This is some brief information about the gallbladder, its function and what happens when it becomes diseased. If you still have questions, ask your doctor for more information.

What does the gallbladder do?

The gallbladder is a small pear-shaped sac, attached to the underside of the liver. The bile duct is a tube that carries bile from the liver to the duodenum. When the patient is fasting, the lower end of the bile duct closes and bile back-flows into the gall bladder. There it is concentrated by the gall bladder, absorbing the water in the bile. When a patient eats a fatty meal, the gall bladder squeezes out the bile to help absorb the fats. So the gallbladder stores and concentrates bile, which is made in the liver and plays a major part in the digestion of fat. Bile will still be present, after your gallbladder is removed.

What are Gallstones?

Sometimes the substances contained in bile crystallize in the gall bladder, forming gallstones. These small, hard concretions are more common in those over 40, especially in women and the obese. They can cause inflammation of the gall bladder, a disorder that produces symptoms similar to those of indigestion, especially after eating a fatty meal. If a stone becomes lodged in the bile duct, it produces severe pain (biliary Colic). Gallstones may pass out of the body spontaneously; however, blockage can occur in the main bile duct preventing the normal flow of bile to the duodenum leading to Jaundice (yellowish discoloration of skin).

What are the Types of gallstones?

• Cholesterol stones
• Pigment stones
• Mixed stones – the most common type. They are comprised of cholesterol and salts

What Causes of Gallstones ?

A number of causes have been suggested. It is thought that some people secrete more cholesterol than others. As the gallbladder concentrates the bile stored in it, the cholesterol precipitates forming crystals and that these adhere together forming the stones. The stones then tend to enlarge or multiply especially if there is any infection involved. Pregnancy, obesity, rapid weight loss and a family history of gallstones are factors that increase the chances of developing gallstones. Other causes include liver cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed. It is also more common in diabetics and people taking Cholesterol-lowering drugs.

What’s next? Is it an operation?

If you have been found to have gallstones or you are having symptoms of nausea, vomiting and abdominal pain then an operation is warranted. The pain is mainly in the upper and right upper quadrant of the abdomen, under the ribs. It might radiate to the back or to the area between the shoulder blades. The pain can be very severe leading the patient to pace around and preventing to find a comfortable position. Attacks are generally but not always provoked by fatty foods such as chips, cream or cheese. During a severe attack, the patient may develop Jaundice (yellow skin).The diagnosis is usually made from the typical symptoms and an ultrasound scan. Many other types of scans are available which will lead to the same conclusion.

Gallstones may be diagnosed incidentally during the course of tests for other conditions. It is a point of debate as to whether these stones warrant an operation; you should discuss this with your specialist. Other presentations include vague indigestion, bloating sensation, and belching.

Is Surgery the only option?

No, but surgery is recommended as the only reliable way for cure. It is possible to dissolve the stones, however, this can take a considerable period of time (over 1 year) or break them into small pieces, but unfortunately these techniques have high failure rate and the drugs used have unpleasant side effects. There is also the high possibility of the gallstones recurring after such a treatment. The problem is that it is the gall-bladder and not the gallstones that is diseased.

What if I decided against having the operation?

The doctor will only advise and not force anything on you. Your gallstones may not cause any trouble. However, if you have already had symptoms and several previous

attacks of colicky pain, then it is unlikely for these to resolve spontaneously. Pain is usually due to the blockage of the duct by a stone and preventing the gallbladder from emptying (biliary colic) or to inflammation of the gallbladder (cholecystitis).

Severe pain can be related to the inflammation of the pancreas (pancreatitis) which can be life threatening and develops as the stones move out of the gallbladder down the common bile duct. You can develop jaundice (yellow discoloration of the skin) with its consequences, if these stones block the main bile duct preventing the normal flow of the bile into the duodenum.

Are there any long-term sequelae?

Very few. The function of the gallbladder is to store bile produced by the liver between meals and release it during mealtime. The absence of a gallbladder allows a constant drip of bile into the intestine. In most patients, the diseased gallbladder has long-since ceased to function and its removal does not alter the digestive balance in any way. A few patients will notice a very slight increase in the frequency at which they open their bowels.

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What is laparoscopic Cholecystectomy?

