Patient Information Leaflet
You will see that some words are high-lighted in the text. If you click on these you will be taken to a section containing more details about gallstones, their complications and treatment. There are some clinical pictures here - do not go there if you are squeamish !!
This is the removal of the gall bladder. It is necessary when gallstones cause problems (pain, infection, jaundice, inflammation of the pancreas gland). Cholecystectomy may be ‘open’ (through a 6 inch cut in the abdomen just under the right ribs) or ‘laparoscopic’ (the operating instruments and camera are inserted through 4 very small cuts in the abdomen and the abdomen distended with carbon dioxide gas – this is also called ‘keyhole’ surgery). We try to do most cholecystectomy operations using the ‘laparoscopic’ method because recovery and return to full activities are quicker. Sometimes, however, we cannot do the operation this way and have to resort the ‘open’ technique. There are a number of reasons for this: there may be a technical problem with the machinery such that we cannot obtain a clear picture; there may be excessive scarring around the gall bladder from previous infections making the operation too difficult; there may be bleeding that interferes with the view. Our aim is to do a safe operation and we will resort to the ‘open’ technique if we are at all unhappy proceeding with the ‘laparoscopic’ technique. It is for this reason that you will be asked to consent to both techniques.
How long will I be in hospital?
If you are not considered suitable for day case treatment you will be admitted to one of the main wards the day before or on the morning of your operation. In this case you will be allowed home the day after your surgery if all goes to plan. If you are suitable for day case treatment then you will be admitted to the Day Case Unit at 8 a.m. on the morning of your operation and you will be allowed home at about 6 p.m. If you do not recover fully, the operation is complicated or the open technique is used then arrangements will be made for you to stay in the hospital.
Preparing for admission to the Day Case Unit
| Do not eat or drink anything after midnight. | ||
| Do not wear make-up, jewellery or nail-polish. | ||
| Bring a dressing gown, night-dress, slippers and toiletries. | ||
| Have a bath or shower before you come to hospital. | ||
| Make sure you arrange for someone (a relative or friend) to escort you home after the operation and stay with you overnight. | ||
| Do not bring too much money or valuables into hospital. |
You will be welcomed by a member of the nursing staff before being asked to change into a theatre gown. Your details will be checked by the nurse. The anaesthetist and surgeon will visit you and answer any questions that you may have. You will be asked to sign a consent form if you have not already done so. You should have had all the tests required already but occasionally the anaesthetist may request some further tests – such as a chest X-ray or a heart tracing (ECG). The ward nurse and a porter will take you to the anaesthetic room.
The operating department assistant will check your details again. Some routine monitoring equipment will be used to check your pulse, blood pressure and the amount of oxygen in your blood. The anaesthetist will insert a needle into the back of your hand and use this to give you drugs to send you to sleep. This is a ‘general anaesthetic’.
The skin of your abdomen will be cleaned with iodine (brown stain) or chlorhexidine (pink stain) and sterile drapes placed to create a clean operating field. A 2-3cm incision will be made just below your belly-button. A metal tube (port) will be inserted into your abdomen through this incision. Carbon dioxide gas will be used to distend your abdomen through this port. A camera will be inserted through this port to allow the surgeon to see inside your abdomen and to safely place 3 other ports for the operating instruments. These ports will be placed through two 1cm and one 2-3cm incisions. Local anaesthetic will be administered to all these sites for pain relief after the operation. Once the operation is completed these ports will be removed and the incisions closed with dissolving stitches or glue. A number of complications are possible during this operation. They occur very infrequently but are listed below:
 | Perforation of bowel during insertion of a port or during the operation. |
| Bleeding during insertion of port or during the operation. This can be due to damage to large blood vessels. |
| Damage to the bile duct. |
| Leakage of bile. |
| Deep vein thrombosis - precautions are taken in all patients to avoid this. These include the use of stockings, injection of heparin into the skin (this thins the blood slightly) and the use of special sequential compression boots (flowtron) to encourage the flow of blood in the legs during the operation. |
| Rarely, death. |
Whereas many of these complications are immediately obvious and can be corrected at the same time, some may not present for a few days (see Back at home).
After your operation you will be taken into the recovery area. The needle in the back of your hand will be connected to a bag of fluid. Routine observations will be carried out. You will have an oxygen mask on your face. Once you are fully recovered (after about 30 minutes) you will be taken back to the ward.
You will be asked to stay on bed rest for 2 hours before sitting out. You may experience pain from the wounds. Sometimes, residual carbon dioxide in your abdomen may cause pain in the shoulders. This gas will eventually be absorbed. If you experience pain or discomfort tell the nurse who will give you the appropriate pain-killer. You will be allowed to have a drink after about half an hour. Take small drinks to start with. If you feel nauseated then cut back - the fluid going through the needle in your hand will be sufficient. If you wish to urinate let a member of nursing staff know so that they can arrange a bed pan / bottle or accompany you to the toilet. After a couple of hours you will be allowed a light diet. Before your discharge you will be seen by the surgeon, given a supply of pain-killers, dressings and a letter for the nurse who will visit you in the evening.
We will make arrangements for you to be visited by a member of the community nursing team. Your GP will also have been informed of your discharge. If you have any problems please contact your GP first. On the first night you should simply rest and stick to non-fizzy drinks and light diet. By the following morning you can resume a normal diet. You will be visited by a member of the community nursing team and receive a phone call from the Day Case Unit. They will be able to answer any questions you may have. For the first few days you will feel more tired than usual. You can carry out normal duties but avoid heavy lifting for 2 weeks. You can drive after 48 hours assuming you are able to do an emergency stop without experiencing pain. You may return to work once you feel able to do so – usually 1-2 weeks after the operation. Your GP will be able to issue a certificate. You must notify your GP if you have:
| A large amount of blood stained fluid discharges from the wounds. |
| Fever or chills. |
| Pain that is not relieved by the prescribed medication. |
| Abdominal distension. |
| Swelling, redness or tenderness of your wounds and the surrounding areas. |
As far as diet is concerned, you can eat anything you want. Be warned though that if you had fatty food intolerance before the operation, you will find that you can now eat those things you have been avoiding - your weight may increase! You may find further information about diets at the following website http://altadiet.com