Laparoscopic Cholecystectomy
(Keyhole gallbladder removal)

Procedure Overview

The procedure involves laparoscopic (keyhole) surgery, performed under general anesthesia and usually takes between 30 and 60 minutes. The healthcare team will confirm the patient’s identity and procedure details before surgery.

Steps of the Procedure

  1. Creating Access: A small cut is made near the belly button to insert an instrument, inflating the abdomen with carbon dioxide gas for better visibility. Additional small cuts are made for inserting surgical tools and a telescope. 
  2. Removing the Gallbladder: – The surgeon holds the gallbladder and carefully cuts the cystic duct and artery. – The gallbladder is separated from surrounding structures and removed through one of the ports. 
  3. Checking for Gallstones in the Bile Duct: If needed, the surgeon may inject dye into the bile duct and take X-rays. Any stones found may be removed during surgery or later using a flexible telescope down the esophagus.
  4. Completion: The instruments are removed, and the cuts are closed. A drain may be placed to remove fluid, especially if there was significant inflammation or bile duct exploration.
Special Cases:
  • If there is severe inflammation, a subtotal cholecystectomy may be performed, removing most of the gallbladder while leaving a portion intact. 
  • Sometimes keyhole surgery may not be possible, and requires open surgery, which involves a larger cut under the right ribcage.  Mr Wood successfully completes keyhole surgery in >98% of all patients and >99% of uncomplicated patients.

How can I prepare for surgery?

1. Lifestyle Changes:

  • Stop smoking to reduce the risk of complications and improve long-term health.
  • Maintain a healthy weight, as being overweight increases the risk of complications. If you are significantly overweight your surgeon may recommend a special diet for two weeks before the procedure to reduce liver size, making surgery safer.
  • Regular exercise can help with preparation and recovery.

2. Reducing Infection Risk:

  • One week before surgery: Avoid shaving or waxing the area where a cut may be made.
  • Bathing: Take a bath or shower the day before or on the day of the procedure.
  • Keep warm: Inform healthcare staff if you feel cold before the procedure.
  • Diabetic patients: Maintain blood sugar levels around the time of surgery.

Following these steps can help ensure a smoother procedure and recovery.

What are the potential risks or complications of the procedure?

1. General Surgical Complications:

  • Bleeding during or after the procedure, rarely requiring a blood transfusion.
  • Hernia formation at the surgical site, which may require further surgery.
  • Infection at the wound site, treatable with antibiotics but sometimes requiring special dressings.
  • Venous thromboembolism (VTE) – Blood clots in the leg (DVT) or lungs (pulmonary embolism), which can be serious.
  • Chest infections, particularly in smokers or those recovering from COVID-19.
  • Adhesions (scar tissue) leading to bowel obstruction, possibly requiring another procedure.
  • Allergic reactions to medications, materials, or dyes (rare but possible).
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2. Keyhole Surgery Complications:

  • Damage to internal structures (e.g., bowel, liver, blood vessels), which may require open surgery (risk: < 3 in 1,000).
  • Surgical emphysema (trapped gas in the skin) or gas embolism (rare but serious).
  • Conversion to open surgery if keyhole surgery is not possible.
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3. Cholecystectomy Complications:

  • Bile or stone leakage, which may require additional treatment.
  • Retained stones in the common bile duct, requiring further procedures.
  • Continued pain post-surgery.
  • Changes in bowel habits, including increased frequency or diarrhea (risk: 3 in 100).
  • Bile duct injury or inflammation (risk: 3 in 1,000), requiring another procedure.
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4. Severe but Rare Complications:

  • Pancreatitis if a stone moves into the bile duct (risk: 3 in 1,000).
  • Serious liver or blood vessel damage, requiring further intervention.

     

    While most complications are rare, and Mr Wood’s complication rates are better than the national average, some may require further treatment or surgery.

Recovery After Surgery

1. Immediate Post-Surgery Care:

  • You will be transferred to the recovery area and should be able to go home the same day unless advised otherwise.
  • Be aware of serious complications, including worsening pain, fever, dizziness, loss of appetite, abdominal swelling, difficulty urinating, or jaundice. Contact your healthcare team immediately if these occur.

2. Returning to Normal Activities:

  • A responsible adult should take you home and stay with you for at least 24 hours.
  • Avoid driving, operating machinery, or signing legal documents for at least 24 hours.
  • Follow healthcare team instructions to prevent blood clots, including medication or wearing special stockings.
  • Return to work within 2 to 4 weeks, depending on your job.
  • Avoid manual labor and heavy lifting for a few weeks.

3. Long-Term Recovery:

  • Regular exercise will help in recovery.
  • Avoid driving or cycling until you can fully control your vehicle, including in emergencies.
  • You should eventually make a full recovery and return to a normal diet.
  • If pain persists or jaundice develops, consult your doctor.

Following these guidelines will help ensure a smooth recovery.

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