Gallbladder removal surgery, known as cholecystectomy, is one of the oldest and commonest operations performed. There are two basic methods of gallbladder removal surgery, namely laparoscopic (keyhole) cholecystectomy and open cholecystectomy.
Laparoscopic cholecystectomy is now the gold standard treatment for gallstones and has significant advantages over open surgery, including:
Reduced hospital stay
Reduced post operative pain
Improved recovery time
Decreased post operative complications
Better cosmetic result
Reduced post operative pain means that patients are able to mobilise sooner. Poor mobilisation after surgery is a significant contributor to complications such as lung infections, deep vein thrombosis and wound infections.
Our surgeon routinely performs laparoscopic cholecystectomy.
Cholecystectomy requires admission to hospital, usually on the day of surgery, and full general anaesthetic.
The procedure itself involves four small (approximately 5 mm) incisions, one just below the belly button and three underneath the right lower ribcage.
Carbon dioxide is then used to inflate the normally collapsed abdominal cavity to allow proper visualisation of the gallbladder. A specialised telescope attached to a camera is then inserted to allow the surgeon to view the operation on a monitor. Laparoscopic instruments which are specifically designed for gallbladder surgery are used to perform the operation.
The operation requires the careful removal of the gallbladder, as well as the stones it holds, away from the liver. Additionally, a specialised x-ray test is performed during the operation to ensure that no stones have previously escaped from the gallbladder and become trapped in the bile ducts. This is all performed at the time of the operation.
The gallbladder is then removed via one of the small incisions created, the abdominal cavity is irrigated with saline. Occasionally a small tube is temporarily left to drain the area where the gallbladder was removed. The tubing again is brought out via one of the small incisions previously created and attached to a drainage bottle.
The incisions are closed with dissolvable sutures beneath the surface of the skin and dressings applied.
Despite gallbladder surgery being very safe, there are complications with all procedures that are important to be aware of. It is important to recognise that these complications are uncommon. The main complications with laparoscopic cholecystectomy include,
Injury Due to Trocar placement. To allow the smooth insertion and removal of laparoscopic instruments in and out of the abdominal cavity , short, hollow ports are used. Insertion of these ports is done under vision, but rarely, injury to blood vessels or underlying bowel may occur which require repair.
Bile Duct Injury. Bile may leak from a number of areas following cholecystectomy and the treatment of a bile leak depends on the source. In some instances, bile draining via the drain inserted during the operation is sufficient treatment, but in others further procedures or even re-operation is required.
Bleeding/Infection. Significant bleeding during or following the operation is rare. Post-operative infection within the abdomen or wound infection are also rare complications. These complications are reduced by the administration of a single dose of antibiotic at the time of operation.
General risks of any procedure. DVT, atelectasis, death is a rare (1:3000) but a possible event usually associated with pulmonary or air embolus
Conversion to Open Cholecystectomy. In less than 5% of all cases, cholecystectomy is unable to be performed laparoscopically. In these cases, open cholecystectomy is performed. The most common reason for conversion is due to scar tissue present in patients who have had previous operations. WMSA’s surgeons conversion rate to open cholecystectomy is less than 1%.
Open cholecystectomy involves a larger incision, usually approximately 10cm horizontally under the right rib cage. The gallbladder is removed along with gallstones as in laparoscopic cholecystectomy.
The major difference between open and laparoscopic cholecystectomy is increased length of the incision and longer recovery time.
Following laparoscopic cholecystectomy, most patients are drinking and eating the same evening. Shoulder tip pain is common following laparoscopic surgery, but is not serious. This is usually due to residual air within the abdominal cavity, which irritates the diaphragm. This usually resolves in a few days.
Mobilisation is encouraged early with the aid of pain relief tablets. The drain, if placed, is usually removed the following day. Once patients are mobilising independently, pain control is achieved with oral medications and they are tolerating a normal diet, discharge is achieved. Most people are able to go home the day after surgery.
A post operative appointment with our nurse will be made within 4 weeks.
