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Patient information
Gallstones are common and often cause no problems. When they do, keyhole removal of the gallbladder is the gold standard treatment.
The formation of gallstones within the gallbladder is common in Western society. It is estimated that about 5 million people in the UK have gallstones, and in most cases they do not cause any symptoms or health problems.
However, in some patients the gallstones block the exit of the gallbladder, leading to bouts of quite severe upper abdominal pain known as biliary colic. This is often associated with nausea and vomiting. The attacks are unpredictable and vary in frequency and intensity. On occasion, an attack of biliary colic can progress to inflammation and infection of the gallbladder, known as acute cholecystitis. This can lead to persistent pain, often with a high temperature, and usually leads to a brief hospital admission, but it can be serious.
Further complications include jaundice, due to a stone moving from the gallbladder into the bile duct and obstructing the flow of bile from the liver to the duodenum. The passage of a gallstone into the duodenum may also cause acute pancreatitis, which presents as severe abdominal pain. These two complications are more serious. Although acute pancreatitis usually resolves without issues, it can lead to sepsis and a severe illness. Jaundice due to the passage of a gallstone often settles spontaneously but sometimes requires an endoscopic procedure to remove the gallstone.
Once a patient develops episodes of gallbladder pain, or has an attack of acute infection, jaundice or pancreatitis, an operation to remove the gallbladder is generally recommended. This keyhole operation is known as laparoscopic cholecystectomy. It has been the gold standard procedure to remove gallstones since the early 1990s and is a common general surgical operation.
The operation is performed via four incisions on the abdominal wall. The first incision is through the umbilicus and measures about 1–2cm; this is where the laparoscope (camera) is inserted to view the operative site. There are then three further incisions in the upper abdomen. Two of these are small, measuring 5–8mm. The third, just beneath the breastbone, usually measures about 2–3cm as it is used to remove the gallbladder and gallstones.
Normally, a laparoscopic cholecystectomy is an uneventful operation. There is some abdominal wall soreness for a few days and it usually takes a couple of weeks to be almost back to normal. However, you can eat and drink on the same day as the operation.
Although laparoscopic cholecystectomy is a common operation, there are small but serious risks associated with it. These are more likely if the gallbladder has been very inflamed or infected, as there is then a lot of thickened scar tissue around important adjacent structures.
Despite careful clipping of the duct and removal of the gallbladder from the liver, there is a small risk of persistent bile leakage into the abdomen. This causes pain and often needs a small endoscopic procedure. The risk is about 1% or less, higher if the gallbladder was severely inflamed.
The bile ducts lie very close to the gallbladder. A major injury is very serious and requires reconstructive surgery. The reported risk is about 1 in 500 operations and every care is taken to avoid it.
Slight, insignificant bleeding is common after previous inflammation. Significant bleeding is unusual; the risk of needing a blood transfusion is around 1 in 300 to 1 in 500.
A small collection of blood or bile may develop after a difficult operation, causing pain and signs of infection. It is usually drained laparoscopically or under ultrasound guidance. The risk is about 1 in 100.
Needed in about 1–2% of operations if complications such as bleeding or a bile leak occur. A full recovery is expected but takes several weeks, with a larger scar.
Occurs in about 2% of cases and is usually managed with wound care or a short course of antibiotics. You will be seen a week or two after surgery to check.
A small risk (about 1%) of a future hernia at an incision. Avoid heavy lifting and significant core exercise for about 6 weeks.
A small number of patients develop loose motions as bile salts enter the bowel continuously. Reducing fat intake usually controls this; medication is rarely needed.
Can complicate any abdominal operation under general anaesthetic, but it is uncommon after laparoscopic cholecystectomy.
In most cases the operation is straightforward and you can be discharged the same day if surgery takes place in the morning or early afternoon. If it is performed in the evening, an overnight stay is usually necessary.
There is inevitably some abdominal wall pain at the incision sites, which is usually easily controlled with painkillers. Sometimes pain is felt over the shoulders, caused by the gas used during the operation irritating the nerves to the diaphragm; this resolves within 24–48 hours.
After about 48 hours the pain has usually settled significantly and moving around, eating and drinking are comfortable. In many cases it is fine to go out and walk the following day, although every patient’s recovery differs. After 7–10 days most patients are almost back to their usual health and can start aerobic exercise after 2 weeks.
The wounds are closed with absorbable sutures and tissue glue or adherent dressings, so you can shower the day after the operation. An appointment will be made within 2 weeks to inspect the wounds and plan your rehabilitation.
If you have any questions about this information or the operation, please do not hesitate to contact Mr Crinnion’s office before your procedure.
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Please contact Mr Crinnion’s secretary, Maxine Levene.
Tel: 0787 028 0264
Email: enquiries@jamescrinnion.co.uk
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Mr Crinnion’s office is happy to help before and after your procedure.