Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic cholecystectomy is a keyhole procedure to remove the gallbladder which is done under general anaesthesia. It is usually a day-case procedure, but some patients may have to stay overnight if required. As an Emergency Surgeon specialising in Upper Gastrointestinal surgery, Mr MIdya performs about 150 laparoscopic cholecystectomies every year, half of which are performed during an acute attack. His complication rates are low with high day-case rates for elective surgery.
Indications:
1) Symptomatic gallstone disease
2) Pancreatitis secondary to gallstones
3) Large or symptomatic gallbladder polyps
Symptoms of gallstones:
1) Central or upper abdominal pain specially after eating
2) Nausea /vomiting
3) Jaundice
Diagnosis:
1) Ultrasound scan
2) MRCP (MRI scan)
3) CT scan
4) Endoscopic ultrasound scan – only in specific cases
Treatment of gallstones:
1) Low fat diet and small meals
2) Laparoscopic cholecystectomy
3) Endoscopic Retrograde Cholangiopancreatography (ERCP) – if there are stones in the bile ducts
Description of Laparoscopic Cholecystectomy
Four small (1-2 cm) incisions are made over the abdomen- one near the umbilicus and three more on the upper right side of the abdomen. The tube (cystic duct) connecting the gallbladder to the bile duct and the artery supplying the gallbladder are clamped and divided. The gallbladder containing the stones is dissected off the liver and removed through one of the small incisions. The skin incisions are closed with dissolvable stitches.
Possible complications:
1) Bile duct injury (less than 1 in 400 procedures)
2) Bile leak (1 in 200 procedures)
3) Retained stones in bile ducts
4) Bleeding
5) Diarrhoea
6) Conversion to open surgery
Recovery
1) Keep the wounds dry for 4-5 day and do not soak the wounds in a bath or swimming pool for two weeks
2) Can gradually go back to normal diet after the surgery.
3) Take regular painkillers for the first few days
4) Most patients are back to desk jobs in two weeks.
5) Avoid driving for two weeks and make sure you can press the pedals for an emergency stop without pain
6) Can go on short haul flights after two weeks, but please check with your travel insurance company and the airlines
7) Avoid heavy lifting / manual labour for six weeks
Additional information:
1) https://www.fhft.nhs.uk/patients-and-visitors/patient-information/gallbladder-surgery-and-gallstones
2) https://www.rcseng.ac.uk/-/media/files/rcs/library-and-publications/non-journal-publications/gall-bladder-removal.pdf
3) https://www.nhs.uk/conditions/gallstones/
4) https://www.nice.org.uk/guidance/cg188