Around 50,000 people undergo gallbladder surgery each year in the UK. Mr Simon Wemyss-Holden, Consultant General and Laparoscopic Surgeon at Spire Norwich Hospital in Norfolk discusses why and how this type of surgery is performed.
The gallbladder is a small pear-shaped pouch in the upper right part of your abdomen. It stores and concentrates bile produced by the liver from bile salts and waste products which help digest the fat content of our food. Similar to the process of a compost bin which breaks down the organic waste into its simplest parts. The bile travels through a tube called the bile duct from the gallbladder to the intestine.
Gallstones can develop if the bile gets too concentrated. These small, hard stones may cause no symptoms and in many cases remain undetected. However, intermittent episodes of pain may be experienced, particularly after eating a fatty meal, if the gallstones are confined to the gallbladder, known as biliary colic.
If a gallstone blocks the exit of the gallbladder the bile may become stagnant, which may cause infection and inflammation of the gallbladder, called acute cholecystitis. Other symptoms include making you feel sick and giving you a temperature. Occasionally, a small stone may escape from the gallbladder and get stuck at the lower end of the bile duct. This can in turn lead to jaundice (yellowing of the skin) or pancreatitis (inflammation of the pancreas), a life threatening condition.
Until the 1990’s the surgical treatment for symptomatic gallstones was to remove the gallbladder via an open operation through a single abdominal incision (15-20cm long). However, with advances in surgical techniques symptomatic gallstones are more commonly treated by removal of the gallbladder by laparoscopic (keyhole) surgery, called laparoscopic cholecystectomy.
What is a gallbladder operation?
Mr Wemyss-Holden explains “A gallbladder operation performed laparoscopically means your surgery may be performed without having to make a large cut on your abdomen. However about 1 in a 100 people may require open surgery. The most suitable method of surgery will be discussed and agreed during a consultation with your surgeon.”
“Laparoscopic cholecystectomy is usually undertaken as a day case procedure, but some patients may need to stay in hospital overnight. The operation is performed under a general anaesthetic. This means you will be asleep during the procedure which usually takes around 30 to 40 minutes.”
How is laparoscopic gallbladder surgery performed?
“The operation is performed through 3 or 4 small (5-10mm) cuts in your abdomen, one below you tummy button, one at the lower end of your breast bone and 2 underneath your ribs. Carbon dioxide gas is then pumped into the abdomen creating a space for your surgeon to work in and making it easier to view the internal organs.”
“The laparoscope (a long, thin telescope with a light and camera lens at the end) is passed through the cut under your tummy button and the laparoscope is connected to a TV screen.”
“Specially adapted surgical instruments are passed through the other cuts on your abdomen to allow your surgeon to dissect and remove the gallbladder whilst watching the TV screen.”
“X-ray pictures are taken to look at the bile duct during the operation, in order for your surgeon to see if any gallstones are blocking the bile duct. Afterwards, the instruments are removed and the gas is allowed to escape. The skin cuts are closed with dissolvable stitches and covered with dressings.”
“Following the operation you are likely to feel some pain in the abdomen as well as ‘referred pain’ in the tip of your shoulder – caused by the gas used to inflate the abdomen. This usually disappears within 48 hours.”
“Laparoscopic cholecystectomy is a safe operation if performed by a well trained experienced surgeon. For most people, the benefits in terms of improved symptoms and prevention of future complications far outweigh the disadvantages.”
What are the risks?
Mr Wemyss-Holden continues “All surgery carries an element of risk. This can be divided into the risk of side-effects and the risk of complications.”
“Side effects –After surgery, you may feel sick as a result of the general anaesthetic. Medication is available to help with this. About 1 in 10 people develop some diarrhoea following removal of their gallbladder. This is due to the bile salts irritating the digestive system. Eating a high fibre diet may help to make your bowel movements firmer. Alternatively, your GP may be able to suggest bulking agents should you have persistent problems with diarrhoea.”
“Complications –The chance of experiencing a major complication during surgery is extremely small, in the order of 1 in a thousand. This relates to the possibility of injury to a piece of bowel, a blood vessel or the bile duct. We know that the more operations a surgeon performs, the smaller this risk. There are other more common but much less serious complications such as bloating, wind and diarrhoea which your surgeon will discuss fully with you before your operation. The exact risk will differ for every person and all risk factors, including your general health will be taken into consideration.”
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