GALL BLADDER

ARE GALLSTONES ALWAYS BAD?

• Whilst 10% of people of people may have gallstones, up to 80% of those will never develop any symptoms or a gallstone related medical problems

• If you have gallstones, 1-2% will develop symptoms per year

 

DO I NEED SURGERY FOR MY GALLSTONES?

• If your gallstones are not causing you any problem, surgery is not usually recommended

• The exceptions to this may include:

  • Large stone/s (>3cm)

  • Multiple small stones filling gall bladder

  • Young age

  • A history of diabetes

• If you have symptomatic gallstones, surgery will usually be recommended

 

WHAT SYMPTOMS/CONDITIONS DO GALLSTONES CAUSE? 

• Gallstones can cause a variety of conditions and thus a variety of different symptoms

 

• Biliary colic

  • Most common cause of gallstone related symptoms

  • Stones block up the gall bladder outlet so when it tries to empty – typically after a meal – you may develop upper and/or right sided abdominal pains

  • Pain may radiate around to the back or to the chest

  • Can be mistaken for heart pain and vice versus

  • May be associated with nausea and/or vomiting

  • Typically self limiting, lasting up to a few hours

 

• Cholecystitis

  • If the stone continues to block the gall bladder in biliary colic, the gall bladder becomes inflamed and potentially infected

  • Pain persists and goes from colicky to constant

  • There may be fever and/or jaundice (yellowing of the eyes and skin)

 

• Cholangitis

  • A bile infection caused by blockage of the main bile duct from stones which either formed there or have entered there from the gall bladder

  • May be associated with right or central upper abdominal pain, fevers, rigors and/or jaundice

 

• Pancreatitis

  • Inflammation of the pancreas which can also be caused by stones in the bile duct

  • Characterised by sever upper central abdominal pain penetrating through to the back and may be associated with nausea and vomiting

 

• Gall bladder cancer

  • Only very rarely associated with gallstones

 

MY GALLSTONES ARE CAUSING ME TROUBLE; WHAT CAN I DO?

• The safest, most effective way of dealing with symptomatic gallstones is surgical removal of the gall bladder – known as cholecystectomy

• This is usually done via “keyhole” surgery, but occasionally open surgery via a longer cut is necessary for your safety

 

WHAT IS LAPAROSCOPIC CHOLECYSTECTOMY?

• “Keyhole” surgical removal of the gall bladder – performed with you asleep under general anaesthetic, in an operating theatre

• It’s usual for 4 small incisions to be made, ranging from 5mm to 2cm

• A long camera-telescope and long instruments are passed through these incisions so Mr Jassal can operate from outside the abdomen whilst seeing what he’s doing inside via camera-telescope

• The gall bladder is detached from the liver and biliary system and removed via one of the small incisions

 

WHAT IS OPEN CHOLECYSTECTOMY?

• Before “keyhole” surgery, cholecystectomy was always performed via a longer incision allowing the surgeon direct access to the gall bladder (ie; not via camera-telescope and long instruments)

• Sometimes open cholecystectomy may still be necessary or Mr Jassal may start your operation laparoscopically (“keyhole”) but convert to open surgery midway through if it is the safest course (<5% risk)

 

CAN I JUST HAVE MY GALLSTONES REMOVED BUT KEEP MY GALL BLADDER?

• This is not recommended

• Higher risk and less effective operation

• Gallstones are at high risk of reforming in the gall bladder

 

ARE THERE ANY NON-SURGICAL WAYS TO FIX MY GALLSTONES?

• Laparoscopic cholecystectomy is the safest way of effectively dealing with symptomatic gallstones

• Medical treatments to dissolve stones and ultrasound shockwave treatment to break up stones have not been shown to be reliably effective but can have a role in specific situations

 

WHAT IS INTRA-OPERATIVE CHOLANGIOGRAM?

• During cholecystectomy, Mr Jassal routinely performs a cholangiogram

• This is an X-ray performed on you during the operation in the operating theatre

• Dye is squirted into the bile duct to outline it’s exact location and course, and to show up any stones which might be in it

• Cholangiogram makes your operation safer and minimises the chance of leaving stones behind in the bile system after removal of the gall bladder

 

WHAT SHOULD I DO BEFORE SURGERY?

• The usual pre-operative recommendations apply (see Preparation for surgery)

• Notify Mr Jassal of any previous abdominal operations

 

ARE THERE ANY POST-OPERATIVE INSTRUCTIONS?

• The usual post-operative advice applies (see Post operative instructions)

• Assuming your operation is completed laparoscopically (“keyhole”), you will usually be home by the next day

• You can expect mild to moderate soreness initially which should improve rapidly within a few days – paracetamol +/- an anti inflammatory such as ibuprofen may be all that is required

• Notify Mr Jassal of increasing pain, fever or any wound problem

• One to two weeks off work is usual

• Avoid strenuous activity for four weeks

• Open cholecystectomy is a bigger operation as the abdominal cut is larger – your hospital stay and overall recovery will be longer

 

WILL I NOTICE A DIFFERENCE AFTER SURGERY?

• You may notice some reduced tolerance to fatty foods, with more frequent bowel motions or even diarrhoea initially

• If this occurs, it should improve in the first few weeks as your body adapts to the operation

 

ARE THERE ANY RISKS OR POTENTIAL COMPLICATIONS OF SURGERY?

• Cholecystectomy is a common, safe and effective procedure, however all surgical procedures carry some risk

• Whilst complications are uncommon, they can include:

  • Anaesthetic complications (including heart and lung problems), allergy to something in the operating theatre, bleeding, infection and development of blood clot

  • Bile leak (1%)

  • Bile duct injury (<0.5%)

  • Injury to nearby organ/bowel (very rare)

  • Gas embolism (very rare)

 

The above information is a general guide only – please feel free to seek further information and/or clarification from Mr Jassal