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Removal of the Gall Bladder
(Cholecystectomy)
We have found that you have gallstones in
your gall bladder. It is recommended that you
have an operation called a cholecystectomy.
This means you will have stones and the gall
bladder removed. ·
This booklet answers some questions you
want to ask before your operation.
If you need any more information about
gallstones or what the operation involves,
please speak to your consultant or one of
the team members who will be more than
happy to help.
What are gallstones and why do I need
a cholecystectomy'?
Gallstones are like small pebbles, which form
in the gall bladder. The gall bladder is a small
muscular bag attached just underneath the
liver. If the surgeon thinks that gallstones have
caused your symptoms and that you will
benefit from having the gallstones and gall
bladder removed, he will recommend a
cholecystectomy.
Alternatives to surgery for gallstones
Cholecystectomy is the treatment of choice
for gallstones. Stones form in the gall bladder
because it does not function properly. If the
stones alone are removed more stones may
form again later. Unfortunately, other
treatments such as trying to dissolve or
shatter the gallstones have proved
ineffective.
Stones in the bile duct can often be
extracted without surgery but bile duct
stones have originated from the gall bladder.
Most patients with bile duct stones will
be advised to have their gall bladder
removed eventually. However, for some
elderly patients or those with other
serious medical problems, just clearing
the bile duct stones may be the best
option.
What are the benefits of having an operation to
remove my gall bladder?
You should not have any further attacks of
pain or other symptoms that the doctor
thinks have been caused by the gallstones.
Types of gall bladder operations
In most cases your surgeon will recommend a
laparoscopic operation because recovery is
usually quicker. However, a laparoscopic
operation may not be possible if you have had
extensive abdominal surgery in the past or if
the gall bladder is very inflamed. In these
circumstances an open operation may be
required which will involve a larger incision
usually just below the rib cage on the right
side. Patients who are offered a laparoscopic
operation should be willing to have an open
operation if the surgeon considers this to be
the safest option during the operation. Overall
the likelihood of a conversion is between 510%.
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How long will I have to stay in
hospital?
This depends on what type of operation
you have. If you have the laparoscopic
(keyhole} method you should be able to go
home either as a day case or after an
overnight stay day following the
operation. If you have an open operation
you should be able to go home
approximately 3- 5 days after the operation
unless more complicated surgery is
required.
What happens before the operation?
Prior to admission you will need to have a preoperative assessment. This is an assessment of
your health to make sure you are fully
prepared for your admission, treatment and
discharge. The pre-operative assessment
nurses are there to help you with any worries
or concerns that you have, and can give you
advice on any preparation needed for your
surgery.
Before the date of your admission, please read
very closely the instructions given to you.
If you are undergoing a general anaesthetic
you will be given specific instructions about
when to stop eating and drinking, please
follow these carefully as otherwise this may
pose an anaesthetic risk and we may have to
cancel your surgery.
What sort of anaesthetic will I have?
The operation is performed under general
anaesthesia. This means that you will be
fully asleep while the operation is being
carried out. One of the anaesthetists will
see you before your operation and will be
able to answer any questions you may
have.
What should I expect after the operation?
Although you will be conscious within a
few minutes of the operation ending you
will remain drowsy for few hours. Some
patients feel sick for up to twenty-four
hours after the operation but this passes. If
necessary you will be given some
medication to control this.
You will have a plastic drip tube in a vein in
your arm and there may be a drainage
tube inserted near the skin wound.
You may also be given oxygen from a
facemask for a few hours.
Some discomfort in the wound is
inevitable. Pain killing tablets or injections
will help to control this.
If you have had a laparoscopic operation
you may notice some discomfort in your
abdomen or shoulder for a day or two.
This is due to the gas used inside the
abdominal cavity during the operation and
should disappear fairly quickly.
You should be able to start drinking
normally and eating light meals on the day
of your operation.
How long will it take me to recover?
After a laparoscopic operation you will feel
tired for a few days and will need to rest. In a
couple of weeks you should be able to return
to your usual level of activity. If you have an
open operation your recovery will take longer
and it will be about two months before you
are back to normal.
When will I be able to go back to work?
If you have a laparoscopic operation you
should be able to return to a light job after
one week. If your job is heavy or manual you
should be able to return after two weeks.
After an open operation you will need to be
off work for about four weeks or up to eight
weeks if your job involves heavy work.
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Will I be able to drive?
It's a good idea to carry out the following test
before you decide if you feel well enough to
drive. Practice the movements of an
emergency stop in a stationary car and if this
does not cause you any discomfort in or
around your wound area you should be able
to drive but make sure you are comfortable.
