Laparoscopic Cholecystectomy

What is a laparoscopic cholecystectomy?

It is the surgical removal of the gallbladder using a laparoscope (tube-like instrument). Instruments that remove the gallbladder are inserted into the abdomen via four tiny cuts. During surgery, an examination of the bile duct is required to look for gallstones. To do this, a contrast medium is injected, and x-rays are taken of the bile duct.

What are gallstones?

The gallbladder is a small pear-shaped organ attached to the underside of the liver. The gallbladder stores bile — a fluid that helps digest fat. The bile flows into the gut along a small tube — the bile duct.

Gallstones may form in the gallbladder and cause pain, bloating, nausea and vomiting. Sometimes stones may travel into the bile duct and cause a blockage. If this occurs, the person may turn yellow (jaundiced) and need urgent treatment. One in 5 people develop gallstones, although not everyone will have problems. However, those who do have problems may develop complications if it is not treated. Complications include inflammation of the gallbladder, inflammation of the pancreas and blockage of the bile duct, causing jaundice and infection.

The procedure

Laparoscopic cholecystectomy is the surgical removal of the gall bladder using a laparoscope (a tube-like instrument). It is safe and effective for most patients who have symptoms from gallstones. Usually, about four minor cuts (incisions) about 0.5-2.5 cm long, made in the abdomen. The number of cuts and their position may vary between patients.

A telescope is passed into one of the small cuts to allow the surgeon to see inside the abdomen. Hollow metal tubes called ports are inserted into the other cuts. Carbon dioxide is blown into the abdomen to lift the abdominal wall away from the liver, gallbladder, small bowel, stomach and other organs. The surgeon puts instruments such as forceps and scissors into the other ports to help remove the gallbladder.

Metal clips are placed to block off the tube leading from the gallbladder to other tubes (ducts) and the arteries leading to the gallbladder. These clips stay in your body. Once the gallbladder is taken out, all instruments are removed from the abdomen. The carbon dioxide gas is allowed to escape before the cuts are closed with staples or sutures. Sometimes during surgery, an examination of the bile duct is required to look for gallstones. To do this, a contrast medium is injected, and x-rays are taken of the bile duct.

Anaesthetic

This procedure will require an anaesthetic.

What are the benefits of having this procedure?

The removal of the gallbladder will, in most cases, relieve pain, nausea and vomiting. It will also prevent complications and the gallstones from coming back.

What if I don't have the procedure?

The symptoms of gallstones may get better but can return if left untreated. Complications will likely develop, making treatment more difficult and increasing the risks.

Alternative treatments

Please note that some alternative treatments may not be available or suitable for everyone:

Oral dissolution therapy:

It involves taking chemicals by mouth to dissolve the gallstones. This method is most effective for patients who are not overweight, young or have a small, single gallstone and gallbladder that is working well. It has a 50% chance of gallstones recurring within five years. The drugs may be poorly tolerated with unpleasant side effects.

Open cholecystectomy:

Removal of gallbladder through an abdominal cut about 10cm long below the right rib cage. This is a safer alternative, requiring a more extended stay in the hospital and a longer recovery time.

Cholecystectomy:

Drainage of the gallbladder and stone removal are usually performed on patients who are too sick to have the gall bladder removed.

Recovery

After the operation, the nursing staff will closely watch you until you have woken up. You will then return to the ward to rest until you are ready to go home, usually within 24h. If you have any side effects from the anaesthetic, such as a headache, nausea, vomiting, tell the nurse looking after you, who will give you some medication to help.

Pain:

You can expect to have pain in the abdomen. You may also have shoulder tip pain caused by the gas used during the operation. Your pain should wear off in 4-5 days. If it does not, tell your doctor.

Diet:

After theatre, you may have a few sips of water then increase from fluids to solids until you are able to manage a normal diet.

Wounds:

You may have clips or stitches, and your wounds will be covered with a dressing. You may also have a drain on your side. This is usually removed a day after the surgery.

Risks of a laparoscopic cholecystectomy:

There are risks and complications with this procedure. They include but are not limited to the following:

General risks:

Infection can occur, requiring antibiotics and further treatment.
Bleeding could occur and may require a return to the operating room. Bleeding is more common if you have been taking blood-thinning drugs such as Warfarin, Asprin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).
Small areas of the lung can collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
Increased risk of wound infection, chest infection, heart and lung complications, and thrombosis in obese people.
Heart attack or stroke could occur due to the strain on the heart.
Blood clot in the leg (DVT) causing pain and swelling. In rare cases, part of the clot may break off and go to the lungs.
Death as a result of this procedure is possible.

Specific risks:

Damage to large blood vessels causing bleeding.
Damage to gut and/or bladder when the instruments are inserted.
Rarely, gas fed into the abdominal cavity can cause heart and breathing problems.
The laparoscope method may not work, and the surgeon may need to do open surgery.
Stones may be found outside the gallbladder.
Gallstones may spill from the gallbladder and be lost in the abdominal cavity.
Some stones may be left behind in the bile duct and need further treatment.
Some of the clips or ties may come off.
Damage to the bile tubes.
The wound may not heal normally. The wound may thicken and turn red.
A weakness can happen in the wound with the development of a hernia (rupture).
Adhesions (bands of scar tissue) may form and cause bowel obstruction.
Symptoms experienced before surgery may persist after the surgery.
An allergic reaction to the injection contrast is rare.