Laparoscopic Gallbladder Surgery

							                Dr. Bernard Beldholm M.B.B.S B.Sc (Med), FRACS (Specialist Surgeon)
                117 Mt Pleasant St                                                                                             Ph:(02) 49319299
                Maitland, NSW 2320                                                                                            Fax:(02) 49329132
                www.beldholm.com
                                                    Laparoscopic Gallbladder Surgery
                                                                                  abdominal cavity to lift the abdominal wall clear of the liver, gallbladder,
                                  What is it?                                     small intestine, stomach and other organs. The GB is identified and careful
                                                About one adult in every 10       dissection of the structures is performed. Dr. Beldholm’s usual practice is to
                                                has gallstones. In people         perform a cholangiogram (X-ray of the bile ducts). A special tube is inserted
                                                who have symptoms caused          into the cystic duct, X-ray dye is injected, and X-rays are taken. This will
                                                by gallstones, removal of the     demonstrate if there are any GB stones in the ducts and will confirm that the
                                                gallbladder is usually the        correct ducts are being clipped and cut. After the cholangiogram the GB is
                                                best treatment. In people         removed from its liver attachment and taken out through the umbilical port.
                                                with complications due to         Dr. Beldholm does not usually leave a drain behind. The incisions are closed
                                                gallstones, prompt treatment      with absorbable stitches (these do not need to be removed).
                                                is important. The most
                                                common way to remove the
                                                GB is by laparoscopic
                                                (keyhole) surgery.


                        Symptoms and Diagnosis
When the amounts of bile and other fluids inside the gallbladder (GB)
become unbalanced, some of the chemicals solidify and form gallstones.
Most gallstones are made primarily of cholesterol.

If the gallstones stay deep within the GB, they may not cause major
problems. If the gallstones move and block ducts, bile can back up, causing
symptoms and leading to infections and diseases of the GB, liver or pancreas.
Symptoms from your GB usually occur after a meal and include;
          Steady, severe pain in upper abdomen (GB Colic) this often wakes                             Effects of surgery and side effects
           the person at night                                                    In Dr. Beldholm’s experience serious problems are uncommon,
          Pain may go through to the back                                        however can happen. Complications related to GB surgery include;
          Bloating                                                                Risks in common to all operations such as anaesthetic and
          Nausea                                                                     cardiovascular complications
          Vomiting                                                                Wound related; infection, bad scarring, keloids and incisional
Symptoms may settle, but they tend to come back if left untreated.                    hernias
                                                                                   Re-operation for internal bleeding, bile leaks or infection
Your GB is not essential for healthy digestion. Once your GB is removed,
bile will still flow (as it always has) from the liver to the small intestine.     Injury to organs close to GB (small bowel, stomach, liver etc)
                                                                                   Common Bile duct injury; this is potentially the most serious
                  Laparoscopic VS Open Cholecystectomy                                complications after GB removal. It is reported to occur 3-5 out of
Laparoscopic (keyhole) surgery is now the standard method for                         every 1000 operations. If this occurs, you may get lifetime
removing the GB. The benefits of laparoscopic surgery are many and                    problems that are difficult to treat
include (compared with open surgery);                                              Gas embolism (a bubble of carbon dioxide gets into the blood
      Less discomfort after surgery                                                  stream), this can be life threatening but is very rare
      Less time in the hospital                                                   There may be some change in bowel habits and eating after this
      A recovery of days instead of weeks                                            operation, this is associated with the post-cholecystectomy
      Small incisions instead of a large painful incision                            syndrome. This has been reported in up to 10 percent of patients.
      Small scars instead of a long scar                                             It can range from vague symptoms to more severe symptoms
Even though you may expect keyhole surgery, sometimes it is                           including; crampy abdominal pain, steatorrhoea and bloating.
necessary to convert the keyhole surgery to open surgery. This                                                       Recovery
happens rarely in Dr. Beldholm’s experience. Open surgery is safe                 After surgery, there may be some minor discomfort in your abdomen
and effective. Converting your operation into an open operation is not            and there may be some right shoulder pain. This is normally
a complication; it is done to protect the patient. The decision to                controlled with simple painkillers such as paracetamol and/ or
convert to open surgery should be considered to be sound judgement.               ibuprofen. You may have some fluids a few hours after surgery and a
                                                                                  full diet 6 to 8 hours after surgery. In Dr. Beldholm’s experience,
A patient may be very disappointed that he or she had open surgery                most patients go home within 24 hours and are back to normal after
instead of keyhole surgery, but open surgery is done in the interests             one week. If you have an open operation, the recovery may take up to
of the patient’s safety and well-being.                                           6 weeks and you may have to stay in hospital for up to 1 week.
                                                                                  Eating
               Technique for Laparoscopic GB Operation                            You may have some gas pains and other discomfort while your
Dr. Beldholm usually uses 4 small cuts to insert the necessary instruments.       digestive system returns to normal. Eat a low fat healthy diet that was
These cuts range from 5 to 12mm. Carbon dioxide gas is blown into the             easy to digest before your gallbladder surgery.
                                                                    This pamphlet is intended to provide you with information. It is not a substitute for
                                                                    advice from your surgeon and does not contain all known facts about this subject.
                                                                    Write down any questions you want to ask, Dr. Beldholm will be more than happy
                                                                    to answer any questions you may have.