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What is Laparoscopic Cholecystectomy?
Laparoscopic cholecystectomy means removal of your gallbladder using keyhole techniques (through small cuts and using a camera and special instruments).
Why do you need this surgery?
Most common reason why you need to remove your gallbladder is when your gallbladder have gallstones in it and it has caused problems such as pain and/or more serious complications. If the stones move out of your gallbladder into your common bile duct, they can cause jaundice (your eyes and skin turning yellow), serious infection of your bile ducts (cholangitis) or inflammation of your pancreas (acute pancreatitis). These problems can be serious and can even cause death. Therefore its recommended to remove your gallbladder if they have problematic gallstones.
Very rarely, a soft tissue growth in your gallbladder may necessitate the removal of your gallbladder.
What are the benefits of surgery?
You should be free of pain and able to eat a normal diet. Surgery should also prevent the serious complications that gallstones can cause. Your body will function perfectly well without a gallbladder.
Are there any alternatives to surgery?
Surgery is the only dependable way to treat gallstones. Theoretically it is possible to dissolve the stones or even shatter them into small pieces but these techniques involve very painful procedures, unpleasant medicines that have intolerable side effects which need to be taken for years and a high failure rates. The gallstones usually come back. These alternatives will not cure the condition and symptoms are likely to come back and in the meantime, you can develop serious complications even threatening your life.
What will happen if surgery is declined?
If you have already had symptoms related to your gallstones such as upper abdominal pain, it is likely that these will continue from time to time. There is also a risk of life-threatening complications.
What does the operation involve?
The surgical team will carry out a number of checks to make sure you are ready for the operation. You may need to wear a special stoking (TED Stokings) prior to the surgery. You need to be fasting for 6 hours. You will be asked to pass urine right before you are taken to the operating theatre.
The operation is performed under a general anaesthetic and usually takes about an hour. You may also have injections of local anaesthetic to help with the pain after the operation. You may be given antibiotics during the operation to reduce the risk of infection. Your surgeon will use laparoscopic (keyhole) surgery as this is associated with less pain, less scarring and a faster return to normal activities. Your surgeon will make a small cut on or near your umbilicus (belly button) so they can insert an instrument in your abdominal cavity to inflate it with gas (carbon dioxide). They will make several small cuts on your abdomen so they can insert tubes (ports) into your abdomen. Your surgeon will insert surgical instruments through the ports along with a telescope so they can see inside your abdomen and perform the operation.
Your surgeon will hold your gallbladder so they can free up your cystic duct and artery. They will clip and then cut the duct and artery, and separate your gallbladder from your liver. Your surgeon will remove your gallbladder from your abdomen through one of the ports. Finally, your surgeon will remove the instruments and close the cuts.
For about 1 in 20 people it will not be possible to complete the operation using keyhole surgery. The operation will be changed (converted) to open surgery, which involves a larger cut usually just under your right ribcage.
What can you do to help?
Let your surgeon know about all the medicine you take. This includes all blood-thinning medicine (aspirin, clopidogrel, warferrin) as well as herbal remedies, dietary supplements, and medicine you can buy over the counter.
If you are pregnant, you should inform the surgeon because some form of intra-operative testing may involve X-Rays and that will not be done if you are pregnant.
If you smoke, stopping smoking several weeks or more before the operation may reduce your risk of developing complications and will improve your long-term health.
Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.
In the week before the operation, do not shave or wax the area where a cut is likely to be made.
Try to have a bath or shower either the day before or on the day of the operation.
What complications can happen?
The surgeon will try to make the operation as safe as possible but complications can happen. Some of these can be serious and can even cause death. When you are recovering, you need to be aware of the symptoms that may show that you have a serious complication. You should ask your surgeon if there is anything you do not understand. Your surgeon may be able to tell you what the risk of a complication for you is.
Complications of anaesthesia
Your anaesthetist will be able to discuss with you the possible complications of having an anaesthetic.
