Laparoscopic Cholecystectomy (removal of the gall bladder using keyhole surgery)

  • Reference Number: HEY-781/2016
  • Departments: Upper GI

Introduction

This leaflet has been produced to give you general information about your procedure.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

Why do I need a Laparoscopic Cholecystectomy?

Keyhole surgery to remove the gallbladder is a treatment for patients who develop symptoms such as pain or complications from gallstones or when the gallbladder goes into spasm and does not empty correctly (gallbladder dyskinesia).

Not all gallstones need treatment. It is estimated that 1 in 3 people will develop gallstones but only 1 in 5 people with gallstones will have any problems from them. Gallstones without symptoms do not usually require an operation.

If you decide not to go ahead with surgery or your individual risks from an operation are too high you may wish to adopt a watch and wait approach under your surgeon or GP’s supervision which is occasionally successful.  In the past medication and shock waves were tried to dissolve stones but was not usually successful, especially as the gallbladder may not work correctly and stones re-occur.

If you choose not to have this procedure, symptoms related to your gallbladder/gallstones may continue, deteriorate or cause life-threatening complications.  This includes pain, infection and inflammation, jaundice and pancreatitis.

What is a Laparoscopic Cholecystectomy?

“Cholecystectomy” means removing the gallbladder.  The gallbladder is a pear-shaped reservoir attached to the liver which stores and concentrates bile between meals allowing greater amounts of bile to be excreted at mealtimes which then helps with the digestion of fats in the diet.  You can still digest food without a gallbladder and although most patients notice no new symptoms after its removal, rarely patients have loose stools which do not easily flush if they eat too much fatty food.

laparoscopicCholecystectomy1

Most cholecystectomies (over 90% at Castle Hill and Hull Royal Infirmary) are completed with “laparoscopic” (keyhole) surgery where several small cuts (approximately 1cm or less) are made to place hollow tube “ports” into the cavity of the abdomen through which long thin instruments and a camera are passed to allow the surgeon access to your organs.

The abdomen is temporarily inflated with a gas (carbon dioxide) to create the space in which the surgeon works.  It is necessary for you to have a general anaesthetic (be asleep) whilst your abdomen is distended by this gas and at the end of the operation the gas is released, the wounds are sutured and you are woken up.  Occasionally it may be necessary to extend one of the scars, such as when gallstones are larger than the small wounds.

Bile is normally made by the liver, stored in the gallbladder and delivered through the bile ducts into the intestines.  Occasionally stones can find their way from the gallbladder into the bile duct and where this is suspected an “operative cholangiogram may be performed.  This is a special scan of the bile ducts taken during the operation and it is performed by injecting a contrast agent into the bile ducts during surgery and taking several X-rays.

If stones are found in the bile duct and it is possible, then the surgeon may attempt to remove these there and then by keyhole surgery (laparoscopic common bile duct exploration).  If a bile duct exploration has been performed, a special soft drain is sometimes placed in the bile duct to relieve the pressure in the bile duct and help the bile duct to heal over several weeks.  This drain is called a “T-tube” and its care will be discussed with you before you are discharged from hospital (often with this still in place).

Other methods to remove stones from the bile duct include:

  • to perform an operation to deal with them
  • to leave the stones and perform an “ERCP” as an outpatient procedure after surgery (see below)
  • scan-guided removal of stones via the liver or T-tube.

If your surgeon has a very high suspicion pre-operatively of stones in the common bile duct, they will discuss this with you.  If you have strong views regarding your treatment options, please discuss this with your surgeon beforehand.

Sometimes a separate drain may be placed next to the liver for a few hours if there has been significant bleeding or inflammation or when the surgeon is concerned about any risk of bile that may leak after the operation.  This will be removed when medically safe to do so.

 Requirement for post-operative removal of bile duct stones

If there are any bile duct stones lodged in the tube that the gallbladder is attached to, these are usually identified before your operation.  Bile duct stones are rarely identified unexpectedly at the time of surgery with a cholangiogram. However cholangiograms are not routinely performed and do not guarantee 100% that stones are detected or will not form later in life in the bile duct.

The commonest treatment approach for this is endoscopic removal.  Endoscopic retrograde cholangiopancreatography (ERCP) uses an endoscope under sedation and X-rays to view the bile ducts attached to the gallbladder (if present), pancreas and liver.  This can identify and usually remove any trapped stones causing symptoms.

Can there be any complications or risks?

Possible complications of laparoscopic cholecystectomy will be discussed with you by your surgeon.  They include:

  • Conversion to a conventional open operation (uncommon)
  • Wound infection (uncommon)
  • Bleeding (uncommon)
  • Bile leakage (uncommon)
  • Heart attack (uncommon)
  • Chest infections (uncommon)
  • Requirement for post-operative removal of bile duct stones (uncommon)
  • Deep vein thrombosis and pulmonary embolism (uncommon)
  • Residual symptoms (uncommon)
  • Wound numbness or incisional hernia (uncommon)
  • Bile duct injury or injury to other organs or peritonitis (rare)
  • Retained gallstones (rare)
  • Radiation risk (very rare)
  • Death (very rare)

Please contact your GP, if you develop any of the following:

  • Abdominal swelling or worsening pain
  • A fever or shivering
  • Redness, swelling or pus drainage from the operation wounds
  • Jaundice (yellow discoloration of your skin or eyes)

How do  I prepare for the Laparoscopic Cholecystectomy?

