What is a cholecystectomy?

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Cholecystectomy is the name of the operation to remove your gallbladder and gallstones. The gallbladder is a small, pear-sized pouch that sits below the liver, on the right side of the abdomen. Its role is to store and concentrate bile; a digestive fluid that helps to break down the fat in food.

Bile is made up of cholesterol, bile salts and other pigments. Sometimes these substances fall out of balance, which can result in gallstones forming within the gallbladder. Gallstones occur in many patients without causing symptoms. However in some people, gallstones can cause pain (biliary colic) or inflammation of the gallbladder (cholecystitis) or pancreas (pancreatitis).

​The best way to treat these problems is to remove the gallbladder. Previously, this was done by making a cut in the top of the abdomen and removing the gallbladder (open cholecystectomy). However, with advances in technology, we are now able to perform this procedure in the majority of patients using ‘key-hole’ surgery (laparoscopic cholecystectomy).

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The operation

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You will be asleep and pain free, under general anaesthetic, during the operation. Cuts will be made around the belly button and just below the rib cage on the right hand side. There will 4 cuts in total, each around 1 cm in size. Through each of these cuts, surgical instruments are passed; the abdomen is filled with carbon dioxide gas and a telescope attached to a small camera is used to allow the surgeon to see inside. The gallbladder can then be removed. Rarely, the gallbladder cannot be removed safely using key-hole surgery, and has to be removed by the traditional method, involving a larger cut to the upper abdomen (usually <10% of the cases).

 

Benefits

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Once the gallbladder is removed, symptoms should settle permanently. The procedure and recovery time are typically short, and if your health is generally good, you should be expected to go home the same day. We do not expect that there will be long-term side effects.

  

Risks

  

Risks specific to cholecystectomies: 

• Wound infection – 1% (1 in 100 people)

• Leakage of bile – 1-3%  (1 to 3 in 100 people)

• Retained stones or sludge - 1-3% (1 to 3 in 100 people)

• Bleeding – 0.2% (1 in 500 people)

• Injury to the common bile duct – 0.1% (1 in 1000 people)

• Injury to organs or blood vessels in the abdomen – 0.1% (1 in 1000 people)

In common with all surgeries, there are also slight risks concerning:

• Anaesthetic risks

• Chest and urinary infections

• Incisional hernias

• Blood clots in the legs, or occasionally the lungs

• Small risk of death – Worldwide, the risk of death after cholecystectomy is estimated at 1 in 800

 The risks of complications are increased in certain patients; for example, in people who suffer from other medical conditions such as heart or kidney disease.

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Preparing For the Operation

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To reduce the risks of complications, patients can: 

• Lose weight – this decreases anaesthetic risk and the chances of getting blood clots. Your surgeon may recommend that you take a very low calorie diet for 1-2 weeks prior to your surgery.

• Give up smoking - reduces risk of blood clots and generally improves health.

 

Pre-assessment clinic

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A specialist nurse or an anaesthetic doctor will assess your health and prepare you for surgery. You will also be told if there are any medications that should be stopped prior to surgery.

 

On the day of surgery

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If you feel unwell or are suffering from any health conditions, it is important to let us know, as it may be more beneficial to you to delay the surgery until you have recovered. To help reduce blood clots, you will be given an injection into the tummy and/or some tight stockings to wear. An anaesthetist will come and assess you and will be able to answer any questions you may have. You cannot eat or drink anything 6 hours before the operation, so that the stomach is empty for your operation. A small tube (cannula) will be placed in your arm to give you medication to put you to sleep. You will be monitored throughout your operation by an anaesthetist.

 

After the operation

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When you wake up, you may feel drowsy, sick and complain of a sore throat. You may experience abdominal bloating and pain in your shoulders. These are normal side-effects from inflating the abdomen with carbon dioxide during the operation and should pass within a few days. During recovery some abdominal bruising and discomfort may be expected, but this should settle with simple pain killers. It is important to mobilise as soon as possible as this helps to speed up recovery. Recovery varies from person to person, but >50% of patients are well enough to leave hospital on the same day of the operation. You will be given any medication you require, including pain relief, before you leave. You will also be given advice to avoid heavy lifting or strenuous exercise for 4-6 weeks after your operation. 

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Frequently Asked Questions

 

Are there any alarm symptoms I should look out for after my surgery?

Some discomfort is to be expected in the first 3 days after surgery, requiring regular painkillers such as paracetamol and codeine. You should be concerned if your pain is suddenly worse or not controlled without stronger painkillers. You should also seek medical advice if you have a persistent temperature or a yellow discolouration of the whites of the eyes or skin (jaundice). 

 

How long will I take to recover?

This varies from person to person, but usually takes 1-2 weeks. It may take you some time to build back up to your normal level of activity. We advise that you avoid heavy lifting and any strenuous exercise for 4-6 weeks.

 

Can I drive as normal?

As a general rule, you should avoid driving until you feel able to perform an emergency stop without hesitation and too much discomfort. This can normally take up to 2-4 weeks.

 

When can I go back to work?

This depends on how quickly you recover. It also depends upon the nature of your work; for example, if it involves heavy lifting or strenuous activity, you may need more time off. Generally, it may take up to 3 weeks before you are able to start work.

 

Will I need my stitches to be removed?

We normally use stitches that dissolve, so you will not need to have them removed. Occasionally, glue is used to close the small wounds, which will come off with time.

 

Can I live a normal life without my gallbladder?

Your liver will still produce the bile required to help digest your food, so you can lead a normal life without a gallbladder. You may experience some bloating or diarrhoea if you’ve eaten certain foods, for example spicy or fatty meals. If this occurs, you may wish to avoid those foods in the future.

 

Will I need further follow-up and treatment from my surgeon?

After your opeation you will be seen once in the clinic for standard post-operative follow-up. In general further treatments are not required.