Laparoscopic cholecystectomy (gallbladder removal) at Exeter Hospital

What are gallstones?

When you eat, your gallbladder empties bile into your intestines to help digest and absorb fats and some vitamins. Gallstones can form in bile, particularly if you eat a lot of refined carbohydrates and sugars.

Gallstones can cause severe symptoms for some people, such as repeated attacks of abdominal pain. This can be so severe that you need to be admitted to hospital. The pain is due to either:

• biliary colic – stones blocking the gallbladder duct (cystic duct), stopping the gallbladder from emptying; or
• cholecystitis – inflammation of the gallbladder.

Is laparoscopic cholecystectomy right for me?

A laparoscopic cholecystectomy is the only dependable way to treat gallstones. 

If you are female, the healthcare team may ask you to have a pregnancy test as some procedures involve X-rays or medications that can be harmful to unborn babies. Sometimes the test doesn't show an early-stage pregnancy, so let the healthcare team know if you could be pregnant.

What happens during laparoscopic cholecystectomy?

A laparoscopic cholecystectomy is usually performed under general anaesthetic and takes about 1 hour.

Keyhole surgery is associated with less pain, less scarring and a faster return to normal activities than open surgery.

In some cases, keyhole surgery can't be performed, and you may need to have open surgery instead. Your surgeon will carefully assess you beforehand. 

Before the procedure

There are a few things you can do in the lead up to the procedure to make sure everything goes as smoothly as possible:

• Let your doctor know about any medication you take and follow their instructions
• If you smoke, stop smoking several weeks before the operation
• Try to maintain a healthy weight
• Exercise regularly 
• Your surgeon may suggest you follow a special diet for 2 weeks beforehand to reduce the size of your liver and avoid complications
• In the week before the operation, don't shave or wax the area where a cut is likely to be made
• Try to have a bath or shower either the day before or on the day of the operation
• If you are diabetic, keep your blood sugar levels under control around the time of your procedure.

During the procedure

1. Once you're under anaesthetic, your surgeon will make a small cut on or near your belly button and insert an instrument to inflate your abdominal cavity with carbon dioxide
2. They'll make a few more cuts on your abdomen so they can insert surgical instruments, as well as a laparoscope (tiny telescope), via thin tubes
3. Your surgeon will free up your gallbladder duct and artery
   
4. Next, they'll clip and cut the duct and artery, and separate your gallbladder from your liver
5. Finally they'll remove your gallbladder through one of the incisions and close the cuts with stitches or staples.

After the procedure

Once your operation is over, you’ll be taken to the recovery room where you'll wake up. A nurse will be there to check your wounds, blood pressure and pulse.

You may have:

• a drain in your abdomen to remove fluid – this will be removed before you leave hospital.
• a drip (infusion) going into your arm – this will keep you hydrated until you're able to drink.

When you're ready, a nurse will take you to your room.

Recovery from laparoscopic cholecystectomy

Most people return to normal activities after about 3–4 weeks.

Short-term recovery 

You may have pain from your surgical wounds and your abdomen may feel bloated. This should ease after a few days. 

You should be able to go home the same day or you may need to spend one night in hospital. If you home on the day of the procedure, for the first 24 hours:

• you’ll need someone to take you home and stay with you overnight
• don’t drive, operate machinery, or do any potentially dangerous activities (like cooking) until you’ve fully recovered feeling, movement and co-ordination
• you shouldn’t sign legal documents or drink alcohol.

Managing your recovery at home

You should get plenty of rest to begin with, but then it’s important to stay active to avoid blood clots. Make sure you follow the instructions from our healthcare team on medication or special compression stockings. 

Here are a few more things you can do to make sure you recover well:

• Take any painkillers we've prescribed
• Avoid any strenuous activity or heavy lifting for the first 2 weeks
• Exercise regularly.

When to call us 

If you notice any of the following symptoms, let the healthcare team know straightaway as it can be a sign you have a serious complication.

• Pain that gets worse over time or is severe when you move, breathe or cough
• A high temperature or fever
• Dizziness, feeling faint or shortness of breath
• Feeling sick or not having an appetite, which gets worse after the first 1–2 days
• Not opening your bowels and not passing wind
• Swelling in your abdomen
• Difficulty passing urine
  
• Jaundice (yellowing of the eyes/skin, along with dark urine).

Time-off work

You should be able to return to work after 2–4 weeks, depending on how you feel. If you have a manual job, you should wait 6–8 weeks.

Follow-up appointments

If your wounds were closed by removable stitches, you'll need to come in to have them removed.

Complications of laparoscopic cholecystectomy

As with any surgery there's a small risk of complications, such as:

• pain
• bleeding
• infection of the surgical site (incision)
• scarring
• blood clots (DVT - deep vein thrombosis)
  

Specific complications of laparoscopic cholecystectomy can include:

• damage to internal organs
• developing a hernia in the scar
• leaking of bile
• retained stones
• diarrhoea
• inflammation of the abdomen

The healthcare team will do their best to minimise any risks. Make sure you discuss any concerns you have about these complications with your consultant.