Gallbladder removal - laparoscopic cholecystectomy.

What is a gallbladder?

The gallbladder is a small pear-shaped pouch in the upper right part of your abdomen. It stores bile produced by the liver. Bile is a digestive fluid that helps to break down fatty food, and it is carried from the gallbladder to the intestine through a tube called the bile duct.

Why have a gallbladder removed?

Gallstones can develop if the bile gets too concentrated. These small, hard stones can block the bile duct, resulting in attacks of abdominal pain, nausea and fever. If these symptoms persist, removal of the gallbladder is often required. The body can function well without a gallbladder. For more information on gallstones, see the separate Bupa health factsheet, Gallstones.












Illustration showing the position of the gallbladder and surrounding structures
The position of the gallbladder and surrounding structures

A gallbladder operation is usually done using "keyhole" surgery - also known as laparoscopic cholecystectomy. This means your surgeon can remove the organ without having to make a large cut on your abdomen. However, some people may need open surgery. Your surgeon will explain which method is most suitable for you.

Keyhole surgery is usually carried out as a day case, but some patients may need to stay overnight in hospital.

The operation is done under general anaesthesia. This means that you will be asleep during the procedure. For more information on anaesthesia, please see the separate Bupa health factsheet, General anaesthesia.

What are the alternatives?

If symptoms are mild, or surgery is not possible for medical reasons, there may be alternatives to having surgery to remove gallstones.

* Medicines can sometimes be used to dissolve the gallstones, but this does not work for everyone and can take up to two years or longer.
* If the gallstones are blocking the bile ducts, it may be possible to view them using an endoscope (a narrow tube that is passed down the throat) rather than open surgery. This is known as an ERCP (endoscopic retrograde cholangiopancreatography). Gallstones can sometimes be removed by enlarging the bile duct and removing the stones with special tools attached to the endoscope.
* Another type of non-surgical treatment breaks up the stones using ultrasound waves (lithotripsy). This is only suitable when a small number of stones is present and is an uncommon treatment option.

Your surgeon will explain the benefits and risks of having your gallbladder removed, and will also discuss the alternatives to the procedure.

Preparing for your operation

The hospital will send you a pre-admission questionnaire. Your answers help hospital staff to plan your care by taking into account your medical history and any previous experience of hospital treatment. You will be asked to fill in this questionnaire and return it to the hospital.

If you normally take medication (eg tablets for blood pressure), continue to take this as usual, unless your surgeon specifically tells you not to. If you are unsure about taking your medication, please contact the hospital.

Before you come into hospital, you will be asked to follow some instructions.

* Have a bath or shower at home on the day of your admission.
* Remove any make-up, nail varnish and jewellery.
* Follow the fasting instructions in your admission letter. Typically, you must not eat or drink for about six hours before general anaesthesia. However, some anaesthetists allow occasional sips of water until two hours beforehand.

Many hospitals operate a strict no smoking policy. If you are a smoker, you may wish to bring nicotine patches to use for the duration of your stay.

At the hospital, your nurse will explain how you will be cared for during your stay, and will do some simple tests such as checking your heart rate and blood pressure, and testing your urine.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins of your legs (deep vein thrombosis, DVT). For more information on stockings and DVT, please see the separate Bupa health factsheets, Compression stockings and Deep vein thrombosis.

Your surgeon and anaesthetist will usually visit you before your operation. This is a good time to ask any unanswered questions.

Consent

If you are happy to proceed with the operation, you will be asked to sign a consent form. This confirms that you have given permission for the procedure to go ahead.

About the operation

Your surgeon will make two or three small cuts (about 5-10mm long) on the skin, above, or just below, your navel.

Using a hollow needle, passed through or near your navel, carbon dioxide gas is pumped into the abdomen. This creates more room for your surgeon to work in and makes it easier to see the internal organs.

The laparoscope (a long, thin telescope with a light and camera lens at the tip) is then passed through one of the cuts. Your surgeon will examine the internal organs by looking directly through the laparoscope, or at pictures it sends to a video screen.

Specially adapted surgical instruments are passed through the other cuts to help move the internal structures so that your surgeon can see around them and to cut and remove the gall bladder. X-ray pictures may be taken to look at the bile duct during the operation, so that your surgeon can find out if any gallstones are blocking the bile duct.

Afterwards, the instruments are removed and the gas is allowed to escape through the laparoscope. The skin cuts are closed with dissolvable stitches and covered with a dressing. The operation takes 60 to 90 minutes.

After your operation

You will be taken from the operating theatre to a recovery room, where you will come round from the anaesthesia under close supervision. After this, you will be taken back to your room, where your nurse will check the wounds and record your heart rate and blood pressure at regular intervals.

You will need to rest until the effects of the anaesthesia have passed. If you are sore, you may need painkillers. Please discuss any discomfort with your nurse.

When you feel ready, you can begin to drink and eat, starting with clear fluids.

Going home

You will usually be able to go home once you have made a full recovery from the anaesthesia. However, you will need to arrange for someone to drive you home and then stay with you for the first 24 hours.

Before you go home, your nurse will give you advice about caring for the healing wounds, hygiene and bathing. For more information, please see the separate Bupa health factsheet,

Caring for surgical wounds.

You will also be given a contact telephone number for the hospital, in case you need further advice, and a date for a follow-up appointment. This is usually four to six weeks later.
After you return home

If you need them, continue taking painkillers as advised by the hospital. General anaesthesia can temporarily affect your co-ordination and reasoning skills, so you should not drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.

Normal activities, including returning to work, can usually be resumed after about a week. You must follow your surgeon's advice about driving. You shouldn't drive until you feel you could do an emergency stop without discomfort. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon's advice.

Dissolvable stitches will disappear in about seven to 10 days. Any scarring should fade with time.

About two out of 10 people (20 percent) will have diarrhoea after having their gallbladder removed. Eating plenty of high fibre foods such as brown rice, wholemeal bread and pasta can help absorb excess water and make your bowel movement more bulky.

Deciding on having a gallbladder removed

Laparoscopic cholecystectomy is commonly performed and generally safe. For most people the benefits, in terms of improved symptoms, are much greater than the disadvantages. However, all surgery carries an element of risk. In order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

These are the unwanted but mostly temporary effects of a successful treatment. An example of a side-effect is feeling sick as a result of the anaesthetic or painkillers.

You are likely to feel some pain in the abdomen as well as "referred pain" in the tips of your shoulders - caused by the gas used to inflate the abdomen. This usually disappears within 48 hours or so.

Complications

This is when problems occur during or after the operation. Most people are not affected but the main possible complications of any surgery are an unexpected reaction to the anaesthetic, excessive bleeding, infection or developing a blood clot in a vein in the leg (deep vein thrombosis, DVT). To help prevent this, most people are given compression stockings to wear during the operation. Complications may require further treatment such as returning to theatre to stop bleeding, or antibiotics to deal with an infection.

Other complications specific to keyhole gallbladder surgery are uncommon but can include accidental damage to other organs in the abdomen (such as the bile duct, bowel, bladder, liver or major blood vessels) requiring further surgery to repair the damage. In extremely rare cases, these complications can be fatal.

Your surgeon will be experienced at performing laparoscopies, but even so a few are not successfully completed and the abdomen may need to be opened. This is known as conversion to open cholecystectomy.

You may have ongoing abdominal symptoms, such as pain, bloating, wind and diarrhoea. These may require further investigation and treatment.

Ask your surgeon to explain how these risks apply to you. The exact risks will differ for every person. This is one of the reasons why we have not included statistics here.