Laparoscopic cholecystectomy (a key hole surgery to remove gallbladder and gallstones) is the treatment of choice for symptomatic gallstone disease. Under general anaesthesia, a small, 1.5cm incision is made around the belly button (umbilicus) and a camera is inserted. The abdominal cavity is inflated with carbon dioxide and three 5mm incisions are made in the upper abdomen to introduce instruments for surgery. An x-ray of bile duct (cholangiogram) is performed during surgery to exclude stones in the bile duct and to confirm the anatomy of the biliary tree. A careful dissection of the gallbladder is performed to achieve “the critical view of safety” and to minimise the risks of complications related to surgery. If an x-ray detects a stone in the bile duct, this can be retrieved either laparoscopically at the time of operation (trancystic exploration of bile duct) or by a subsequent endoscopic procedure (Endoscopic Retrograde Cholangio-Pancreatography or ERCP). Occasionally, laparoscopic cholecystectomy is completed by an open surgery (open cholecystectomy) when it is not safe to persist with a laparoscopic approach.
Although laparoscopic cholecystectomy is safe and is rarely associated with serious complications, it is important to be aware of potential complications, which include:
- General risks of surgery – heart attacks, stroke, pulmonary embolus.
- Specific risks of surgery – internal bleeding, infection, bile leakage, bile duct injury, injury to organs near the gallbladder.
Laparoscopic cholecystectomy usually takes one to one and a half hours to complete. Patients can eat and drink once fully awake from anaesthetic.
Post-operative instructions
Most people recover sufficiently to go home the morning after the laparoscopic surgery and have a virtually complete recovery within a week. A review appointment is made for two weeks time. After returning home, most of normal activities, including light exercise such as walking, can be resumed in 3 – 5 days. Simple pain medications are usually required during this period. Driving whilst on narcotic pain medications and lifting (> 5kg for 4-6 weeks) should be avoided. Waterproof dressings may be removed in 7 days and showers can be taken without dressings.
Patients may have some gas pains and loose bowel motions while the digestive system returns to normal. During this period of adjustment, eat healthy food (avoiding fatty food) that is easy to digest.
If you develop any of the following symptoms after surgery, please contact me or see your doctor: fever, chills, red and discharging wound, severe abdominal pain and vomiting.
