Laparoscopic Gall Bladder Surgery (Cholecystectomy)

What is the Gall Bladder?

The gallbladder is a small pear-shaped pouch that sits just under the liver. 
It merely stores bile produced by the liver and in response to signals, squeezes stored bile into the small intestine through a series of ducts.

What causes the formation of stones in the Gall Bladder?

• Genetic
• Weight loss or weight gain
• Repeated gall bladder infection
• Low Fibre diet, high fat content in diet, meat etc.

Why should I suspect if I have Gall stone disease?

Gall stones can be completely asymptomatic (silent). Subtle symptoms include bloating, acidity, constipation, flatulence.

More severe symptoms could include...

• Sudden and rapidly intensifying pain in the upper right portion of your abdomen or just below your breastbone
• Back pain between your shoulder blades
• Pain in your right shoulder
• Nausea or vomiting

Sinister symptoms include :

• Abdominal pain so intense that you can't sit still or find a comfortable position
• Yellowing of your skin and the whites of your eyes (jaundice)
• High fever with chills
• This is the time you must see your doctor immediately.

How can I be sure of a Gall Bladder problem?

A good detailed history and clinical examination by a surgeon will arouse a suspicion which is confirmed, most often, by a simple ultrasound and liver function tests. In certain cases, however, a specialized MRI called MRCP may be advised to corroborate the diagnosis and to rule out a complication.
Additionally, an Endoscopic Ultrasound (EUS) or a HIDA scan may be required.

What will happen if I ignore my Gall stones?

A) Inflammation of the Gallbladder (Cholecystitis) 

A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.

B) Blockage of the common bile duct (Cholangitis) 

Gallstones can block the ducts through which bile flows from your gallbladder or liver to your small intestine. Severe pain, jaundice and bile duct infection can result.

C) Blockage of the pancreatic duct (Pancreatitis) 

The pancreatic duct is a tube that runs from the pancreas and connects to the common bile duct just before entering the duodenum.  A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.

D) Gall bladder cancer

Though very rare, people with a history of gallstones have an increased risk of gallbladder cancer. 

Can a Gallstone be cured medically?

The process of medical dissolution of a call stone is not only lengthy, expensive, tedious and uncertain, there is also a possibility of stones coming back once the treatment is discontinued. One must understand that gall stones is the face of the disease called gall bladder malfunction. Medicines, unfortunately, won't be able to cure this dysfunction.

Do all Gall stone patients require surgery?

More often than not, one may get away without a surgery, especially if there is a single large stone as against multiple small stones. Silent gall stones can be observed provided you pick up hints of advancement of the disease and report to the doctor to prevent complications.
Multiple small stones are at a larger risk of slippage and complication thereof. One must understand that there is no permanent cure of gall stoned apart from Surgery. With advance anesthesia and surgical techniques, the risk of surgery is minimal. It is prudent to operate if the risk of waiting outweighs the risk of surgery.

What is the surgical treatment of Gall stones?

As mentioned earlier, it is the dysfunctional gall bladder which is the culprit and gall stones is the mere face of the issue. Hence surgical removal of the gall bladder (cholecystectomy) is the nature of surgical treatment. This is unlike urinary stones where organ removal is seldom needed.
Laparoscopy is the gold standard for performing cholecystectomy. It is done usually under general anesthesia and 4 tiny cuts are made on the abdomen. Surgery typically lasts less than an hour. Feeds are initiated about 6 hours after the surgery.

What are the advantages of laparoscopic surgery?

The biggest advantage remains that a thorough survey of the visible parts of the abdominal cavity can be made to rule out other concomitant or mimicking pathologies and treat them simultaneously.
Other advantages include.

• Minimal post-surgical pain.
• Reduced risk of post-surgical infection.
• Shorter hospital stay.
• Early return to work.
• Better cosmetic outcome

Will I be in pain after surgery?

Not really. Principally, it is not a very painful surgery; moreover, painkillers do their job really well.

How early can I go home after surgery?

As early as 24 to 36 hours.

When can I have bath after surgery?

Almost invariably, all your dressings are waterproof permitting you to bathe the very next day.

Will there be tubes put into me?

More often than not, stomach tube or urinary catheter are not put, unless it's a very tough scenario. Very occasionally, tube drains are put inside the abdomen in difficult cases as a safety measure.

Would there be sutures that require a painful removal?

Firstly, suture or staple removal is a totally pain-free procedure. More often, surgical glue will be used to approximate skin wherein removal isn't essential.

How many times do I have to come for follow up after I get discharged?

Usually only once, around the 8th day for a wound check.