Gallbladder removal is one of the most commonly performed surgical procedures in the United Kingdom. Gallbladder surgery is performed by Key hole or by laparoscopic surgery. In my practice 95 percent of patients the operation is completed by key hole surgery.
CAUSES GALLBLADDER PROBLEMS?
Gallbladder problems are usually caused by the presence of gallstones. There are a number of causes of gallstone formation. Majority of gallstones are asymptomatic but in some patients these stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting, indigestion and, occasionally, fever. This condition is called cholecystitis. If the gallstone blocks the common bile duct, jaundice. Small stones can cause pancrititis which can become a life threatening problem.
HOW ARE THESE PROBLEMS FOUND AND TREATED?
Gall stone disease is diagnosed by patient’s symptoms and the diagnosis is confirmed by Ultrasound examination. Other helpful diagnostic tests may include blood tests. Computed tomography (CT) Scan. In few patients MRCP or Endoscopic retrograde cholangiopancreatiography (ERCP) may be considered where gallstones can cause blockage in the bile duct.
WHAT ARE THE ADVANTAGES OF PERFORMING THE PROCEDURE LAPAROSCOPICALLY?
Rather than a five to seven inch incision, the operation requires only four small openings in the abdomen or by the latest single port technique. Patients usually have minimal post-operative pain. Patients usually experience faster recovery than open gallbladder surgery patients. Most patients go home on the same day or within one day and enjoy a quicker return to normal activities.
ARE YOU A CANDIDATE FOR LAPAROSCOPIC GALLBLADDER REMOVAL?
Although there are many advantages to laparoscopy, the procedure may not be appropriate for some patients who have had previous upper abdominal surgery or who have some pre-existing medical conditions. A thorough medical evaluation by your personal physician, in consultation with a surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal is an appropriate procedure for you.
HOW IS LAPAROSCOPIC GALLBLADDER REMOVAL PERFORMED?
- Under general anesthesia, so the patient is asleep throughout the procedure.
- Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen in the area of the belly-button.
- A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient’s internal organs on a television screen.
- Other cannulas are inserted which allow your surgeon to delicately separate the gallbladder from its attachments and then remove it through one of the openings.
- Many surgeons perform an X-ray, called a cholangiogram, to identify stones, which may be located in the bile channels, or to insure that structures have been identified.
- If the surgeon finds one or more stones in the common bile duct, (s)he may remove them with a special scope, may choose to have them removed later through a second minimally invasive procedure, or may convert to an open operation in order to remove all the stones during the operation.
- After the surgeon removes the gallbladder, the small incisions are closed with a stitch or two or with surgical tape.
WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED OR COMPLETED BY THE LAPAROSCOPIC METHOD?
In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.
The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.
WHAT SHOULD YOU EXPECT AFTER GALLBLADDER SURGERY?
- Gallbladder removal is a major abdominal operation and a certain amount of postoperative pain occurs. Nausea and vomiting are not uncommon.
- Once liquids or a diet is tolerated, patients leave the hospital the same day or day following the laparoscopic gallbladder surgery.
- Activity is dependent on how the patient feels. Walking is encouraged. Patients can remove the dressings and shower the day after the operation.
- Patients will probably be able to return to normal activities within a week’s time, including driving, walking up stairs, light lifting and working.
- In general, recovery should be progressive, once the patient is at home.
- The onset of fever, yellow skin or eyes, worsening abdominal pain, distention, persistent nausea or vomiting, or drainage from the incision are indications that a complication may have occurred. Your surgeon should be contacted in these instances.
- Most patients can return to work within 10-15 days following the laparoscopic procedure depending on the nature of your job. Patients undergoing the open procedure usually resume normal activities in four to six weeks.
- Make an appointment with your surgeon within 2 weeks following your operation.
WHAT COMPLICATIONS CAN OCCUR?
Complications of laparoscopic cholecystectomy are infrequent, but include bleeding, infection, pneumonia, blood clots, or heart problems. Unintended injury to adjacent structures such as the common bile duct or small bowel may occur and may require another surgical procedure to repair it. Bile leakage into the abdomen from the tubular channels leading from the liver to the intestine may rarely occur
WHEN TO CALL YOUR DOCTOR
Be sure to call your physician or surgeon if you develop any of the following, Persistent fever over 101 degrees F (38 C), Bleeding, Increasing abdominal pain and swelling, Persistent nausea or vomiting, Persistent shortness of breath, Purulent drainage (pus) from any incision, Redness surrounding any of your incisions and if you are unable to eat or drink liquids.