What is the Gallbladder?
The gallbladder is a small pear-shaped organ that acts as a storage tank for bile. The bile is made in the liver by liver cells and is sent through tiny ducts or canals to the duodenum (small intestine) and to the gallbladder. The gallbladder stores the bile to have it available in larger quantities for secretion when a meal is eaten. The ingestion of food and especially fats cause the release of a hormone, which in turn signals the relaxation of the valve at the end of the common bile duct which lets the bile enter the small intestine. It also signals the contraction of the gallbladder which squirts the concentrated liquid bile into the small intestine where it helps with the emulsification or breakdown of fats in the meal.
About Gallbladder Removal (sometimes referred to as Laparoscopic Cholecystecomy)
You may need your gallbladder removed if:
- you have gallstones that are causing you pain caused by inflammation or infection of your gallbladder
- you have jaundice (yellowing of your skin or the whites of your eyes) caused by a gallstone blocking your bile duct
- you have inflammation of the pancreas (pancreatitis) caused by gallstones
- you have cancer of your gallbladder
There are two surgical techniques used to remove the gallbladder.
- Laparoscopic cholecystectomy – your gallbladder is removed through small cuts in your abdomen (tummy), using a surgical technique called keyhole surgery.
- Open cholecystectomy – your gallbladder is removed through one large cut in your abdomen, using a surgical technique called open surgery.
What happens during Gallbladder Removal?
Gallbladder removal is usually done using keyhole surgery, which means your surgeon won’t have to make a large cut in your abdomen.
Keyhole surgery to remove your gallbladder usually takes between 30 and 90 minutes. Your surgeon will usually make four small cuts in your abdomen. He or she will inflate your abdomen using harmless carbon dioxide gas to create space and to make it easier to see your internal organs. Your surgeon will then pass a laparoscope (a long, thin telescope with a light and camera lens at the tip) through one of the cuts to view your internal organs on a monitor.
Your surgeon will then insert specially adapted surgical instruments through the other cuts so that he or she can remove your gallbladder.
During the operation your surgeon may take X-rays to check there are no gallstones in the bile duct.
At the end of the operation, the carbon dioxide gas is allowed to escape and the instruments are removed. Your surgeon will close the wounds with stitches or metal clips and cover them with a dressing.
What are the alternatives to Gallbladder Removal?
If you have gallstones but they aren’t causing any symptoms, or surgery to remove them isn’t suitable for you, there may be alternative treatments. Sometimes gallstones can be dissolved using medicines, however gallstones often come back after this type of treatment and it is therefore rarely used.
If gallstones are in your bile duct and not in your gallbladder, they can be removed during ERCP. An endoscope, which is guided using X-rays, is passed into your mouth and down to your bile duct. Special instruments can also be inserted inside the endoscope to allow your surgeon to remove the gallstones from your bile duct. ERCP can only be used to remove gallstones if they are found in your bile ducts. If gallstones are in your gallbladder itself, you may need gallbladder surgery as well. Your surgeon will discuss any possible alternative treatments with you.
Frequently Asked Questions
1. When can I go home?
Usually on the same day as the surgery as long as your pain is manageable with tablet painkillers, you have passed urine and someone can pick you up and there is someone at home with you.
2. When can I go back to work?
If you have a desk job or work from home then whenever you are able to manage this is up to you. If you do more manual work or have to travel a lot then most people take one week off work.
3. When can I drive?
Not for 48 hours after a general anaesthetic and then afterwards not till you are completely comfortable to make an emergency stop. For most patients this is around 3-5 days after the surgery.
4. When can I fly?
Usually 2-3 days after your surgery as long as it was uncomplicated and you feel comfortable to travel.
5. What tablets do I take?
The pain killers that were given to you on discharge – please take them regularly for the first 24 hours at least and then when you feel you need them. Carry on any other normal meds as per your discussion with the surgical team members prior to discharge. Take special advice if you are diabetic, take aspirin, or warfarin.
6. When can I go to the gym/swim?
Usually once the wounds have healed completely – usually around 10 days post op. Start with gentle exercises first in the gym. Please remember that it is especially important to get out of bed and walk regularly as soon as you are able to on the day after surgery as this will reduce the risks of complications such as clots in the legs and lungs.
7. What about wound care?
If your skin incisions have been closed with clips these need to be removed by the GP nurse 7-10 days after the surgery. After 2 days you do not need to have any dressings on your wound – allow them to air dry and shower and bathe as normal. Prior to this please shower / bathe with the dressings on and replace them with fresh ones if they get soaked through.
8. What should I eat and drink after the operation?
Eat sensibly as the anaesthesia, painkillers and surgery may make you feel nauseous – so have small light meals. Avoid rich, spicy or fatty foods and alcohol for 48 hours after the surgery but after this you should be able to return to a normal diet.
9. How do I know if there is a serious problem after the surgery and what should I do if I feel unwell after I am discharged?
We would want you to return to the hospital if you have any of the following:
- severe abdominal or shoulder pains that are not alleviated by the painkillers you are discharged with after a few hours
- high temperatures or fevers and chills
- jaundice (when your skin and whites of the eyes become yellow and your urine becomes coca-cola coloured)
- repeated vomiting
- wound problems that your GP or GP nurse cannot manage
10. Do I need to be followed up?
If the operation was uncomplicated and there were no problems with the surgery, then no you should not be followed up in the hospital. If you have repeated problems with something related to the surgery then please make an appointment to see your GP unless it is one of the severe symptoms above for which we would want you to present to the Accident and Emergency Department of the hospital where you had your surgery.
