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Cholecystectomy - Gall Bladder Removal

 
 

What is it?

The gallbladder lies behind your right ribs at the front, below the liver and above the duodenum (gut). It is a pouch which is connected with the tubing (bile ducts) that carries bile from the liver to the duodenum. Stones forming in the gallbladder often cause pain. If stones escape from the gallbladder they can block the bile ducts and cause pain, fever and yellow jaundice.

The Operation

There are two types of operation: Keyhole and Open. The keyhole method is the most popular, but is not a good idea if you have scars from earlier operations, late pregnancy, or very severe inflammation. In this case, the open method is done. The keyhole method means making 3 wounds about half an inch long in the front of your tummy, plus another wound in your tummy button. A very narrow telescope called a laparoscope  is passed through one of the wounds. The surgeon can see what is going on inside your tummy on a television screen. Special narrow instruments are passed through the other wounds. The gallbladder is freed and drawn out through your tummy button wound. The removal is called a cholecystectomy. Using the telescope makes it a laparoscopic cholecystectomy. The wounds are then closed with stitches or sticky strips on the skin. Most patients can go home the day after this operation. Rarely, the gallbladder cannot be safely taken out the this way . Then, the open method has to be used to do the job. This can only be decided at the time of the operation. This usually means being in hospital for 4 days or more. In the open method a cut is made in the skin below the right ribs at the front. It is usually made in a skin crease across your tummy so that it hardly shows afterwards. The gallbladder and its stones are removed. X-rays are taken to show whether there are any stones in the bile ducts. If there are, they are removed. The exact procedure depends very much on the detailed findings at the time of the operation. The cut in the skin is then closed up. This method is called an open cholecystectomy.

Any Alternatives

If you leave things as they are, you are likely to have more of the same trouble. This may only be more pain from the gallbladder, which is unpleasant but not dangerous on its own. If you have had only one attack, you may like to wait and see. If you feel you could not take the operation, and especially if you are over 70 years old, this is worth thinking about. If you have had yellow jaundice, or pancreatitis, you can get seriously ill in another attack. If there are stones in the bile ducts, it is often possible to clear them out from below. This is done through a special flexible telescope you swallow. There may be no need to take out your gallbladder if this works.

Before the operation

Stop smoking and get your weight down. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to hospital. On the ward, you may be checked for past illnesses and may have special tests, ready for the operation. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks. 

After - In Hospital

If you have had the keyhole operation, your wounds are injected with a pain killing drug during the operation. They are usually only a little uncomfortable. Ask for tablets or even injections if the wounds are troubling you. You may notice some discomfort in your shoulder tips for a day or two. This is caused by the special gas used to help the surgeon see clearly in your tummy during the operation. It settles down. If you have had the open operation, the wound is painful and you will be given injections and later tablets to control this. Ask for more if the pain is still unpleasant. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. Do not make important decisions during that time.

If you have had the keyhole operation you will have 4 little wounds; if you have had the open operation you will have just one wound. The wounds will have a dressing which may show some staining with old blood in the first 24 hours. In the keyhole operation the wound dressings will be changed before you go home if they are stained. Keep the dressings on for a week until you are seen at a follow up visit. In the open operation there may be stitches or clips in the skin. Any plastic drain tube is removed when it stops draining - usually after 48 hours. If there is a thick tube, this means you have needed an additional procedure to get rid of misplaced stones. This drain is taken out after 10 days. You can wash the wound area as soon as the dressing has been removed. Soap and tap water are entirely adequate. Salted water is not necessary. After the keyhole operation most patients can go home the day after the operation. Some can even go home the same day. You can stay longer if you are not feeling fit enough to go home so soon. For the open operation, if you have only had a gallbladder removal, plan to go home in 5 days after the operation. If you have had more done, 10 days is a sensible time for planning. Please ask the nurses about sick notes, certificates etc.

After - At Home

You are likely to feel very tired and need rests 2 to 3 times a day for a week or more. You will gradually improve so that after a week in the case of the keyhole operation, or 2 months in the case of the open operation, you will be able to return completely to your usual level of activity. You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after 1 to 3 weeks. After a keyhole operation you should be able to return to work after 10 days. After an open operation you should be able to return to a light job after about 4 weeks, and any heavy job within 8 weeks. The wound may be closed with stitches, clips, or paper strips, which need to be taken out by the nurses about a week after the operation. Sometimes there are stitches under the skin instead. These melt away, so that the wound does not need any more attention. A plaster on the wound makes it more comfortable. You can wash, bathe, or shower as soon as the stitches, clips or paper strips are taken off. Soap and tap water are quite all right. Salted water is not needed. Some hospitals arrange a check up about one month after you leave hospital. Others leave check-ups to the General Practitioner. The nurses will advise about sick notes, certificates etc.

Possible Complications

Complications are unusual but are rapidly recognised and dealt with by the nursing and surgical staff. If you think that all is not well, please ask the nurses or doctors. Wound infection is a rare problem and settles down with antibiotics in a week or two. Aches and twinges may be felt in the wound for up to 6 months. Occasionally there are numb patches in the skin around a wound which get better after 2 to 3 months. Rarely, not all the stones can be removed. This would be discussed with you by the surgeon. If you have had the keyhole operation, sometimes bile can collect in your tummy in the first 2-3 days after the operation. This can be uncomfortable and put you off your food. Report it to your General Practitioner, or phone the ward. If you have had the open operation, occasionally leakage of bile from the drainage tubes is slow to stop. Patience is needed for a few days. Rarely the bile ducts can be damaged by either operation.

General Advice

The keyhole operation should be straight forward. Patients are often surprised how quickly they get back to normal health. The open operation should not be underestimated. Some patients are surprised how slowly they regain their normal stamina. However, virtually all patients are back doing their normal duties within 2 months. These notes should help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.

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