The gallbladder stores and concentrates bile. Gallstones form when substances in the bile crystalize and become solid. While some patients with gallstones may remain symptom free the majority eventually develop symptoms, notably pain due to a stone blocking the outflow from the gallbladder, fever due to infection of the gallbladder or bile duct and jaundice or pancreatitis due to a stone passing out of the gallbladder into the bile duct. Gallstones are typically diagnosed on ultrasound examination of the abdomen.
Patients with symptomatic gallstones are advised to have their gallbladder together with the gallstones removed. Over 90% of gallbladders are removed laparoscopically (keyhole surgery). This surgery involves four small incisions, 1-2cm in diameter in the upper abdomen. A camera inserted immediately below the belly button (umbilicus) is connected to a video screen and three dissecting instruments are inserted through the three other incisions in the upper abdomen. The gallbladder attachments to the main bile duct system and the main arterial system are dissected free, isolated, clipped and divided and the gallbladder attachment to the under surface of the liver is then divided using cautery. The gallbladder is then inserted into a sterile bag, and removed through one of the upper abdominal incisions with or without extension of that incision. The wounds are closed with dissolving sutures inserted beneath the skin and are covered with sterile dressings for at least one week following the surgery. Patients may shower or bath and afterwards replace the wet with dry dressings.
Typically, the surgery takes less than one hour to perform, and particularly if performed prior to midday the majority of patients who are otherwise healthy and well can be discharged the same day. Patients are typically advised to return for one follow up visit approximately one month later, where the wounds are inspected and the pathology report of the removed gallbladder is reviewed. Complications may occur following laparoscopic cholecystectomy, but these are rare. Significant haemorrhage occurs in less than 1% of patients. A bile leak from the main bile duct system, or from the tube connecting the gallbladder to the bile duct (cystic duct) occurs in approximately 1.5% of patients, but the vast majority of these can be managed by inserting a drain into the gallbladder bed in the x-ray department, together with inserting a stent up the bile duct in the gastrointestinal (GI) department. Serious injury or transection of the bile duct occurs in less than 0.3% (3 per 1000) and requires major surgery to correct it. Injury to other abdominal organs during the procedure occurs in less than 1%. Infection in the wound is uncommon following laparoscopic cholecystectomy. The patients may complain of tiredness for up to four weeks following the procedure.