What is a laparoscopic cholecystectomy?
Laparoscopic cholecystectomy means the removal of the gallbladder (“cholecystectomy”) with keyhole surgery (“laparoscopic”).
When is this operation required?
Laparoscopic cholecystectomy is generally performed for gallstone diseases. As a general rule, once a patient develops symptoms from gallstones, there is a high chance of having further symptoms and other complications from gallstones (inflammation of the gallbladder etc). Not only does gallstones cause pain, it can also cause complications which can potentially be life-threatening such as pancreatitis. It is in these patients which we recommend surgery.
The problem is that gallstones cannot just be removed as the disease is due to the way the gallbladder processes bile rather than simply due to the gallstones itself. That is why the removal of the gallbladder is recommended.
Caption – The gallbladder is found underneath the liver and hangs off the side of the bile duct. Surgery involves removal of the gallbladder whilst keeping the bile duct intact.
How is the gallbladder removed surgically?
The gallbladder hangs off the side of the bile duct, which drains bile from the liver. The operation simply involves clipping off the blood supply of the gallbladder and then taking the gallbladder at its stalk off the bile duct. The important point of this operation is that the bile duct is left intact so that the passage of bile from the liver to the bowel is unaffected.
In most cases, the operation can be performed by keyhole surgery (“laparoscopically”). In a small proportion of patients (less than one in twenty), laparoscopic surgery cannot be performed due its difficulty – the operation is then “converted” to an open operation. During this surgery, an x-ray of the bile duct (“cholangiogram”) may also be taken to ensure no stones have escaped into the bile duct.
Usually, the operation takes about an hour and most patients can be discharged either on the same day of surgery or on the following day. If an open operation is performed, patients generally stay for about 5 days to a week.
What are the risks of surgery?
Like any operation, there are risks. Firstly, there are risks associated with the anaesthetics – this risk is related to the patient’s age and medical issues.
With regards to surgical risks, the specific risks of surgery include:
- Bile leak – leakage of bile from where we have clipped the stalk of the gallbladder or from the liver. This occurs in approximately 1 in 100 cases. The treatment for this is drainage of bile with a tube and possibly endoscopy to decompress the bile duct (ERCP).
- Bile duct injury – the most feared complication of gallbladder surgery. This is where the main bile duct carrying bile from the liver to the bowels is damaged. This is rare (about 1 in 300 cases). The treatment for this is usually a further operation to repair the damage or to redirect bile to the bowel elsewhere.
- Damage to surrounding structures – The small and large bowel can be found in approximately the same area as the gallbladder and this can be damaged during surgery. This is very uncommon.
- Conversion to an open operation – as stated above, there is a chance that keyhole surgery is not possible. This may be due to inflammation, scarring or abnormal anatomy. This should be less than 1 in 20.
I am having surgery for the gallbladder, do you have any further information regarding this operation?
Yes. We have created an information sheet for our patients undergoing gallbladder surgery. Do note that this is generic information and may not apply specifically to your circumstance.
If you are undergoing surgery with us at CESA, our surgeons will explain everything to you in detail with information which is tailored to your specific circumstances. Also, feel free to ask your surgeon any questions which may not be covered in the information sheet.