Surgery

The main form of treatment for symptomatic gallstones is surgery. The commonest form of surgery performed is called laparoscopic cholecystectomy, which involves key-hole surgery to detach the gallbladder and remove it. Information about the benefits and risks, as well as postoperative recovery, are provided below. It is also available in a leaflet which can be downloaded by clicking here.

 

Laparoscopic cholecystectomy

Key-hole surgery is the preferred way of removing the gallbladder. This usually involves 4 or 5 small incisions in the abdomen and is performed under a general anaesthetic. Many patients who are suitably fit can have the operation performed as a day case procedure, where they are discharged home on the same day that the operation is performed. Previous major abdominal surgery, or some specific problems from gallstones, may mean a person is not suitable for key-hole surgery, in which case an open operation is performed through a single, larger incision. This requires an in-patient stay for a number of days to recover before being able to go home.

Benefits

The main benefits of having your gallbladder removed are to treat symptoms, such as pain, and to prevent further problems that gallstones may cause, such as infections, jaundice or pancreatitis. Sometimes the gallbladder may be removed to treat polyps which may not be causing symptoms, but are associated with a risk of gallbladder cancer.

Risks

Any operation carries with it some associated risks. While every effort is made to minimise the risks associated with surgery, the risks of surgery cannot be removed entirely. General risks of having an operation include bleeding, wound infection, clots on the legs or lungs, and anaesthetic problems such as allergic reactions to medications. Specific risks associated with having gallbladder surgery include:

• Leakage of bile from the bile tubes
• Injury to the main bile duct
• Undetected stones being left behind in the bile duct
• Diarrhoea or dietary intolerance of fat

While the specific risk of these complications may vary according to your circumstances, a large national study in the UK quantified some of the specific risks as follows: bile leak - approximately 1 in 100; main bile duct injury - approximately 1 in 300 (CholeS Study Group, 2016).

Recovery

After successful key-hole surgery, most patients are discharged within 24 hours. After the operation, you will be able to get up and walk around and perform usual activities such as washing and dressing. You will be given regular pain killers to help control the pain from the operation. After a few days, the pain should steadily improve and you will then be able to cut down the pain killers you are taking. Most people are able to return to office-type work after 2 weeks, but more physical work may require a longer period such as 4 to 6 weeks. You should not drive until you are able to comfortably wear a seatbelt, perform an emergency stop and twist to check your blind spot. If you can do these without hesitating due to pain, we advise you must notify your insurance company before resuming driving.

Most patients do not require any further follow up after the operation. However, you should monitor your wounds, and if you develop any redness, increasing pain or tenderness, discharge from the wounds, or develop a fever, or are concerned you are not recovering from the operation, you should consult a doctor.

Liver reducing diet

If you are having surgery to remove your gallbladder and you are significantly overweight, you will need to follow a special diet for 2 weeks before your operation to make the operation safer for you. This is called the 'Liver reducing diet' and further information about this can be found here. This special diet is advised for all patients with a Body Mass Index (or BMI) over 40. BMI is worked out from your weight in kilograms and your height in metres. You can find an NHS BMI calculator by clicking here.

This is a short-term diet for the specific purpose of preparing people who are overweight for their operation. Please read the information leaflet carefully and follow it as advised.

References

CholeS Study Group and West Midlands Research Collaborative. Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases. British Journal of Surgery (2016);103(12):1704-1715.