Patients recover very quickly from this abdominal operation and it is rare to suffer serious side-effects. Cholecystectomy produces a number of minor post-operative complications so it is important to understand these as well as the rare potential for more critical complications.
The Gall Bladder and its Removal
The liver manufactures bile and this is held in a small pouch behind it, an organ known as the gall bladder. When a person eats a meal the gut has to digest the fats in the food and to assist this bile is released into the digestive system. It is common for small stones of various kinds to develop in the gall bladder and many middle-aged or older people have them. However they are mostly not troublesome and never need surgery.
Stones may in some cases cause inflammation and pain in the gall bladder and some stones escape from the gall bladder where they move into the main connecting tube between the gut and the liver, the main bile duct. This can cause blockage of the duct and lead to a yellowing of the skin (jaundice). A surgical removal of the gall bladder, known as a cholecystectomy, may be needed in these cases.
Is Gall Bladder Surgery Harmful?
Many people live a completely normal existence without their gall bladders as it is only an organ to store bile. Cholecystectomy should cause no serious long-term side effects.
How Cholecystectomy is Done
Surgeons can use the more traditional open surgical technique or the more modern laparoscopic or keyhole surgery which is the overwhelmingly more common method but about one in twenty or five percent of operations are through an open incision. This is because the surgeon decides it is safer and the most common reasons for open surgery are because the gall bladder is very inflamed or if it has a lot of adhesions sticking it down to nearby organs.
Although surgeons mostly intend to perform the gall bladder removal laparoscopically, patients need to understand that during the operation the decision may be made to convert to an open operation on clinical grounds.
Keyhole Surgery for Gall Bladder Removal
The surgeon performs four small incisions so that the operative instruments can be inserted into the abdomen. A laparoscope is used to allow visualisisation the abdominal contents. This is a telescope device with a strong light and an attached miniaturised video camera. The surgeon can see a clear view of the inside of the abdomen on a television screen, enabling him or her to find the gall bladder and perform the operation.
Carbon dioxide gas is pumped into the abdomen to increase the viewable space for the surgeon. The laparoscope is introduced into the abdomen through an incision below the tummy button (umbilicus) and three small incisions are made on the right hand side under the ribcage for the other instruments to be used. The gallstones and the gallbladder are removed through the incision below the umbilicus.
Cholecystectomy via Open Operation
Laparoscopic operation may not always be possible and so an open operation is opted for, with the surgeon making an incision on the right side about ten to fifteen centimetres long under the rib cage. To enter the abdominal cavity the muscles and skin are divided, enabling the surgeon to identify the gallbladder beneath the liver and then remove it. To reduce the chance of a fluid collection in the abdomen a drain can be inserted.
The Anaesthetic
An injection inserted into the arm or hand is the typical way of starting off the anaesthetic. After a typical hour long operation the surgeon often places some long-term anaesthetic at the sites of the incision to ensure the maximum comfort for the patient when they wake up.
A suppository may be inserted in the back passage by the surgeon late in the operation to give some longer acting painkilling action after operation. Clear advice is given to patients that they should not eat for six hours prior to the operation and not drink anything for two to three hours before it. Patients may mobilise themselves as soon as they feel they can with someone ensuring they are safe when they initially get up.