Laparoscopic cholecystectomy is surgery to remove your gallbladder by a minimally invasive method (Keyhole surgery). The laparoscopic removal of the gall bladder (cholecystectomy) is performed under general anaesthetic so that the patient must be in reasonable health.
It involves the following:

• Making four small incisions, one inch or less, in the abdomen, including one in your naval
• Putting gas (CO2) into your abdomen, so that your gallbladder can be visualised
• A telescope attached to a tiny video camera is introduced and the abdominal contents are inspected
• Other instruments are put to hold and assist in dissecting and removing the gallbladder
• The gall bladder is readily located and is grasped with forceps. It is freed from attachments to the liver
• The cystic duct (a small tube, connecting the gall bladder to the bile duct) is dissected free of the fatty tissue that encases it and a catheter inserted into it.



• A special dye may be injected down this and an x-ray of the main bile duct, which takes bile from the liver to the duodenum, is taken. This is to confirm that no gallstones have entered the bile duct where they could cause a blockage leading to obstructive jaundice. Once the X-ray has been completed, the cystic duct and the little artery feeding the gall bladder are clipped with little metal clips and divided.
• The gallbladder is then dissected away from the liver and removed through the small incision beneath the umbilicus in a retrieval bag.
• This type of gallbladder surgery takes on average about 1-1½ hours, sometimes less.

Laparoscopic Cholecystectomy does not use dissolving agents to dissolve the stones or laser to remove the gallbladder.

The advantages of the Laparoscopic technique (Keyhole surgery) in terms of small incisions, diminished pain, short hospital stay and early return to normal activity were so obvious that it has quickly become the standard method of gall bladder removal.For a small number of patients the gallbladder cannot be removed Laparoscopically and if it proved that the laparoscopic procedure is not to the best advantage of the patient, the doctor decides for safety reasons to remove your gallbladder by the open (old fashioned standard) method.

What is the open method?

In the open method the gallbladder is removed through a 6 to 8 inch incision in your abdomen. If you have the open method to remove your gallbladder, your stay in hospital will be about 3 to 5 days. The surgical principle of the removal of the gallbladder is similar to that of the Laparoscopic one

What are the complications of surgery?

• Perforation of viscus, at the time of entry especially if there has been previous surgery and adhesions around the naval (entry site). With the use of an open entry technique, and a special blunt tipped instrument to enter the abdominal cavity through the incision beneath the umbilicus. This is usually a rare complication.
• Injury to the bile duct which can lead to leakage or obstruction of bile flow. If this occurs, then further intervention in the form of endoscopy (ERCP) or operation to drain or repair the bile duct may be necessary. This is a serious but relatively rare occurrence.
• Bleeding from blood vessels feeding the gall bladder or liver. This is usually controlled at the time of the operation. If the bleeding happens after the surgery has finished, then the patient may have to return to the operating theatre to stop the haemorrhage. Again this is a very rare complication.
• Other complications such as the damage to other organs or blood vessels, gas embolism, Deep venous thrombosis & Pulmonary embolism, allergic reactions, heart attacks, pneumonia and strokes can occur but are exceedingly rare.
• Wound infections are not uncommon especially in the umbilical wound, which can be contaminated by the bacteria in the gall bladder as it is removed. These are usually minor and respond to antibiotics but can be painful and a nuisance in the short term.
• Hypertrophic and Keloid scars. These are thickened scars to which some patients are prone. With the small incisions, scarring is minimal in most cases.

General Information about your Gallbladder Surgery

Before Your Surgery

You will have pre-assessment by a nurse or a doctor. Blood tests will be done, if needed.

Day of Your Surgery

On the day of your surgery, your vital signs (blood pressure, pulse, temperature and breathing rate) will be checked. Dentures or partial plates, contact lenses, eyeglasses, hearing aids, and any other prosthesis must be removed before going to theatre. Nail polish, make-up, jewellery, and hair clips also will be removed.You will be visited by the anaesthetist who will talk to you about the anaesthetic procedure.

