Gallbladder removal surgery (cholecystectomy)

It is an operation to remove the gallbladder, which is part of the biliary system. It is also known as a cholecystectomy (lap chole when performed laparoscopically) and is a very common procedure. The primary reason for removal of this organ is when gallstones develop that cause symptom.

Most patients with biliary pain, which is also called biliary colic, have pain in the upper abdomen, particularly the top right-hand corner of the abdomen, usually after eating and often after eating rich food. Pain sometimes is associated with nausea or pain radiating to the back or the shoulder blades. In more severe attacks, this can also be associated with inflammation of the gallbladder, with some people developing a fever and the pain can last longer than a couple of hours. Other, more serious symptoms, can include a rapid heartbeat, yellowing of the skin and white of the eyes, itchy skin, diarrhoea, shivering attacks, confusion, and a loss of appetite.

Gallstones arise when the patient produces a bile from the liver that has the wrong concentration of bile and cholesterol which then forms the stones. Bile is a liquid produced by the liver to help the digestive process. Gallstones can also form if there are particularly high levels of cholesterol inside the gallbladder or abnormally high levels of a waste product called bilirubin inside the gallbladder.

However, whilst it is known how gallstones are formed, the exact cause or causes of them is not. In recent years, it has been discovered that very rapid weight loss can produce gallstones in the gallbladder and increase symptoms but there is no simple known cause for development of the vast majority of gallstones.

Patients will undergo an assessment in hospital in the weeks leading up to surgery. This may include blood tests and a general health check to ensure patients are fit enough for surgery and that this is the most suitable course of action for them. Patients will be advised about things they can do to reduce their risk of complications following surgery, including quitting smoking and losing weight. Patients must inform their doctor of any medication or supplements they are taking, especially if they have not been prescribed by a doctor.

Most of the surgery is done with "keyhole" or laparoscopic surgery. This procedure involves a small incision of around 2-3cm made near the belly button and two or three smaller incisions of around 1cm or less are made on the right side of the tummy. A small tube will be inserted into one of the incisions and carbon dioxide gas will be pumped into the tummy to inflate the abdomen making it easier for the surgeon to operate on the gallbladder.

An instrument called a laparoscope, which has a small camera, will be put through the incision, providing full visibility of the tummy for the surgeon to see on a monitor. The surgery to remove the gallbladder is then conducted. Once the procedure is complete, the gas is released, and the incisions are stitched up and covered with dressings. Patients will usually have the operation done within a day in a non-emergency setting.

In a few cases, it is not possible to conduct or finish the operation with keyhole surgery, and a procedure called open surgery would be the next course of action. It involves a much larger incision of around 10-20cm in the tummy. This operation requires admission to the hospital for around three to five days.

They should be medically fit and lose as much weight as possible. Patients should also ensure they starve at least six hours before the operation and ideally begin starving the night before. Other than that, there is not much preparation required.

Can the patient bring a relative or friend with them?

This is encouraged as the patient may still be feeling the effects of the anaesthetic up to 24 hours after the operation. Patients should not drive afterwards and should ask someone to escort them home. Someone should be close by to the patient the first night they are home following surgery.

The majority of patients will undergo keyhole surgery, which is an operation done in a non-emergency setting and they will be home the same day as the operation. The first week they will suffer some discomfort that will require regular pain killers. In the second week, their condition will be much improved. Patients should eat fairly simple food in the first week with no restrictions in the second. Most people are back to work after two weeks.

For patients who undergo open surgery, they will normally have to stay in hospital for three to five days and their recovery time will be much longer. It can take up to six to eight weeks to return to work and other normal activities.

For most people, this is a very effective and safe operation from which they make a very rapid recovery and they are no longer suffering debilitating types of abdominal pain, which can be extremely distressing. Patients will be able to return to eating a normal diet, without the severe complications that gallstones can cause. Removing the gallbladder will have no impact on the normal functions of the body.

There are risks to any form of surgery, including excess bleeding, infection, deep venous thrombosis, the risks from the anaesthesia. In laparoscopic gallbladder surgery, there are two main risks. Firstly, there is damage to the bile duct, the tube that leads from the liver to the intestine that carries the bile. This is a very significant problem if it happens, but fortunately it is rare.

Secondly, the biliary system is like the body's domestic plumbing, so post-operatively a small leak can occur from where the operation took place and that can create inflammation in the tummy, requiring admission to hospital and further treatment. This happens in about one in a hundred cases. People's bowel motions can become looser and patients may experience some residual pain postoperatively. Other, less common, side effects include digestive issues, heart problems, pancreatitis, and pneumonia.

Sometimes, patients with gallstones can present with no symptoms and if they have a painful gallstone episode, there may be no recurrence. In such cases, surgery will not be needed as the problem may solve itself without medical intervention.

However, if patients are unable or unwilling to undergo surgery but require treatment, there may be a number of possible non-invasive techniques that could be considered. There is the option of undergoing an endoscopic retrograde cholangiopancreatography (ERCP). This test is for diagnosing gallstones, but the doctor may be able remove some of the gallstones if they are found at the same time as conducting this procedure. However, patients may still require surgery to remove the gallbladder as an ERCP will usually not be able to remove all of the gallstones.

It may also be possible to dissolve gallstones by taking ursodeoxycholic acid tablets, especially if the stones are small and do not contain any calcium. However, such treatment is rarely effective, needs to be taken for a prolonged period of time of up to two years, and the stones can come back once the patient ends treatment.