobilise, rest in the afternoon and very gradually do a little more each day. Your abdomen (tummy) may feel rather distended (swollen) for a few days from the gas put in to allow the operation to be performed.
This gas will rapidly absorb and the discomfort ease. Please seek advice if the pain worsens.
Do not do any heavy lifting, gardening, sports etc for at least two to three weeks after the operation. Do not drive for about a week after the operation. When you feel ready try a short test drive on a quiet road. It is also advisable to check with your insurance company before driving, to make sure that they are happy for you to drive.
You can return to work as soon as you feel able - this is usually after about three weeks.
You will not usually be seen in outpatients after the operation, but if you have any problems or questions please feel free to telephone the surgical office and we will be happy to see you in the Surgical Clinic.
If you need further advice please ask.
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