Laparoscopic cholecystectomy is a treatment option for individuals who have symptomatic gallstones or confirmed gallbladder disease. It may be helpful for patients with functional disorders of the gallbladder (biliary dyskinesia) or as a prophylactic measure for gallbladder polyps (small growths arising from the gallbladder wall).
Surgical removal of the gallbladder via a large open incision in the abdomen was the traditional operation until the 1990’s when keyhole surgery was developed. Since then, laparoscopic cholecystectomy has emerged as the gold-standard and it is only very rarely that the open operation is now performed.
Small incisions (usually two 12mm and two 5mm) are made in the abdomen. The large ones are around the umbilicus and just below the breast bone, the two smaller ones are below the rib-cage on the right side.
The gallbladder is carefully identified, and any adhesions of abdominal tissue (common in inflammation) are slowly dissected away to reveal just the gallbladder. It is crucial at this stage to correctly identify the anatomy of the gallbladder, the location of the cystic duct and cystic artery, structures that connect solely to the gallbladder. These structures are then clipped and divided. The gallbladder is dissected free from the liver and placed in a bag which helps remove it through the upper 12mm incision.
If there are concerns about the correct anatomy, or the presence of stones in the common bile duct (tests are usually performed prior to surgery to rule these out) then an X-ray of the bile ducts (cholangiogram) is carried out. Usually the operation takes about an hour, but can be considerably longer if the gallbladder is very badly diseased. Every effort is made to complete the operation by keyhole surgery, but in about 1/50 cases, it may be necessary to convert to an open operation.
A quick note to say thank you for my cholecystectomy – absolutely brilliant.
After the operation, patients can eat, drink and get around as soon as they are able. Most patients are able go home on the same day as their operation, a few may need to stay overnight. Return to normal activities is rapid and there is no restriction on food intake after gallbladder removal, but a healthy balanced diet is always recommended. Most people return to work after about two-weeks, but this also depends on your occupation.
Laparoscopic Cholecystectomy is regarded as safe operation when carried out by Specialist Upper GI surgeons who perform large numbers of cases regularly. As with all surgical procedures however, there are risks and complications but these are rare. Damage to internal organs (visceral injury), bleeding, bruising and infection are problems common to all keyhole abdominal surgery. Injury to the common bile duct is a rare but potentially very serious complication. Bile leakage can occur from the liver bed or from the cystic duct stump. In most cases, these conditions can be managed without further intervention, but in some situations radiological, endoscopic or surgical treatment may be necessary.
Once the gallbladder has been removed, we would not anticipate any further problems. Patients are encouraged the partake in a healthy and active life-style with a normal but balanced diet (no specific restrictions).