Cholecystectomy

Advice for patients undergoing cholecystectomy

 
What are gallstones?

The gall bladder is a small pear shaped sac attached to the underside of the liver. It stores bile which is used to digest the fat in food. Gallstones are a common problem that may occur if there is an imbalance in the substances that make up bile. There may be one large stone or several small ones and they irritate the gall bladder causing severe pain. If stones escape from the gallbladder they can block the bile ducts and cause pain, fever and jaundice.

What does cholecystectomy mean? 

Cholecystectomy means removal of the gall bladder. The liver continues to produce bile so that the fat in food can be digested.

What does laparoscopic mean?

In recent years surgeons have developed a way of removing the gall bladder without making a large cut (laparotomy) in the skin.

A small telescope is inserted through a cut below the umbilicus, and together with instruments through 2-3 small cuts, the surgeon can see the gall bladder. The gall bladder is removed through a small incision at the top of the abdomen, directly above where the gall bladder is sited. This procedure is called laparoscopic cholecystectomy (key hole surgery).

Sometimes it is not possible to use this technique and the operation is completed through an abdominal incision, this procedure is called an open cholecystectomy. This occurs in less than 5% of patients, and tends to occur in patients who have previously had abdominal surgery; recurrent severe inflammation of the gall bladder (cholecystitis) or pancreatitis; those who have a tendency to excessive bleeding; or if the surgeons vision of the gall bladder is obscured for any reason.

Alternatives to surgery:

Removal of the gall bladder with the gall stones in it offers the best chance of avoiding further trouble in the future. Some gallstones can be dissolved by taking appropriate medical treatment but such treatment has to be taken for life; otherwise as soon as the treatment is stopped, the gall stones will start to reform. Only gallstones without calcium in them are suitable for dissolving, unfortunately the treatment to dissolve the stones does tend to have side affects, in particular, diarrhoea.

Some patients can avoid further symptoms by being rigorous in avoiding all forms of fat (both “healthy” and “unhealthy” fats), but even they find that it is very hard to eat no fat in the long term and any “sinning” risks further trouble. While these represent potential alternatives to removal of the gall bladder and the gall stones, the latter is certainly the most reliable method of avoiding further trouble in the long term.

Adverse effects of surgery

Very rarely problems occur which may require further surgery. Complications may include bleeding, infection and injury to the duct (tube) that carries bile from your gallbladder to your bowel. Also, during laparoscopic cholecystectomy, the intestines or major blood vessels may be injured when the instruments are inserted into the abdomen.

All of these complications are rare less than 1 in 20 patients. Your doctor will discuss this with you before your operation.

After the operation

When you return to the ward after your operation, you will probably have an intravenous drip - this is to replace fluid loss due to your starving prior to and during surgery. The nurses will advise you when you may have a drink and the drip will be removed as soon as you are drinking normally.

Depending upon your surgeon, you may be allowed to go home the same day as your surgery, or stay in the hospital overnight. Your surgeon will advise you.   In the case of open cholecystectomy, you would have to stay in the hospital about four days.

You will be given pain relief (analgesia) in injection form initially, and then in tablet form. A supply of analgesia will be given to you on discharge home.

Care of your wounds 

The plasters that cover your wounds can be removed after five days (the ward nurse will advise you prior to discharge). You can have a bath or shower (it is not necessary to add salt to the water). If you notice that your wounds become red, inflamed or have a discharge, contact your family doctor.

Pain

When you get home you may still feel some discomfort, you will be prescribed pain relief . If you require further pain relief, consult your General Practitioner.

Returning to work

With laparoscopic cholecystectomy you may return to work as soon as you feel able, usually within 1-2 weeks. If a laparotomy was required, you will return to work 4-6 weeks after surgery. If you require a sickness certificate for the time that you have been in hospital, please ask the ward receptionist. The hospital will supply the first two weeks certificate, for additional certificates visit your General Practitioner.

Diet and health

It is not necessary to follow a special diet following your operation, although a diet that is low in fat and high in fibre is healthiest, as when taking any analgesia, you may become constipated. If you would like advice about diet, exercise, smoking, alcohol or any other health matter, please ask your doctor or nurse or help yourself to any of the advice leaflets on the ward.

Sexual relations

You may resume relations when you are comfortable.

Driving

It would be wise to check with your car insurance company if there are any restrictions. As a general rule, do not drive for 2 weeks after surgery, and only resume if you feel comfortable and pain free.

General advice

Do leave yourself enough time to get over the operation. Practically all patients are back to their normal activities within four to six weeks. These notes should help you through your operation. They are a general guide. They do not cover everything. Also, hospitals and surgeons vary a little. If you have any queries or problems, please ask your surgeon.

If you are overweight please try to reduce. This will reduce the anaesthetic risk and optimise your recovery.