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Surgery to the Gallbladder (Cholecystectomy)

A rapid recovery from this operation is typical and patients are unlikely to experience any serious complications. Minor problems are very common after this intervention so patients should be aware of these as well about the more serious complications which occur much more rarely.

About Gall Bladder Removal

The liver manufactures bile and this is held in a small pouch behind it, an organ known as the gall bladder. When a person eats a meal the gut has to digest the fats in the food and to assist this bile is released into the digestive system. It is common for small stones of various kinds to develop in the gall bladder and many middle-aged or older people have them. However they are mostly not troublesome and never need surgery.

Sometimes the stones can lead to pain or inflammation with the gall bladder. In some patients stones may escape from the gall bladder and get into the main bile duct (the main tube connecting the liver to the gut) where they can cause an obstruction leading to jaundice (yellow pigmentation of the skin). In these cases it may be necessary to perform a cholecystectomy (surgical removal of the gall bladder).

Is Gall Bladder Surgery Harmful?

The gall bladder only acts as a storage organ and it is therefore possible to live a completely normal life without a gall bladder. There should be no adverse effects after cholecystectomy.

The way Gall Bladder Operation is Performed

Keyhole or laparoscopic surgery is by far the most commonly used surgical method for this operation although about 5 percent of operations involve the open technique with an incision several inches long. There may be several reasons why a surgeon decides that it is safer to employ the open technique and these include if there is a large degree of gall bladder inflammation, making laparoscopic removal unwise. If there is a lot of scarring between the gall bladder and the surrounding organs (adhesions) then open operation may be again preferred.

Although surgeons mostly intend to perform the gall bladder removal laparoscopically, patients need to understand that during the operation the decision may be made to convert to an open operation on clinical grounds.

Laparoscopic Cholecystectomy

The surgeon will make four small cuts so that he or she can insert the instruments they will use into the abdominal cavity. The main instrument is a laparoscope, a flexible device which has a small video camera and a bright light attached, allowing a clear view of the inside of the abdomen. This allows surgeons to view the abdominal contents on a television screen, find the gallbladder and guide the operation procedure.

 

The surgeon needs a good view of the abdomen so carbon dioxide is passed into the cavity to increase the room for manoeuvre. An incision below the umbilicus (tummy button) is used to insert the telescope and further instruments are introduced through three smaller cuts below the right ribs. The umbilical incision is used to withdraw the gallbladder and gallstones.

Open Cholecystectomy

When it is not possible to perform the operation laparoscopic ally an incision is made under the rib cage on the right which is usually 10-15cm (4-6 inches) long. The skin and the muscles are cut and divided to enter the abdomen. The gall bladder can then be identified and removed from underneath the liver. A drain may be inserted to ensure that no fluid collects inside the abdomen.

What about the Anaesthetic?

The anaesthetic is usually administered by injecting it into one of the arm or hand veins. Laparoscopic cholecystectomy typically takes about an hour and a long-acting painkiller is placed in the wound sites to reduce the pain experienced by the patient when they come round.


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