Cholecystectomy
General Information
Reason for surgery
- Gallstones can be found and cause no symptoms.
- Asymptomatic patients do not require treatment.
- In symptomatic patients, gallstones can cause
- Biliary colic
- Cholecystitis
- Cholangitis
- Pancreatitis
- Some symptoms of gallstones can be serious such as cholangitis, pancreatitis and treatment will be more complicated.
- In some patients, additional procedure such as ERCP may be needed.
- One third of the patients will experience recurrent symptoms if gallbladder still left inside their body.
- Cholecystectomy is the gold standard of gallstones disease treatment.
- Bile production and liver function is not affected by cholecystectomy.
- After surgery, patients can live as usual.
Anatomy of Gallbladder
- A pear-like organ located at right upper quadrant of abdominal cavity.
- Attach to the lower part of liver.
- Gallbladder itself does not produce bile.
- Bile production comes form the liver.
- Gallbladder will store and concentrate the bile.
- When you have a meal, gallbladder will contract to make the bile go into the bowel to help digested food especially fatty food.
Pre-Operative
About the Procedure
Minimally Invasive gallbladder Surgery
Laparoscopic cholecystectomy (LC)
- Minimally Invasive gallbladder Surgery is the standard treatment nowadays..
- Doctor will make 3-4 small holes and use special instrument and camera to perform the surgery
- Doctor will put CO2 gas into your belly to create space for working.
- This gas will be removed after surgery.
- This procedure always require general anesthesia.
- Because of small incision, patient will have faster recovery and less pain.
- Normally, patient will stay in the hospital after operation for 1-2 nights.
- In some difficult situation, doctor may consider changing form small incision to open surgery, meaning change from laparoscopic cholecystectomy to open cholecystectomy.
Open cholecystectomy (OC)
- Doctor will make oblique incision below your right ribs cage.
- Mostly require general anesthesia.
- Doctor may prefer this procedure in some patients which expect to be difficult to remove the gallbladder with laparoscopic technique such as patient with multiple episode of gallstones attack, patient with history of abdominal surgery, patient with severe inflammation of gallbladder.
- In some difficult situation, doctor may convert from laparoscopic surgery to this open surgery during the operation for patient safety.
Consideration for LC or OC depends on patients condition, patient preference and doctor expertise. In our hospital, most of our cholecystectomy successfully perform with laparoscopic technique.
Surgical procedures
- Doctor will ligate the cystic duct (a small tube at the end of gallbladder) using thread or clip
- Doctor will dissect gallbladder for its attachment with liver.
- Gallbladder will be put in small bag and remove form your body, mostly via incision near your belly button.
- Most of the time, we will cut open the gallbladder and keep the stone for the patients.
- Gallbladder will be sent to pathology department for detailed examination.
Risk of Procedure
Specific risk
- CBD injury 0.3 – 1%
- Bleeding 1 – 2%
- Conversion to open surgery 2 – 10%
- Injury to other organs 0.3 – 1%
- Intra-abdominal abscess 1 – 2 %
- Incisional hernia 2 – 10%
General risk
- Pain
- Wound infection
- Lung collapse (Atelectasis)
- Clot in leg vein (Deep vein thrombosis)
Post-Operative
Common symptoms after surgery
Wound pain
- Although the incision is small, patient still experience wound pain.
- Severity of wound pain varies from person to person.
- Normally, doctor will prescribe pain killer for wound pain.
- If you still feel a lot of pain after medication, you can always call our staff.
Right shoulder pain
- It commonly occur after laparoscopic surgery because of the gas we use.
- This condition is transient and normally improve within 24-48 hours after surgery.
Bloating
- Some patients still feel a lot of gas in their stomach after surgery.
- This condition is transient and will improve over a period of time.
- It may takes 1-3 months after surgery until this symptoms is fully gone.
Recovery after surgery (In hospital)
Diet
- Normally, doctor will allow oral diet when patient is fully awake form anesthesia.
- In some special circumstances, such as difficult surgery, doctor may asks patient not to eat anything for another 1-2 days after surgery.
- It is preferable to avoid fatty meal for couple months.
- Our dietitian will help you with your diet as a part of our ERAS program.
Activities
- We encourage patient to have normal activities and move their body as soon as possible.
- The faster patient has activities, such as walking around their bed, is better for patient’s recovery.
- Our physical therapist will help you with your activities as a part of our ERAS program.
Intravenous fluid
- Normally, doctor will remove the intravenous fluid as soon as possible.
- The catheter may still attach for some of your medication and will be removed before your discharge
Medication
- You can take your personal medication after surgery which will be arranged by our staff.
- Doctor will prescribe pain killer or other medication to suit your condition.
Pain control
- Doctor will prescribe pain killer medication which mostly are in oral form.
- There’s also extra dose of pain killer to suit your need.
- Normally, the pain should not so intense. If you feel abnormally severe pain, please inform our staff immediately.
Post-discharge
Follow up
Follow up appointment
- Doctor will make an appointment about 1 week after the surgery.
- Doctor will examine your wound upon appointment.
- Doctor will also inform the pathology result of your resected gallbladder.
Follow up call
- There may be a call from our staff as a part of our services.
- Our staff will check for your symptoms and recovery.
- They will also remind you for your next appointment.
Report your symptoms
- If you feel anything wrong, please feel free to contact our staff and report your symptoms.
Long term follow up
- Normally, this procedure do not need long term follow up.