Please read this information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

 On the day of admission please bring:

  • This information leaflet
  • All medication in original containers along with the electronic printed list supplied by your GP
  • Dressing gown, slippers and small overnight bag/toiletries in case of overnight stay
  • Contact telephone number for a lift home
  • Something to read or occupy you to pass the time

Please do not:

  • Bring any valuables or wear jewellery
  • Wear nail varnish or false nails
  • Wear face make up or lipstick

 Before your operation

You will be having a general anaesthetic, and will have a pre-operative screening appointment to assess your suitability for surgery, before you are given a date for your operation.  At this appointment the nurse will take details of your:

  • Medical history and current medication
  • Home care arrangements after you have been discharged from hospital including relative/carer/friend support and transport arrangements

Please use this opportunity to ask any questions about your surgery and aftercare.  You will also be given instructions about preparing for your operation, which will include advice about:

  • Having a bath or shower before you come to the hospital
  • Eating and drinking
  • Pausing or taking your normal medication, if appropriate
  • Returning to work after surgery

What will happen?

On the day of surgery

You should have a bath or shower before you come to hospital.  Please do not eat from 2am but you are encouraged to drink clear fluids only up to 6am before your operation, e.g. no milk or pure orange (black tea or black coffee is allowed). Chewing gum is not allowed on the day of surgery.  If you wear contact lenses, you will need to remove them prior to your operation.  Please bring your spectacles or an extra pair of contact lenses with you.

On admission to the ward you will be greeted by a nurse who will check that your details are correct.  The surgeon and the anaesthetist will talk to you and you will be invited to ask any questions you may have before signing your consent form.  You will also be given compression stockings to wear.

A member of staff will escort you to the operating theatre.  After the operation, you will recover in a special recovery area near to theatre until you are awake sufficiently to return to the ward.

Following your operation

You will be transferred to the ward area where nurses will continue to monitor your condition.  If you feel any discomfort, please inform the nurse looking after you, so that pain relief can be given.  As long as you do not feel sick (after a general anaesthetic) you will be encouraged to have something to eat or drink.

If the doctor/nurse feel you are sufficiently recovered you may be discharged home the same day, or the following morning.  It is important that you arrange someone to collect you at an appropriate time (if you have stayed overnight this will be before 11am).  Due to the nature of the ward you may be expected to vacate your bed early and wait for your discharge transport in a discharge area.

Care at home

You will have some mild pain for up to a week after the operation.  You may also have some neck and shoulder tip pain, this is due to the gas used (carbon dioxide), which can get trapped and will disappear after a couple of days.

You will be prescribed pain relief medication to take home with you.  Please take only as directed on the packaging.  You will need to continue to wear the compression stockings on your legs that were applied prior to the operation for 5 days (day and night).

You will be informed if the stitches in your wound are dissolvable or need to be removed.  Some patients have Steristrips (small strips of adhesive tape) rather than stitches in their wounds.  Even if you have dissolvable stitches, it is recommended that you have your wound checked by the Practice Nurse at your GP surgery 4-5 days after your operation.  You may shower on the day following your surgery.  Any waterproof dressings over your wounds should remain in place for 5 days and then you may remove them.

You should remain off work for approximately 2 weeks, or as directed by the surgeon.  Your surgical team will provide initial fitness to work certificates and any required extension is provided by your GP.  Routine follow up is not required after gallbladder surgery unless specifically directed by your surgeon.

Driving and Flying

You should not drive until you can perform an emergency stop but please clarify this with your insurance company.  This will not be for the first 48 hours following your surgery.  Please check that your insurance policy does not prohibit you from driving for a longer period, following general anaesthetic or surgery.  Based on Civil Aviation Authority guidance we recommend at least 48 hours before flying after keyhole surgery or 10 days after an open surgical operation.

If you experience problems regarding your surgery after being discharged PLEASE ALWAYS CALL FIRST FOR ADVICE

It is important you DO NOT present yourself to the ward from where you were discharged.

Telephone the ward from which you were discharged – Monday to Friday 8-6pm.

After 6pm and weekends – contact Ward 14 Castle Hill (01482) 623014.

If you are unable to get in touch with Ward 14 please call your GP emergency service or 111.

You will receive advice over the telephone as to the appropriate care for you. This may be:

  • Over the telephone advice
  • To contact your GP practice to arrange a nurse-led clinic appointment
  • An urgent outpatient clinic follow up appointment with your surgeon
  • To contact your GP to arrange emergency admission to Hull Royal Infirmary

If you are severely unwell contact your emergency GP, attend Hull Royal Infirmary Emergency Department or dial 999 for an ambulance (Castle Hill Hospital does not have on-site emergency services).

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.