General complications of any operation
Pain: The surgical team will give you medicine to control the pain and it is important that you take it as you are told so you can move about and cough freely. After keyhole surgery, it is common to have some pain in your shoulders because a small amount of carbon dioxide gas may be left under your diaphragm. Your body will usually absorb the gas naturally over the next 24 hours, which will ease the symptoms.
Bleeding during or after the operation: Rarely, you will need a blood transfusion or another operation.
Infection of the surgical site (wound): It is usually safe to shower after two days but you should check with the surgeon. Let the surgeon know if you get a high temperature, notice pus in your wound, or if your wound becomes red, sore or painful. An infection usually settles with antibiotics but rarely you may need another operation.
Blood clot in your leg (deep-vein thrombosis DVT): This can cause pain, swelling or redness in your leg, or the veins near the surface of your leg to appear larger than normal. The surgical team will assess your risk. They will encourage you to get out of bed soon after the operation and may give you injections, medicine, or special stockings to wear. Let the surgical team know straightaway if you think you might have a DVT.
Blood clot in your lung (pulmonary embolus): if a blood clot moves through your bloodstream to your lungs you will develop shortness of breath. Let the surgical team know straightaway if you become short of breath, feel pain in your chest or upper back, or if you cough up blood. If you are at home, immediately go to your nearest hospital.
Developing a hernia in the scar: if you have open surgery, caused by the deep muscle layers failing to heal. This appears as a bulge or rupture called an incisional hernia. If this causes problems, you may need another operation.
Specific complications of this operation
Surgical emphysema: (crackling sensation in your skin caused by trapped carbon dioxide gas), which settles quickly and is not serious.
Leaking of bile or stones: Your surgeon can usually deal with this at the time of surgery but you may need another operation.
Retained stones in your common bile duct: Your surgeon may remove the stones during the operation or later using a flexible telescope.
Bile duct injury: which is potentially serious (risk: 1 in 200). You may need another operation.
Damage to structures: such as your bowel, bladder or blood vessels when inserting instruments into your abdomen (risk: less than 3 in 1 000). The risk is higher if you have had previous surgery to your abdomen. If an injury does happen, you may need open surgery. About one in three of these injuries is not obvious until after the operation.
Diarrhoea: because you no longer have a gallbladder controlling the flow of bile into your intestines.
Developing a hernia near one of the cuts used to insert the ports (risk: 1 in 100). Your surgeon will try to reduce this risk by using small ports (less than a centimetre in diameter) where possible or, if they need to use larger ports, using deeper stitching to close the cuts.
Allergic reaction to the equipment, materials, medicine or dye. This usually causes a skin rash which settles with time. Sometimes the reaction can be serious (risk: less than 1 in 2 500) or even life-threatening (risk: 1 in 25 000). Let your surgeon know if you have any allergies or if you have reacted to any medicine or tests in the past.
How soon will you recover?
After the operation you will be transferred to the recovery area and then to the ward. You should be able to go home the next day. However, your surgeon may recommend that you stay a little longer if there are concerns.
- You need to be aware of the following symptoms as they may show that you have a serious complication.
- Pain that gets worse over time or is severe when you move, breathe or cough.
- A high temperature or fever.
- Dizziness, feeling faint or shortness of breath.
- Feeling sick or not having any appetite (and this gets worse after the first one to two days).
- Not having any bowel movements and not passing wind.
- Swelling of your abdomen.
- Difficulty passing urine.
If you do not continue to improve over the first few days, or if you have any of these symptoms, let the surgical team know straightaway. If you are at home, contact your surgeon or GP. In an emergency go immediately to your nearest hospital.
Returning to normal activities
You should be able to return to work after two to four weeks, depending on how much surgery you need and your type of work. Your surgeon may tell you not to do any manual work for a while. Do not lift anything heavy for a few weeks. Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the surgical team or your GP for advice.
Do not drive until your surgeon tells you that you can.
You should make a full recovery and be able to return to normal activities and eat a normal diet. If your pain or jaundice continues, let your surgeon know.