Cholecystectomy

What is a cholecystectomy?

A cholecystectomy is a procedure to remove the gallbladder.

What is a gallbladder?

The gallbladder is a small organ situated under the liver. Its main purpose is to collect and store bile, which is a substance secreted by the liver that helps the body break down fats during digestion.

Why is Dr Adams recommending this surgery?

Sometimes the calcium salts, cholesterol, and pigment within bile crystallises and solidifies. These deposits are called gallstones. Gallstones can be as small as a grain of salt or as big as a golf ball, and can cause serious problems if left untreated.

These problems can include:

  • Painful gallbladder attacks (biliary colic)
    • Occur when a stone temporarily blocks the outlet (cystic duct) of the gallbladder. When this occurs, patients experience pain as the gallbladder tries to squeeze out its bile but can’t due to the blockage.  After a few minutes or hours if the stone then falls away from the outlet or duct the pain resolves.  This pain is often recurrent and typically occurs after eating or at night time
  • Inflammation of the gallbladder (cholecystitis)
    • When a gallstone blocks the duct in the gallbladder and does not move away again the pain does not resolve. This can cause painful inflammation which can sometimes cause complications such as infection or perforation.  Inflammation of the gallbladder is often an indication for unplanned or emergency surgery
  • Blockage of the common bile duct (choledocholithiasis)
    • If gallstones block the flow of bile from your gallbladder or liver to your small intestine, jaundice and infection can result.
  • Blockage of the pancreatic duct (pancreatitis)
    • Blockages caused by gallstones between the pancreas to the common bile duct can result in pancreatitis. Pancreatitis is a painful condition which varies from a mild condition which gets better by itself to a severe life threatening condition requiring prolonged intensive care and hospital stays.
  • Gallbladder cancer
    • Even though gallbladder cancer is relatively rare, people with a history of gallstones do have an increased risk of developing the disease.

Are there any alternatives to surgery?

Treatment for gallstones is typically only necessary if you are experiencing symptoms. Gallbladder removal is the only permanent cure for gallstones.  Medical or drug therapy is of limited effectiveness, not without side effects; and needs to be continued indefinitely to prevent gallstones recurring.

Can I live without my gallbladder?

Almost everyone lives a normal life without their gallbladder. The liver still makes bile for digesting your food, but as your gallbladder isn’t there to store it for later use, the bile continually drips into the digestive system instead.

Some people (very few) experience symptoms when eating high fat foods following gallbladder removal.  This may include bloating, crampy pain, diarrhoea. Simple lifestyle changes are usually all it takes to negate any uncomfortable issues.   Eating a healthy diet, avoiding fatty foods, and eating small meals frequently is recommended for everyone (whether they have a gallbladder or not).

What is a laparoscopic cholecystectomy?

This type of cholecystectomy involves removing the gallbladder using laparoscopic techniques. It’s a minimally invasive surgery practiced by Dr Adams that reduces pain and promotes faster healing for patients.

Instead of making a large cut and opening the body up to gain access to the gallbladder, laparoscopy involves making a few smaller incisions in the abdomen. A tiny telescope with camera are manoeuvred through the incision to the site, which allows Dr Adams to view the procedure from the inside. Specially designed instruments are then inserted through the additional incisions to perform the operation.

What preparation is required?

Before your procedure, Dr Adams will consult with you to get your full medical history and discuss the best way forward. It’s important to tell her about all medications you regularly take, as she will potentially need to adjust your doses, and some may need to be ceased.

You will be required to fast for at least 6 hours prior to your procedure. You may drink water only during this time. You can still take your regular medications (as directed by Dr Adams) with a small sip of water.

What should I expect during my procedure?

Immediately before the procedure, Dr Adams will come and see you with the anaesthetist, who will take a health history and insert a drip to administer medication. You will then be moved to the procedure room.

The anaesthetist will set up monitoring equipment and administer the drugs for the procedure. You will be fully anaesthetised and unconscious during the procedure. Your condition will be carefully monitored by the anaesthetist.

Once you are unconscious, small incisions about 1-2cms wide are made in your umbilicus (belly button) and abdomen, and plastic tubes called ports are inserted. The laparoscopic camera is then threaded through the umbilicus port and carefully guided to the gallbladder area. Then the required instruments for the operation are inserted through the other ports.

The camera transmits an image of your insides to Dr Adams so she can perform the procedure internally. A harmless gas is used to inflate your abdomen to give Dr Adams a clear view of the area.

Dr Adams will place a small tube called a catheter into the cystic duct which drains bile from the gallbladder into the common bile duct. Then a dye will be injected into the duct, and an X-ray will be taken to look for gallstones that may have moved from the gallbladder into the bile duct. This part of the procedure is called an intraoperative cholangiogram.

Then the gallbladder is completely detached from the liver, and placed into a bag to be extracted via the umbilicus port.

After the gallbladder is removed, Dr Adams gently removes the instruments, deflates the gas, and closes the incisions. Then you will be transferred to recovery.

What happens after following my procedure?

When you’re in recovery, a nurse will stay with you to monitor you as you come out of the anaesthesia. Most often patients stay for one night in hospital after laparoscopic cholecystectomy.   Dr Adams will see you on the ward the same day and/or the day after your surgery.

You may feel a little pain after a few hours when the anaesthetic wears off. Your wounds may be a bit sore and sometimes you can be nauseas. Please make sure you advise your nurse if you have pain or are unwell so painkillers or other medication can be administered to make you feel better.

Your wounds will have a dressing to protect them as they heal. The dressings can be removed at 48-72hrs.  Dab the area dry after showering and avoid swimming or soaking in the bath.  Watch for any redness or increasing pain in the wounds, this may be sign of infection, so contact Dr Adams’ clinic if it occurs.  Stitches are internal and dissolvable and to not need to be removed.

You will be able to move about and go for short walks immediately. Take it slow and gradually build up your activity each day. Most people do not feel like doing much for 7-10 days after their surgery.  Generally patients are back to their most of their normal activities within 2 weeks.  Listen to your body, if you are having more than a twinge of pain with a certain physical activity you may need to decrease the intensity temporarily.

Dr Adams’ secretary will be in touch to arrange your follow-up appointment, usually three weeks following surgery. If you don’t hear from her, please contact Dr Adams’ offices to arrange an appointment.

What are the risks involved?

As with all surgical procedures, laparoscopic cholecystectomies carry a small risk of complications. These can include bleeding, infection, leakage of bile in the abdomen, damage to the common bile duct, retained stones, damage to other structures/organs and anaesthetic issues.

However, these risks are infrequent and the majority of patients recover and return to normal activities without incident. Naturally, all care is taken to reduce every patient’s risk prior, during, and after surgery.  If you have any specific fears or concerns about the procedure, please raise them with Dr Adams at your initial consult.

Please contact us to discuss if you are uncertain if your treatment needs can be met by Suncoast Surgical.

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