Gallbladder Surgery

What is a Laparoscopic Cholecystectomy and Operative Cholangiogram?

 

As you are aware there is a better way to remove the gallbladder these days.  It's a keyhole operation.  You come into hospital and have a quick general anaesthetic.  We make five small cuts in the abdomen and put the telescope in.  We find the gallbladder, remove it and take an x-ray of the bile duct.  If everything looks okay then if everything looks okay, then we wake you up and send you home same day.

 

Risks of Laparoscopic Cholecystectomy?

 

There are risks with the operation. Like any operation, there is the risk of the anaesthetic.  Not everyone who has an anaesthetic survives that anaesthetic. There are medical risks; heart attack, stroke, clot on lungs, and pneumonia. There are surgical risks; bleeding, infection, hernias, injury to the bowel. There are risks specific to the operation; these are the important ones.  Rarely I can't remove the gallbladder with the operating telescope, in which case I will make a cut under the rib cage and remove the gallbladder the old-fashioned way.  About 4% of the time and when we take the X-ray of the bile duct we see a stone in your bile duct.  Occasionally I can remove the stone at the time of the operation.  Usually, however, you will  need another procedure after the operation: called an ERCP.  An ERCP is where a telescope is introduced via the mouth under sedation and passed through the stomach to the first part of the small bowel.  The lower end of the bile duct is identified and the stone is hooked out from below.  About one percent of people leak bile into the abdomen from that part of liver that the gallbladder comes off.  If this happens then a few days after the operation you will become unwell with pains, fevers and vomiting.  If this happens you will need to go to the emergency department, ask them to perform a scan for you and give me a call with the result. Usually, this problem can be treated by placing a needle in the abdomen, under local anaestheitc, to drain the bile away.

 

The big risk of this operation; in one in every 300 patients, we damage bile duct.  The bile duct is the tube that bile from liver and puts it into the small bowel.  If we damage the bile duct, it is a major problem. It means more time in the hospital and further surgery.  We try very hard not to injure the bile duct, but occasionally it happens.  If I think that I am going to injure the bile duct, then I will just remove three quarters of the gallbladder and the gallstones.  That works in 98% of cases.

 

85% of people are happy after the operation because it fixes their pain.  In small group of people, taking the gallbladder out doesn't fix their pain and that usually because the pain is not coming from the gallbladder.  80% of people don't miss their gallbladder at all.  20% of people will have some heartburn or diarrhea after the operation that usually gets better after the operation but occasionally requires medications to help with. 

 

Post-operative instructions

 

You should go able to go home on the day of your surgery, once you've had something to eat.  All the sutures will be dissolving and buried under the skin, so nothing needs to be removed.  The dressings are waterproof; you can shower over them and get them wet.  If the dressings are still in place a week after the operation, then you can remove them.  if the dressings fall off before hand, then that is not a problem. You should not drive for a week after the operation.  You should avoid any heavy lifting or strenuous exercise for six weeks after the operation; this means no running, swimming, cycling or weightlifting.  It's fine for you to go for you to walk and resume all other normal activities.  Try and avoid lifting anything over 5 kg in weight.  You should avoid fatty meals for a month after the operation.

 

I would like to see you about a month after the operation. If you have any problems, then you can go to hospital, see your GP or call me via the hospital.  It is a good operation, and we rarely have problems.  The most common problem that we have after the operation is leakage of bile from the liver.  This only occurs in about 1% of people.  If this happens, then you will be unwell with pains, fevers and vomiting a couple of days after the operation.  If you have these symptoms, then you need to go to the emergency department and ask them to perform a CT scan of your albumin.  You can ask the emergency doctor to give me a call once the results of the scan are available.