During Surgery

You will notice theatre staff wearing special scrub clothes, caps, and masks. Theatre room can be quite cool with bright lights. Once you had your anaesthesia you will be covered with an extra blanket if you are cold. During your surgery your vital signs will be closely checked and your heart will be monitored. The Monitor’s beeping noise should not alarm you. A small clip (pulse oxymeter) will be placed on your finger to measure your pulse and the amount of oxygen in your blood. Your surgery may take a longer or shorter time than you and your family were told. If so, it does not mean that something is wrong. After your surgery is over, the surgeon will talk and explain the operation to you and your family.

After Surgery

You will be moved to the Anaesthetic Rrecovery Area. A nurse will check your pulse, blood pressure, respiration and Oxygen saturation. An oxygen mask may be put on your face. It is not unusual to wake up shivering and feeling cold after having general anaesthesia. There might be some activity and noise in the area. The nurse will try to wake you up and give you pain killers if you have pain. When you are awake and your vital signs are normal, you will be taken back to the ward.

How will I feel after surgery?

In the first few hours, you may feel pain and/or nausea. There is often surprisingly little discomfort. People feel pain after surgery in different ways. Some have abdominal cramps, or shoulder pain, because of residual gas. This will eventually disappear. If you feel nauseated or sick, tell your nurse and you will be given a medication to relieve it. Most patients are able to move out of bed in the evening.

How can I relieve my pain ?

It is normal to have some pain around the area of surgery, which responds to pain killers, so you can move, walk, cough and deep breathe comfortably. Pain killers are usually effective as long as you don’t wait to take them until the pain is severe.
Other ways to relieve your pain are:

• drinking warm fluids, walking
• Any method of relaxation, such as listening to music or deep breathing
• Your pain should become less each day. If your pain does not decrease, call your doctor who might contact your surgeon urgently

How long will I be in hospital?

Your stay varies from 1-5 days depending on whether you had a laparoscopic or open
cholecystectomy
Your recovery can take up 4 to 6 weeks.

What can I eat and drink after surgery?

Initially you will be given fluids intravenously (IV). Once you are fully awake and if you were not feeling sick, you will be able to drink liquids and eat within few hours. If you have nausea, then you should have clear liquids first, and afterwards you can progress carefully to regular food. It will probably take a few days for your appetite to return to normal. When you go home, you do not need to eat a special diet. Eat as you did before.

What about bowel Movements?

You may have some bowel changes (diarrhoea or constipation) which will settle once your stomach and intestine return to normal. Eating fruits & vegetables and increasing your fluids can help prevent constipation.

What activity can I do?

For the first few hours after surgery, and while you are awake do your deep breathing and coughing exercises each hour. You can stop them once you are able to get up and walk around. As you feel stronger, you will be able to take longer walks and gradually resume your normal activities. It is common to feel very tired on returning home, it is easy to underestimate the magnitude of the surgery that has taken place when there is very little to see on the outside.

When can I have a bath?

You may shower or bathe the day after surgery. Use a mild soap and ensure you pat dry your incisions.

When can I drive?

Whenever you feel comfortable to wear the seat belt and perform the emergency stop in your garage without complaining of pain or discomfort, then it is probably safe to drive. Patients are normally safe to drive after about 7-10 days.

Returning to work

The usual time off work is 2-3 weeks and most patients can start office duties by then. Time can vary depending on the type of work you do.

How do I care for my incisions?

The incisions should be dry. They may be covered with a dressing and tapes (steristrips). Try to keep the tapes clean and dry for a couple of days. If they fall off you can leave them off. All the sutures are dissolvable so you do not have to worry about having them removed.

When do I see the surgeon again

A follow-up appointment with the surgeon will be arranged within 4 weeks after your surgery.

Call your doctor if you notice:

• Wound is red, swollen, or painful
• Developing a fever (high Temperature)
• Excessive bleeding or drainage from the wound, (a small amount of bleeding or drainage is common)
• Continue to feel sick & vomiting
• Became Yellow (Jaundice)

Are there any long-term sequelae?

Very few. The function of the gallbladder is to store bile produced by the liver between meals and release it during mealtime. The absence of a gallbladder allows a constant drip of bile into the intestine. In practice, in most patients, the diseased gallbladder has long-since ceased to function and its removal does not alter the digestive balance in any way. A few patients will notice a very slight increase in the frequency at which they open their bowels.

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