Gallstones and Cholecystectomy

 

If you have severe or repeated symptoms from your gallstones, or if they lead to a hospital admission, you may need to have your gall bladder, and the contained gallstones, removed (cholecystectomy). In over 95% of cases this can be carried out by a laparoscopic procedure. Laparoscopic surgery is often referred to as 'keyhole' surgery. Unlike ‘open’ surgery, the gallbladder is repaired through
small incisions in the abdomen rather than a single incision over the hernia. Very small cuts are made in the abdomen and a fine telescope (a laparoscope) and other specialised instruments are inserted through these cuts. Usually there are 12mm incisions around the umbilicus and between the ribs, as well as a 5mm incision on the right side of the abdomen. Occasionally more incisions may be necessary.

The laparoscopic method has the advantage of causing less post operative pain and patients are able to return to full
activity in a shorter time. The reasons for an open (non-keyhole) operation usually relate to scar tissue from previous surgery or unusual anatomy relating to the blood supply and ducts of the bile system.

Surgery
You will usually have a pre-op assessment in the week before surgery where blood tests, chest X-ray and an ECG (heart recording) may be taken. You will be admitted a few hours before the approximate planned time of surgery having had nothing to eat for six hours before the start time (you may drink water up to two hours before your proposed time of surgery - with any of your regular medications). You will see your surgeon and the anaesthetist before your operation. After your surgery you will wake up in the recovery room, and then be transferred back to the ward. Later the same day you may have something to eat and drink if you wish. Most people are discharged home later the same day but if you have had on open operation you will need to stay for a further one or two days. You will be provided with painkillers before discharge but it is recommended that you take regular paracetamol and ibuprofen (unless you are sensitive to these) after a few days of these. Stronger painkillers such as cocodamol are occasionally necessary but if so it is important to take a laxative such as lactulose at the same time. You can expect to have some discomfort for up to a week after surgery, but this will gradually subside. It will more uncomfortable for longer if you have had an open procedure but most people are predominantly back to normal by six weeks. In the first few days you may notice pain in the shoulder tip. This relates to the carbon dioxide used to inflate the abdomen, and disappears on it’s own. With both types of surgery there will still be minor twinges for many months as the tissues around the mesh organize themselves. You will be able to take gentle exercise but should avoid heavy lifting or strenuous work for 4 weeks. You may drive a car when you are able to perform an emergency stop.

You might have some bruising around the wounds and this may take several weeks to settle. You may also feel bloated for a few weeks. If the wounds swell, become more painful and hot, or start to discharge, you should contact the ward or your General Practitioner. There are usually no stitches to be removed.

You will be seen for follow-up six weeks following your surgery.

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