Gall Bladder Surgery
A cholecystectomy is an operation that involves removing the gall bladder.
Chole = bile cyst = bag ectomy = removing
Cholecystectomy = removing the bile-bag (ie the gall bladder)
The most common reason to remove the gall bladder is for symptomatic gall stones. The second most common cause is for gall bladder polyps.
A cholecystectomy is performed under general anaesthetic. It is usually performed laparoscopically (key-hole).
A 12-15mm incision is made around the umbilicus for the camera port.
Three smaller ports (5mm) are placed in the right upper abdomen through which the operating instruments are inserted.
The gall bladder is dissected out. The artery to the gall bladder (cystic artery) is divided between titanium clips.
The channel connecting the gall bladder to the main bile duct is called the cystic duct. It is clipped on the gall bladder side and an x-ray test is performed to rule out the presence of stones in the bile duct. It is called a cholangiogram (chol = bile, angio = tube, gram = picture).
If the cholangiogram is normal, the cystic duct is closed with titanium clips and divided. The gall bladder is then removed off the liver, put into a plastic bag and removed through the umbilicus. It is sent to the pathology laboratory to be analysed under the microscope.
A drain may be left inside the abdomen and is usually removed the next morning.
The skin is closed with dissolving sutures.
The channel connecting the gall bladder to the main bile duct is called the cystic duct. It is clipped on the gall bladder side and an x-ray test is performed to rule out the presence of stones in the bile duct. It is called a cholangiogram
If the cholangiogram is normal, the cystic duct is closed with titanium clips and divided. The gall bladder is then removed off the liver, put into a plastic bag and removed through the umbilicus. It is sent to the pathology laboratory to be analysed under the microscope.
A drain may be left inside the abdomen and is usually removed the next morning.
The skin is closed with dissolving sutures
If a stone is seen inside the bile duct, a bile duct exploration may be performed. This is where a small camera is passed through one of the 5mm ports and then into the cystic duct and the bile duct. The stone is removed under vision. If this fails, you may require another procedure later on called an ERCP. This involves a camera being passed into the mouth through to the duodenum where the stone is removed from the bottom of the bile duct.
Surgical procedural risks can be divided into anaesthetic and surgical risks.
Anaesthetic risks are usually discussed with the patient by the anaesthetic team.
Surgical risks specific to gall bladder surgery relate to:
- Bleeding
- Infection
- Bile duct injury– The risk of bile duct damage is estimated around 3 in 1000. This is a serious complication that may require future major bile duct surgery. It is avoided by careful dissection of the gall bladder and performing a cholangiogram.
- Conversion to open surgery – This may be required if it is considered unsafe to proceed laparoscopically due to excessive adhesions or bleeding or where the anatomy is unclear. An incision is made under the right costal margin.
- Deep venous thrombosis or DVT: formation of blood clots in the legs. This risk is reduced by wearing compression stockings (called TEDS), injection of blood thinning medications (Clexane) and mechanical calf-compression.
- Chest infection: This is prevented by adequate pain-relief, deep breathing, early mobilization and chest physiotherapy.
Before elective surgery
Fast from midnight for a morning procedure OR from 7am for an afternoon procedure.
You will be contacted by the hospital the day before your procedure to let you know what time to come in. This is usually 1-2 hours before your procedure to allow for the hospital check-in procedures.
After surgery
- Take regular Panadol (as long as there are no medical reasons for you not to take it such as an allergic reaction or liver disease).
- Non-steroidal anti-inflammatory medication such as Neurofen and Voltaren can also help with pain and inflammation but should be taken on a full stomach. Take these for the first 3-5 days as required.
- Stronger pain killers such as opioid anaelgesics (Endone, Codeine) should be taken sparingly as they can cause constipation which results in more straining.
After gall bladder surgery, you are started on free fluids followed by a light diet.
If a drain is inserted during surgery, it will usually be removed the next day after.
Dressings are usually in two layers – Steristrips with a padded-Opsite on top.
These are waterproof so you can shower but cannot swim or have a bath for 2 weeks or until after your follow up wound review.
The top dressing stays on for 5-7 days.
Once the top dressing comes off, leave the Steristrips on for a few more days until they start to peel off by themselves.
You should avoid any heavy lifting or straining for 6 weeks after surgery to avoid an incisional hernia.
Following a laparoscopic cholecystectomy, you can go home the next day.
If the procedure was converted to open, you will be in hospital for 3-5 days.
Follow up is usually 1-2 weeks to review the wounds and discuss pathology of the gall bladder.
The appointment is usually made for you by the ward clerk before leaving the hospital.