Description
Laparoscopic cholecystectomy refers to the removal of the gallbladder using a keyhole approach. This involves 4 small incisions. The gallbladder is dissected of the liver and the bile ducts defined. A dye test (cholangiogram) is performed to ensure no bile ducts are damaged, and to exclude any gallstones being impacted in the lower bile ducts. The procedure is often done as a day case. Local anaesthetic in the incisions and abdominal cavity mean that pain is minimal.
Conversion to open surgery is extremely rare. The risks of damaging the bile ducts, whilst much higher 20 years ago, are now very low (less than 1:2000).
Indications
Gallstones are very common (15 – 20 % of people) and usually asymptomatic. Because of the recurrent pain and more severe problems gallstones can cause, particularly pancreatitis, all international guidelines recommend removal of the gallbladder once gallstones become symptomatic.
Gallbladder polyps are also common, and can progress to become gallbladder cancer, a very serious cancer that has a very poor prognosis and is always terminal. Once gallbladder polyps reach 6mm in size, international guidelines recommend cholecystectomy. If smaller than 6mm, gallbladder polyps should be closely watched / surveilled with regular ultrasound scans. Some patients may prefer to have their gallbladder polyps removed at a smaller size to avoid the annoyance of multiple follow up ultrasound scans.
Side effects
Because the bile flow becomes a constant trickle, rather than a pulsed release with meals, some patients experience symptoms after surgery, particularly with fatty meals. These can include nausea, bloating, diarrhoea or flatulence. If such symptoms are experienced, the vast majority of patients will find they settle in the first 6 - 8 weeks after surgery.