Gallstones -

Laparoscopic Cholecystectomy

Gallstone (stones within the GB) is a common condition affecting women more than men, with slight familial risk. Consumption of high fatty food for years could predispose to development of gallstones.  Losing weight in a short time (following bariatric surgery) could raise the workload of cholesterol on the GB and precipitate within the GB and form a nidus for gallstone. They are commonly asymptomatic and usually found incidentally by ultrasound scan requested to investigate another condition. They only cause symptoms in about 20% of patients having gallstones.

 

 

Symptoms:

 

Nonspecific: 

Indigestion, dyspepsia, bloating and flatus after fatty meals. 

 

Biliary Colic: 

This is related to stone(s) blocking the GB outlet. Acute right upper abdominal pain colicky in nature and lasting for few minutes that sometimes radiates to the back/shoulders. Associated with nausea +/- vomiting. Usually settles spontaneously.

 

Acute Cholecystitis (Acute inflammation of the gallbladder): 

Acute abdominal pain (more persistent), fever, nausea and vomiting and feeling unwell. This condition usually requires hospital admission and treatment with intra-venous antibiotics and analgesia. Occasionally, these patients need to have intervention if not settled.

 

Jaundice +/- Cholangitis: 

This happens when a stone is passed into the bile duct (duct joining liver to bowel) causing blockage +/- infection. Patients present with yellowish discolouration of eyes and skin associated with dark colour urine and may develop itching. This condition needs scan(s) to prove the presence of a stone in bile duct before subjecting him/her to a camera test to fish the stone from the bowel end of the bile duct, a procedure called ERCP. The patient may also need hospital admission with treatment with antibiotics and analgesia.

 

Acute Pancreatitis:

Acute inflammation of the pancreas as a result of a stone blocking the pancreatic duct or reflux of bowel content into the pancreatic duct following passage of gallstone into the bowel. This condition will cause severe central abdominal pain radiating to the back, nausea and vomiting, feeling unwell, fever, sweating and may be associated with jaundice. This condition requires hospital admission, conservative treatment with analgesia and may need some antibiotics.

 

 

Diagnosis:

  • Symptoms and signs of gallstones

  • Ultrasound scan is the usual investigation utilised to diagnose gallstones and assess the GB wall thickness and the diameter of the bile duct and can diagnose bile duct stones.

  • X-Ray of abdomen can detect gallstones in about 10% of cases, usually incidental findings 

  • MRCP scan, magnetic resonance imaging (MRI) of the abdomen specifically assessing the bile duct and gallbladder

  • Other scans (CT scan, HIDA scan…etc)

 

Treatment of Gallstones:

 

  • Avoiding fatty food could control the symptoms to some extent 

  • Avoid sleeping on your left side as in this position the gallstones could move by gravity and block the outlet of the GB

  • Drugs that could dissolve certain types of gallstones, but such treatment can take more than a year and the recurrence of gallstones is inevitable in addition to the side effects of the medicine.

 

 

     Before Operation:

 

      You can reduce risks of surgery by:

  • Stop smoking, try to maintain good health (higher complication rate with overweight patients) and regular exercise 

  • Having a bath or shower on the night before or same day of surgery

  • While waiting for your surgery in the hospital, try to keep warm.

  • Avoid shaving the area as this should be done in theatre (to reduce infection risks).

 

      Operation:

 

       Keyhole surgery includes 4 incisions (as shown in diagram in RED).

       The bellybutton incision is about 2-3cm long and the rest are less than 1cm.

       There is always a risk of converting into a larger cut to remove the GB if the

       operation cannot be completed through keyhole surgery. The operation is

       under general anaesthesia, as a day surgery (aiming to be home within 24hr

       from surgery). The operation includes clipping the GB duct and artery and

       removing the GB using special bag. The GB will be sent to the lab for histological

       analysis. The operation takes an average of 45 minutes. There will be no stitches

       to be removed neither any dressing. The wound will be glued instead.

 

      Potential complications:

 

       Infection, bleeding, visceral injuries (injuries to surrounding organs), biliary leak (<1%), bile duct injury (1:500), drain (tube)                  insertion, adhesions, hernia, and anaesthesia risks that include DVT/PE (development of clot in the leg which might migrate to          the lung) and cardiorespiratory complications (risks to the heart and chest). The risk of conversion to open surgery is <1%.

 

Recovery:

 

You will have general ache with backache and shoulder pain due to the inflation of the abdomen with gas that takes 48-72hr to be absorbed and cleared. It is advisable to have your pain killers regularly for the first 3 days then tail them off. 

 

The glue over the wounds, you can have a shower from the next day following your operation but no bath until day 5 when you can rub the glue off in the bath.

Most patients can be discharged within 24hr of surgery except those who had conversion to open surgery, who need to stay for an extra 2-3 days to recover. Before discharge from hospital you need to meet 5 conditions:

 

  • Feeling well and mobilising

  • Tolerating food and drinking without being sick (vomiting)

  • Normal observation (pulse, blood pressure, respiration and temperature)

  • Passing urine normally

  • Someone will stay with you at home overnight

 

We can give you a sick note for two weeks and if you need an extra week, your doctor (GP) can provide you with one. You can walk, but be careful with stairs and always protect your umbilical wound when coughing, sneezing or straining. You should avoid driving the first 10 days, after that, if you are able to control your vehicle and press emergency brake, then you can drive. (double check with your car insurance). Gradually increase activity back to normal over the three weeks after surgery but avoid heavy lifting or exercise for this period. Ideally, you should avoid flights, especially long distance ones, in the first four weeks after surgery and better to check with your flight insurer before booking.

 

Long term effects of living without GB: Most patients are able to eat and drink normally including fatty food. Around 1/3 of patients may develop indigestion, dyspepsia and bloating especially after consumption of fatty food. In that case you need to reduce the fatty food in your meals for 3 months then gradually introduce it afterwards; this will give the liver time to work without GB and cope with the fat load in your diet. Most of these symptoms will settle within 6-12 months.

 

I will review you in the clinic around 4 weeks following the surgery to assess your recovery and provide you with the lab analysis of the GB; if you have any problems then you can contact my secretary or the hospital ward and I will be in touch the same day.

Spire Harpenden Hospital

Alternating week between

                        Wednesday 6:30 - 8:30pm

                        Thursday 2:00 - 4:00pm

Contact Secretary: 

Marguerite Watkins  Tel/Fax: 01582 765 015   Email: primesecretarial@gmail.com

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