Laparoscopic gallbladder removal

Laparoscopic gallbladder removal, also called laparoscopic cholecystectomy, is the main treatment for gallstones.

It is usually planned in advance, but emergency gallbladder removal is sometimes necessary. Many people develop gallstones with one in ten adults having them by the age of 50.

Some never show any symptoms, therefore do not need surgery but others experience unpleasant symptoms that affect their daily life. Examples of this are recurrent nausea, vomiting, jaundice and intense upper abdominal pain.

What are gallstones?

Gallstones are solid deposits that develop inside the gallbladder. Many form due to excess cholesterol, but they can have many other components.

Ironically, smaller gallstones are more likely to produce symptoms than larger ones, as they can block the bile duct.

Laparoscopic gallbladder surgery versus open surgery

Until the late 1980s, anyone having their gallbladder removed had open surgery. An incision about 6 inches (15 cm) long was made just under the right ribs. The area of the abdomen above the gallbladder was opened up so that the operation could take place.

Laparoscopic surgery techniques became popular quite quickly and now the vast majority of the 60,000 cholecystectomies carried out in the UK each year are done laparoscopically.

Open gallbladder removal	Laparoscopic gallbladder removal
Three to four days in hospital	Usually done as a day case, or with an overnight stay if your operation is in the afternoon
Typical recovery time to be able to do light activity/sedentary work is about four to six weeks	Faster recovery, usually seven to ten days and you are back at work
Significant wound pain after surgery, with patient-controlled analgesia (morphine with button control) required for two to three days	Some discomfort and soreness for two to four days after surgery, but only mild painkillers required (e.g. paracetamol)
A six inch (15cm) scar	Four small incisions made to act as ports for the laparoscope and surgical instruments, so minimal scarring and less pain

The procedure for laparoscopic gallbladder removal

Once gallstones have been diagnosed, usually on the basis of your symptoms, medical history and an ultrasound scan, you will typically be advised to have an operation. The procedure will remove the gallbladder together with the stones it contains. Most people are suitable for a laparoscopic cholecystectomy and this is now done wherever possible.

The operation is done as elective surgery meaning it is planned in advance. Within the NHS there is a waiting time, although this is kept as short as possible.

The advantages of going privately for treatment is that you can have the consultation with an expert. The investigations and surgery will be much sooner. You are guaranteed that the surgery will be performed by (rather than simply supervised by) a Consultant Surgeon.

Checks prior to gallbladder surgery

• A cholangiogram, an X-ray using a special dye to produce detailed images of your gallstones (usually a non-invasive MRI in today’s practice).
• The usual pre-operative checks to make sure you are well enough to have a general anaesthetic.
• Instructions on fasting the night before, with advice on when to come into hospital.

Gallbladder surgery step by step

On the day of the operation, you will be prepared for surgery, brought into theatre and given a general anaesthetic for your laparoscopic cholecystectomy. The procedure usually takes about 60 minutes to complete.

• An incision about 1 cm long is made near to your navel, and the laparoscope is inserted into your abdomen.
• Carbon dioxide gas is used to inflate your abdomen so that the surgeon can get a view of your internal organs, and so that manipulating the surgical instruments is easier.
• Three additional but smaller incisions are then made, two just under your right ribs and one in the centre of the upper abdomen. These provide access points for the different surgical instruments required.
• The bile duct and the main artery that carries blood to the gallbladder are clipped to stop the flow of bile and blood.
• The instruments are then used to cut away the gallbladder from the liver, and it is removed in a bag through one of the three smaller abdominal incisions.
• The incisions are closed with a few stitches, which will dissolve over the next few weeks as your skin heals.

Complex laparoscopic cholecystectomy

Not all laparoscopic gallbladder removals are straightforward, which is why the experience of your surgeon is important. If the gallbladder is very inflamed, the bile duct is affected, or you have acute pancreatitis (inflammation of the pancreas), it may be more difficult to perform minimally invasive surgery.

Your surgeon will explain if you are one of the few people who need open surgery, or may warn you that there is a possibility that your operation may start as a laparoscopic cholecystectomy but may then need to be converted into open surgery.