The Gallbladder & Gallstones

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The liver produces bile that is used to breakdown fats in the diet. This is usually stored in the gallbladder and once a fatty foods are eaten, the gallbladder contracts to squeeze this out into the intestines to break down this fat. Stones form in the bile with age and with diets that are high in fatty foods. These stones can block the tubing from the gallbladder (Cystic duct) and case the pains associated with biliary colic. If stones pass through this into the tubing from the liver (Common Bile Duct) then this can cause life threatening infections of the liver (Cholangitis) or inflammation of the pancreas (Pancreatitis). Blocking the tubing can also cause a yellow discolouration of the eyes and skin (jaundice).

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Surgery aims to avoid the complications above.

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Alternatives to Surgery

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Conservative management with a low fat diet can help to reduce the gallbladder from contracting and therefore the pains associated with stones blocking the cystic duct. This does not cure or prevent stones from forming. This is recommended to whilst awaiting surgery and relieve symptoms.

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Drugs that dissolve gallstones and ultrasounds that breakdown stones are of very limited use, can lead to smaller stones getting stuck and so not prevent stones from re-forming.

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Surgery is the only way to potentially prevent recurrent symptoms and complications associated with gallstones.

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What does an operation involve?

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The vast majority of operations are done through keyhole surgery (Laparoscopic). Once under anaesthetics and asleep, a port is inserted to the umbilicus (10mm) with a further port in the upper abdomen (10mm) and 2 on the right side of the abdomen (5mm in size). The gallbladder is separated from the liver, any bowel and the tubing from the liver (common bile duct). Clips are placed across the cystic duct and artery supplying the gallbladder. The gallbladder is removed through the umbilical port. If there are problems with identifying the anatomy as there can be variations, then dye can be used with X-Rays to identify and prevent damage to other structures. In less then 1 in 20 people it is not possible to do the operation by keyhole surgery and an open cut is required to remove and gallbladder.

 

Before the operation.

 

Ensure you tell your specialist and anaesthetist about all medication you take. You will usually also have a pre-assessment appointment to ensure you are optimised before your surgery.

 

General recommendations for all operation are to reduce or stop smoking as this decreases complications of wound infections, breakdown, chest infections and longer term health problems. Regularly exercising even leading up to your operation has shown to improve on outcomes post-operatively by leading to better ‘pre-habilitation’. It is also recommended to not shave the week before surgery over the abdomen and is advisable to have a shower/bath the day before or morning of surgery to decrease infection risks.

 

On the day operation day. 

 

The procedure is usually done as a day case procedure and therefore be admitted and discharged from the hospital on the same day. After the anaesthetic, you will be given local anaesthetic to help with any pain post-operatively and may be given antibiotics.

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Potential Complications

 

Complications can be both general for any operation and specific for the particular procedure.

Your specialist will be able to go over specific ones with you.

 

General Complications of Laparoscopic Surgery:

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1. Pain: Local anaesthetics are given at the time of surgery and would be important to continue oral pain killers after the operation. Pain should be well controlled to enable you to take a deep breath in to expand the lungs and prevent chest infections from occurring. Shoulder tip pain (if this occurs from retained air after the operation) should settle within 24 hours.

2. Bleeding: Bleeding is rare but if occur may require a blood transfusion or re-operation.

3. Infections: This usually causes a high temperature, redness, swelling and increased pain at wound sites Antibiotics are used to treat this. It is safe to shower after 2 days following the operation.

4. Blood clots in the legs or lungs: Keeping mobile is important to prevent this along with the use of TED stockings.

5. Damage to Other Structures: This can occur rarely in less then 3 in 1000 people and is not obvious in one third of people. Previous surgery and scar tissue (adhesions) can increase the risk of this.

6. Hernias: Where cuts are made in the skin, there is a risk of 1 in 100 people of developing a hernia at these sites which can be repair at a later date if this does occur.

 

Specific Complications:

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1. Collections of fluid: Leakage of bile or blood can form a collection of fluid which is usually dealt with at the time of surgery. If oozy at the time of surgery then a drain may be inserted. Collections can also happen if a clip comes off following surgery and may require a camera test (ERCP) or re-operation.

2. Stone retention: Stones can be dislodged into the common bile duct which may require a flexible camera test to remove.

3. Common bile duct injury: This is rare and can occur in 3 in 1000 people and usually required a further operation if this occurs.

4. Continued Pain: Sometimes pain ca be due to alternative diagnosis or contraction of tubing that does not respond to surgery.

5. Change in bowel habits: Some patients may go to the toilet more often (3 in 100 people) as bile continually is released into the intestines and have looser stools (1 in 100) especially with higher fatty intakes.

6. Injury to other organs: One in 500 people may have bowel injury if stuck to the gallbladder and liver injuries are even rarer. Both may require a further operation.

7. Pancreatitis: This can occur when a stone passes down the tubing from the gallbladder and blocks the pancreatic duct. The risk of this is about 3 in 1000 people.

 

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Recovery from the Operation

 

Following the operation, you will be wake up in recovery and usually go home the same day. You will require a responsible adult to be with you at home for the first 24 hours and have access to a telephone in case you help or advice is required. It is important to continue to take regular pain killers to avoid chest infections as mentioned above.

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You will need to seek medical advice if you develop worsening pain, high temperature, shortness of breath, abdominal swelling/distension or problems in passing urine or opening your bowel.

 

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Activities following surgery

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For the first 24 hours following a general anaesthetic or sedation, do not drive, operative machinery, carryout dangerous activities, drink alcohol or sign legal paperwork. You can usually start driving once you can control and make an emergency stop.  It is important to be mobile to avoid blood clots and may need to wear stockings to prevent these. Depending on the type of work you do, you can usually return within 2-4 weeks.

 

You will usually have a follow-up after you operation between 4-12 weeks depending on the operation carried out.