What is a Cholecystectomy?
This procedure is the standard treatment for gallstones and for some other conditions affecting the gallbladder. It involves the complete surgical removal of the organ.
It is only necessary where the presence of gallstones is causing symptoms - the commonest symptom of inflammation of the gallbladder (cholecystitis) or the blockage of a gallbladder duct, is severe abdominal pain. Gallstones that are not causing any symptoms do not require the removal of the gallbladder.
Removal of the entire organ is preferable to other treatments, since the body is capable of functioning perfectly normally without a gallbladder, and other treatments can have side effects and even if the initial episode is treated, there may still be a recurrence of the symptoms.
How should I prepare for the procedure?
Being an active smoker greatly increases the risk of poor wound healing and breakdown of wounds after the procedure. For this reason, we strongly recommend you either give up smoking entirely, or not smoke at all in the six weeks before the procedure. At an absolute minimum you must stop smoking at least one week prior to the procedure.
If you are taking an anti-inflammatory medication or Warfarin, Aspirin of Plavix you must stop taking these one week before the procedure. Please contact Dr Silverman if you have any questions relating to your current medication.
You will receive any further specific instructions on how to prepare for your procedure from Dr Silverman well ahead of the date of the procedure.
What is involved in the procedure?
A cholecystectomy is normally performed in an operating theatre under general anaesthetic.
The procedure is most commonly conducted using laparoscopic surgery. Using this approach four small incisions are made to the skin on the abdomen and laparoscopic instruments allow the surgeon to locate and remove the gallbladder.
In some cases, a laparoscopic procedure may need to be converted to open surgery if there are technical or safety considerations dictating this course of action. If this is the case the four incisions are closed and one larger incision is made in the upper right quadrant of the abdomen to complete the procedure.
During the operation an x-ray is taken of the bile duct to check that no gallstones have moved into the duct. If they have, a further procedure called an 'Endoscopic Retrograde Cholangio-Pancreatography ('ERCP') may be required to remove these.
This procedure is endoscopic, that is no surgery is required as the endoscopic device is inserted via the mouth and navigated to a section of the small intestine (the duodenum), where any remaining gallstones in the duct can be visualised and extracted.
As it is a relatively straightforward procedure, the patient will normally need to stay in hospital overnight and can return home the following day.
Medication for pain relief
There is normally very little or no pain after this procedure. There may be some pain once the effects of the local anaesthetic have worn off around two hours after the procedure.
If this is the case we recommend the following combination of Panadol and Ibuprofen for the initial 72-hour period after surgery:
- Two (500mg) Paracetamol tablets every four to six (4-6) hours.
- Two (200mg) Ibuprofen tablets every six to eight (6-8) hours.
If pain continues beyond this period, or if it becomes severe, you should contact your doctor.
After the surgery your incision wounds will be covered with waterproof dressings, which should be removed after five days. You are able to shower with them on during this period. Once the dressings have been removed, no further dressings are required.
Returning to normal activities
Very light exercise, such as walking can be resumed immediately after returning home and will in fact help the healing process. Patients can resume driving three days after the procedure but should wait 7-10 days before returning to light physical activity, such as office work or day-to-day domestic activity.
Heavier manual labour or sports activities (including for example jogging, cycling, swimming) should not be undertaken until 10-14 days after surgery. Intense sports activity such as weightlifting or gym workouts is not recommenced until after your first post-operative appointment with Dr Silverman.
There are no dietary restrictions after this procedure.
When to contact Dr Silverman
If you have more severe pain than outlined above, you should contact Dr Silverman or outside hours, visit the nearest accident and emergency department.
Risks / complications
There are risks associated with all surgical procedures, such as wound infection, and risks relating to anaesthesia and bleeding during the procedure.
The risks / complications specific to cholecystectomy include:
- Bile leak.
- Injury to bile duct.
- Post-cholecystectomy syndrome.
Patients sometimes develop post-cholecystectomy syndrome (PCS), which is where the same symptoms caused by gallstones continue after removal of the gallbladder. It is believed to be caused by leakage of bile into the stomach. Generally, the condition clears up in days, but it can last a lot longer with some patients.
Dr Silverman will be able to discuss any possible risks or complications with you well ahead of the procedure.