Gall bladder surgery (laparoscopic cholecystectomy)

Sometimes stones may form inside the gall bladder. These stones often prevent the gall bladder from working properly and can cause pain – especially one to two hours after eating. This pain is usually referred to as biliary colic and usually affects the upper and right side of the abdomen.  Occasionally, stones may come out of the gall bladder and cause blockages in the tubes around the liver. This may lead to jaundice (yellow appearance of the eyes) and sometimes inflammation of the pancreas (pancreatitis).

Gallstones are usually diagnosed with an abdominal ultrasound scan. Sometimes an MRI scan is needed if there is concern that stones may have come out of the gall bladder and caused any blockages in the tubes around the liver.

Unlike kidney stones, gallstones cannot generally be broken down or dissolved by medicines or radiological devices. The definitive treatment for gallstones is surgery to remove the entire gall bladder. This is recommended because the gall bladder itself is often diseased (inflamed) and to prevent any more stones from forming in the future. The gold standard procedure is a laparoscopic (keyhole) cholecystectomy.

This is usually a day-case procedure, performed under general anaesthetic.
Four laparoscopic ports are positioned in the upper abdomen and, after clipping and dividing the cystic duct (tube that connects the gall bladder to the bile duct) and cystic artery (small blood vessel that supplies the gall bladder), the gall bladder is dissected from the liver and removed.

The four, small skin incisions are then closed using dissolvable sutures. Most people are able to return to gentle activities fairly quickly after the procedure but usually take between one and two weeks off work.

Complications after laparoscopic cholecystectomy are rare but include injury to the bile duct (less than 1 in 500 patients’ ), bile leak (about 1 in 200 patients), bleeding and haematoma (rarely requiring further surgical intervention), retained stones (in the bile duct) and diarrhoea (rare and usually settles within a few weeks). As with any laparoscopic procedure, there is a very small risk of visceral (internal organ) injury but this is usually only a significant risk in patients who have had previous major abdominal surgery.