Most people can drive after about one week
following a laparoscopic operation or after
approximately three weeks following an open
operation. Check your insurance policy covers
you.
Will the gallstones come back?
New gallstones can sometimes form in the bile
ducts but this is very rare. It this does happen
the stones can usually be treated without the
need to have an operation.
Complications of gall bladder surgery
General complications include:
• Bleeding or bruising associated with
the skin incisions.
• •Infection in the skin incisions can
occur during the recovery period.
This occasionally requires antibiotic
treatment.
There is a small risk of a clot forming in the leg
veins (Deep Venous Thrombosis or DVT)
associated with any form of abdominal
surgery. This is the same type of clot that
passengers on long aeroplane flights
may develop. A DVT may cause the leg to
swell and occasionally the clot may break
loose and lodge in the lung (Pulmonary
embolism or PE). Overall the risk of a DVT or
PE is small and we will take active measures to
minimise this risk to you.
A DVT is more likely if you are overweight or
smoke. You can reduce the risk of developing
a DVT by getting up and walking about as soon
as possible after your operation.
A DVT may only be obvious after you have
gone home. If you notice any swelling of the
calf or more rarely the thigh, or you
experience pain or tenderness in the calf, or
notice that your leg is shiny or discoloured you
should seek medical advice quickly. You
should also contact a doctor immediately if
you develop shortness of breath or pain on
breathing following surgery.
Bile duct injury and bile leak
Removal of the gall bladder requires its
disconnection from the bile duct. Rarely, the
bile duct or one of its branches may be
inadvertently damaged during the procedure.
The risk is small, less than one in one hundred.
Bile duct damage can cause either blockage or
leakage of bile.
If a bile duct leak occurs it can often be
managed without the need for further
surgery. The insertion of a drainage tube
under local anaesthetic may be necessary and
the hospital stay is usually prolonged. More
serious bile duct injuries are very unusual but
may require additional procedures such as
surgery or endoscopic procedures to correct
them.
Injury to other organs in the abdomen
During any operation within the abdominal
(peritoneal) cavity there is a small risk of
inadvertent injury to neighbouring organs.
However, this risk is small and your surgeon
will take every care to minimise it during your
operation. When damage does occur, it is
often obvious at the time of injury and it can
be repaired immediately without long-term
consequence. Less commonly, it is only
obvious later that an inadvertent injury has
occurred and sometimes further surgery is
required.
Retained bile duct stones
It is usually not advisable to operate on a
relatively narrow bile duct for very small
stones. Most tiny stones will pass without
problems whilst surgery in such circumstances
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can cause complications. There has to be a
balance of risk when deciding whether or not
to operate to remove stones from the bile
duct and your surgeon cam explain this in
more detail to you.
When should I seek help?
•
If you have troublesome stones left in the bile
duct after your cholecystectomy they can
usually be removed without further surgery by
endoscopic procedures.
•
•
Persistent Symptoms after cholecystectomy
•
•
Most patients have their gall bladder removed
for attacks of relatively short lived but severe
pain under the right ribs (bilary colic). A
smaller proportion of patients have longer
periods of pain (cholecystitis) or other related
problems such as Jaundice or pancreatitis.
A diagnosis is made based on the symptoms
the patient describes and the finding of
gallstones on an ultrasound scan. If the
symptoms fir and there is no suggestion of
other problems the diagnosis is made. In these
circumstances the gallstones are the most
likely cause of the symptoms. Gallstones are
very common and do not always cause
problems. If gallstones appear on the scan this
does not prove that the stones are causing the
pain nor can any other test confirm this. Most
patients thought to have bilary colic feel much
better after their gall bladder has been
removed. A cholecystecomy is usually a safe
and straightforward operation. Sometimes the
only way to be sure whether or not the
gallstones are causing the patients symptoms
is to remove the gall bladder and see what
happens. If the stones are a ‘red herring’ the
symptoms will persist. If the gallstones are
responsible for the symptoms the removal of
the gall bladder should be an end to the
problem.
If you have existing or new symptoms
triggered by food and drink after having you
gall bladder or gallstones removed you should
seek advice from your GP
•
If you develop a fever above 38C or
chills.
Persistent vomiting or nausea.
Increasing abdominal pain or
distension.
Increasing pain, redness, swelling or
discharge of any of the wound sites.
Severe bleeding
Difficulties in passing urine
Where should I seek advice or help?
If you are unwell or develop any of the
symptoms above please contact your GP or
111. If you are not unwell but do wish to
discuss a problem please contact your
surgeons secretary via switchboard and they
will arrange for you to be seen in clinic.
Telephone 01246 277271
March 2015.
Review date: March 2017
Surgical Division Clinical Lead