Surgery Resources

An information leaet on gallstone disease and it's treatment

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Surgery Gallbladder

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​Introduction: Laparoscopic cholecystectomy is a keyhole surgical procedure to remove the gallbladder using small incisions. It's often recommended for patients with gallstones or other gallbladder issues. It is normally performed as a day case procedure but occasionally patients stay overnight before going home the next morning.

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​What is the gallbladder and what does it do? The gallbladder is a small organ, that sits underneath your liver and stores bile, a uid that helps digest fat. When we eat, the gallbladder releases bile into the small intestine to aid digestion.

 

Can people live without a gallbladder?  Absolutely! The gallbladder does not produce bile, it simply stores it. Producing bile is the job of the liver and this will continue to happen when the gallbladder is removed.  

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What are gallstones and why do they form? Gallstones are small, hard deposits that can develop in the gallbladder. They are extremely common. In the UK up to 1 in 3 people will develop gallstones. 2 in 3 of those people will never experience a problem. Gallstones form when substances in bile, such as cholesterol or bilirubin, become concentrated and solidify. Once gallstones begin to cause problems, this tends to continue until they are removed.

 

Why do I need a laparoscopic cholecystectomy? Mr Hornby may recommend this procedure if you have recurrent gallstone attacks, which cause pain and inammation, or if you're at risk of serious complications like gallbladder infection, blockage of the bile duct or the pancreatic duct. Occassionally the gallbladder can contain polyps and if these grow to a certain size Mr Hornby will recommend that your gallbladder is removed.

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Why does the gallbladder need to be removed, can you not just remove the stones? The gallstones are a consequence of a gallbladder that is not working properly. They could be removed but they are certain to reform. There is no evidence of any treatment that can dissolve stones in the gallbladder, and indeed the passage of small stones into biliary ducts can cause signicant complications such as pancreatitis.

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What happens during the procedure? You'll receive a general anaesthetic and will be asleep during the procedure. Mr Hornby will make one small incision in your belly button and insert a laparoscope, a thin tube with a camera, to guide the surgery. Instruments are then used to remove the gallbladder through 3-4 further small incisions.

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Why do I need a preoperative assessment? This is an important part of the treatment process where your suitability for anaesthetic and surgical procedure are assessed. This includes a review of your medical history, current medications, any past reactions to drugs and some basic blood tests. This will occur at a separate appointment after your consultation with Mr Hornby and before the day of surgery.

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How should I prepare for the procedure? If your procedure is the morning Mr Hornby recommends that you do not eat after midnight the previous evening but you can drink water up until 6am. Your preoperative assessment will guide you on which medications need to be stopped and which can be taken up to the morning of the procedure.

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What are the risks and complications associated with the procedure? A laparoscopic cholecystectomy is a very safe procedure that is performed routinely. There are some recognised rare, but important risks, that are worthy of mention.

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Bleeding - Most bleeding is seen and dealt with during the operation. On very rare occasions bleeding can require a return to the operating theatre to manage.

 

Infection - When seen, the commonest site for infection is the wound at the belly button. In rare cases infection can develop at the site the gallbladder is removed. It is normal for wounds to be a little red as they are healing but if there is excessive redness and discharge this can be a sign of infection and is treated with antibiotics.

 

Damage to liver or bowel  - The liver occasionally sustains very minor damage as the gallbladder is removed but this rarely has any consequences for the patient and heals very quickly. Bowel injury is a more serious issue but is thankfully a very rare complication.

 

Damage to common bile duct -  This is a potentially serious but very rare injury that may require further surgery to correct.

 

Bile leak - A bile leak is rare and usually presents several days following the procedure with the patient feeling unwell. It may require another laparoscopy to wash out any leaked bile and control the leak.

 

Retained Stone(s) - Stones can either be spilt from the gallbladder or travel down the bile pipes and cause a blockage. This is rare complication that may require other procedures to manage.

 

DVT/PE - A clot in the legs (deep vein thrombosis) and lungs (pulmonary embolism) can occur following surgery but is rare following cholecystectomy. You will be asked to wear stocking on your lower legs whilst you are recovering and if you are at particular risk of developing a clot you may be given medication to thin your blood.

 

Risks of General Anaesthesia - General anaesthesia in the modern era is incredibly safe. You will be allocated an expert consultant anaesthetist. Anaesthetists are specially trained doctors and they will go through the small risks with you on the day of surgery.

 

Pain - It is normal to be sore following any surgery but that with regular simple painkillers this is very manageable. Patients occasionally have longer term pain that requires specialist management.

 

No resolution of symptoms - Unless Mr Hornby has a high degree of certainty that the patient’s symptoms are caused by their gallbladder he will not offer surgery. However on rare occasions the pain the patient is experiencing can continue.

 

Hernias - Hernias are rare consequence of the small cuts made to do the operation. They are a gap in the muscle layer and sometimes need to be repaired at a further operation.

 

Diarrhoea - About 30% of people will experience a brief period of diarrhoea following removal of their gallbladder. This normally lasts a couple of weeks. About 1 in 200 people will have longer term diarrhoea that may need treatment with medication.

 

What can I expect during recovery?  Most patients go home the same day or the next morning. You may experience mild pain, shoulder discomfort, or bloating. You will be given regular medications that you should take without waiting for pain to start. You will wean off these over the next 14 days. 

 

There are no specic dietary requirements following the procedure, in fact, you will likely be able to enjoy a much wider variety of foods again.

 

When can I get back to normal activity?  You should be comfortable to mobilise around your home from the rst day. Mr Hornby normally recommends two weeks off work. The hospital will provide you with a sick note for that period. He generally recommends you do not drive for 2 weeks and it is important that you avoid heavy lifting for 4-6 weeks.

 

When should I seek medical advice after the procedure? Contact Mr Hornby’s team or the private hospital if you experience persistent pain, fever, chills, nausea, vomiting, or signs of infection like redness, swelling, or drainage from the incisions.

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Will I be followed up? The hospital will perform a wound check within the rst couple of weeks of surgery and Mr Hornby will follow you up, either in person or via video consultation 4-6 weeks following surgery. These appointments will be arranged for you, and you will be contacted by email or letter. Will I be followed up? If you have any concerns whatsoever, then please do not hesitate to let Mr Hornby’s team know and they can arrange for him to see you earlier.

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Conclusion: Laparoscopic cholecystectomy is a common, safe procedure that can signicantly improve your quality of life if you're experiencing gallbladder issues. Do not hesitate to discuss any specic concerns or questions with Mr Hornby at your appointment.

 

 

 

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