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Gall bladder surgery – Laparoscopic cholecystectomy

What is the gall bladder?

The gall bladder is a pear-shaped organ, about the size of a golf ball, that lies just beneath the right side of the liver. Its main function is to act as a reservoir to collect and concentrate bile, a digestive fluid produced by the liver. Bile, which is a clear golden yellow liquid, is needed for digesting fats in the food we eat.  After eating, bile is released from the gall bladder and travels down tubular channels (bile ducts) into the small intestines for fatty food digestion.


 

What causes gall bladder problems?

Gall bladder problems are usually caused by the presence of gallstones. The stones consists primarily cholesterol and bile salts that form in the gall bladder or in the bile duct. As time passes, these stones, started as sediments, may grow bigger tobecome gallstones. It is not known why some people develop stones and there is no known means to prevent them.  The gallstones may block the flow of bile out of the gallbladder causing it to swell. Patients may experience sharp abdominal pain that may radiate to the back or shoulder, fever, vomiting or indigestion. If the gallstone blocks the main duct (common bile duct), patient may become jaundice, a yellow discolouration of the skin.


 

How are gallstones diagnosed?

Following a medical history and physical examination, your doctor will usually order an  abdominal ultrasound or CT scan and some blood tests to confirm the presence of gallstones.


 

How are gallstones treated?

Once formed, the gallstones will not go away unless the gallbladder is removed. Medications used to dissolve gallstones and dietary modification such as low fat diet, have little success  in the management of such problems and therefore not recommended. Only surgery to remove the gall bladder is the time honoured and safest treatment of gallstones.


 

How is surgery performed?

Open surgery is the traditional method of removing the gallbladder. This is done through a long incision over the abdomen. With advancement in technology, we are now able to perform such surgery through ‘key-hole’ method also know as laparoscopic or minimally invasive surgery. The operation only requires 4 tiny stab incisions in the abdomen. A laparoscope (telescope) is inserted through one of these incisions to give your doctor a magnified view of the internal organs including the gallbladder, on a television screen. Instruments  are subsequently inserted through other incisions and use to delicaetely dissect the gallbladder and detach it from the liver bed. The gall bladder is then removed through one of the incisions.


 

What are advantages of laparoscopic cholecystectomy?

By performing through 4 tiny stab incisons, patients will have significantly less postoperative pain than the traditional open method of long incision. Patients usually only need to stay a day or two in the hospital and can recover faster and return to work or normal activities early. The wounds will heal faster and the scars are hardly visible.


 

What happens if the operation cannot be performed or completed by the laparoscopic method?

Majority of patients will be eligible for the laparoscopic method. However, a small number of patients may not be suitable candidates for such an approach, for example, patients with previous upper abdominal surgery or complex pre-existing medical conditions. In such situations, open or the traditional method will be used to remove the gallbladder. A thorough consultation and evaluation by your surgeon will determine if the laparoscopic approach is appropriate for you.

In a small number of situations, the laparoscpic method may be required to convert to an open approach to complete the surgery. Such situations include patients with obesity or previous upper abdominal surgery causing dense scarring around the operating field, difficult to visualise the anatomy or bleeding encountered during operation. The decision to perform the open method is a judgement decision made by your surgeon before or during the actual operation and this is based strictly on patient safety.


 

What are the potential complications of laparscopic or open surgery for gallbladder removal?

This is a very safe and effective surgery with majority of patients experience few or no complications and quickly return to normal activities.

The complications of gallbladder surgery are uncommon, but include bleeding, pneumonia, blood clots, heart attack or stroke. Unintended injury to surrounding structures such as the common bile duct or small intestine may require subsequent surgical repair. Bile leakage from the duct or liver bed may rarely occur.

Medical studies have concluded similar complications for gallbladder surgery be it the laparoscpic or open method.

 

***This is intended to give a general overview on laparoscopic gallbladder surgery. It is not intended to serve as a substitute for professional medical care or a discussion between you and your surgeon about the need for a laparoscopic gallbladder surgery. It is recommended that you discuss with your surgeon before the operation or if you have any queries.