Gall Bladder Removal

The medical term for gallbladder removal is cholecystectomy. A Laparoscopic Cholecystectomy is a procedure in which the gallbladder is removed by laparoscopic techniques.

Why does a gallbladder need to be removed?

The gallbladder is a small, pear-shaped pouch in the upper right part of your abdomen. The gallbladder stores bile, the digestive fluid produced by the liver that helps to break down fatty foods.

The bile is made from a mix of cholesterol, bile salts and waste products. These substances can get out of balance and cause small, hard stones called gallstones to appear. In many people cause no symptoms and remain undetected.

They do however, in a small number of cases become trapped in a duct (opening or channel), irritate and inflame the gallbladder, or move out of the gallbladder and into other parts of the body.

The symptoms these are can cause are:

• Sudden intense pain in your abdomen
• Feeling and being sick
• Jaundice (yellowing of the skin and the whites of the eyes)
  

Laparoscopic (keyhole) Surgery

For this procedure three to four small cuts with be made in your abdomen. These cuts are strategically placed in order to remove the gallbladder without open surgery. One of these cuts is made by the belly button and the others will be on the right sight of your abdomen.

Your abdomen is inflated using carbon dioxide gas. This is harmless to you and makes it easier for the surgeon to see your internal organs.

A laparoscope (a long, thin telescope with a tiny light and video camera at the end) is inserted through one of the cuts in your abdomen. This allows the surgeon to view the operation on a video monitor.

The surgeon will then remove your gallbladder using special surgical instruments.

A bile duct x-ray (operative cholangiogram) will be taken during the operation if there is any level of risk of gallstones in the bile duct.

If gallstones are found during the procedure they can sometimes be removed during the keyhole surgery. Bile duct stones can also be removed after your operation with a special endoscopy called endoscopic retrograde cholangiopancreatography (ERCP).

After the gallbladder has been removed, the gas that your abdomen was filled with will escape through the laparoscope. The cuts that have been made in your skin are closed with dissolvable stitches and covered with dressings.

The operation takes 60 to 90 minutes and is usually carried out as a day case, so you can normally go home that day.

Complications of Cholecystectomy

The removal of the gallbladder is a relatively quick and safe procedure; there is however, like any surgery, a potential risk of complications.

These risks include:

• Infection- this can occur after any type of abdominal operation and occurs in around 1 in 15 cholecystectomies. This infection can be from simple would infections and infections inside you abdomen and can be treated with a short course of antibiotics.
• An allergic reaction to the General Anaesthetic
• Bleeding (haemorrhage) can occur (this is rare) and may require further operation
• Bile leakage- following the gallbladder removal, special clips are used to seal the tube that connects the gallbladder to the main bile duct, draining the liver, this bile can sometimes leak out. 

1. These fluids can be drained. In the rarer cases and operation maybe need to drain the bile out and wash the abdominal cavity. Bile leakage occurs in 1-2% of cases.
2. Injury to the bile duct occurs in 1 in 500 cases. If this is done during surgery, it may be possible to repair it straight away. In some cases, further complex and major corrective surgery is needed after your original operation.
3. Injury to intestine, bowel and blood vessels can occur, as the keyhole instruments used can injure the surrounding internal organs. This is usually repaired at the time of the operation. If these injuries are noticed afterwards another operation will be needed.
4. Deep Vein Thrombosis - some patients are at a high risk of developing blood clots during surgery. This usually occurs in the leg vein. During the procedure, you may be given compression stockings to wear during the operation as a preventative measure.
5. Post-cholecystectomy syndrome - One in seven people will experience symptoms similar to those caused by gallstones (although they will be considerably milder). These are: abdominal pain, indigestion, diarrhoea, yellowing of the eyes and skin (jaundice) and a high temperature (fever).  PCS is not very well understood as a condition; it’s thought to be caused by altered bile movements through the body. In most cases symptoms are mild and short-lived, some cases can however, persist for months. If they are persistent, you will need to see your GP for advice. One of the treatment options is to carry out an endoscopic retrograde cholangiopancreatography (ERCP) to check for remaining gallstones. There are also medicines such as antacids, proton pump inhibitors and loperamide to relieve the symptoms such as abdominal pain, indigestion and diarrhoea.