Gallstones

Gallstones are extremely common. We aren’t sure why some people get gallstones and others don’t. Many people have gallstones and no symptoms but for some people gallstones can cause problems such as:

intermittent attacks of severe abdominal pain (biliary colic)
inflammation of the gallbladder (cholecystitis)
jaundice
inflammation of the pancreas gland (pancreatitis)

For people with symptomatic gallstones the best treatment is removal of the gallstones and the gallbladder by keyhole surgery. This operation is called a laparoscopic cholecystectomy.

Nowadays, this is a straightforward operation that can often be performed as a day case procedure.

I have now performed several thousand of these operations.

My conversion rate to open surgery is very low at at less than 1 in 500 operations.

Q. What are gallstones?

A. The liver produces bile, which is necessary to dissolve

the fats in our diet. The bile is stored and concentrated in

the gallbladder, which lies just underneath the liver. Many

people develop gallstones but nobody knows quite why.

In most people they don’t cause any problems but in

some people they can cause severe intermittent abdominal

pain (biliary colic) or inflammation of the gallbladder (cholecystitis)

Q. How do you get rid of gallstones?

A. People have tried dissolving gallstones with drugs and shattering them with ultrasound – invariably though they come back with these methods. The only effective way to get rid of the gallstones is to remove them - together with the gallbladder – with an operation. This operation is called a laparoscopic cholecystectomy.

The gallbladder, like the appendix, is an organ that you can live without.

Q. What does the operation involve?

The operation is performed under general anaesthetic. Three or four small incisions, each no more than 1cm long, are made in the tummy wall as shown. Through these incisions a camera and instruments are inserted into the abdominal cavity to remove the gallbladder and gallstones.

The operation takes about an hour to perform. At the end of the procedure the gallbladder and gallstones are placed into a bag and removed via the umbilical incision. The incisions are closed with invisible stitches beneath the skin.

Q. How long will I be in hospital?

A. Most patients go home within 24 hours of surgery and some, if they’re feeling well enough, will go home the same day.

You should look at taking it easy for about one or two weeks afterwards. Remember that even if it is done through keyhole surgery, having your gallbladder removed is still a major operation.

Q. Will there be pain?

A. You must expect some abdominal pain after your operation. This may be around the umbilicus, in the upper tummy where the gallbladder has been removed or in the right shoulder-tip. You will be given painkillers, which you should take regularly for 3 or 4 days.

Q. What are the risks of the operation?

A. A laparoscopic cholecystectomy is a safe and straightforward procedure for the vast majority of people. However, no operation is completely without risk and there are some points you need to be aware of:

It is possible that we may not be able to remove the gallbladder through keyhole surgery because of inflammation, bleeding or unusual anatomy. In this situation we proceed immediately to an ‘open’ operation which involves a 15cm scar under the right ribs, a longer stay in hospital (4-5 days) and a longer recovery at home afterwards (6-8 weeks). This happens in only about 1 in 500 operations in my hands.
The gallbladder is attached to a tube called the bile duct. In any operation on the gallbladder this duct may get damaged. If it does, it may require further operations to fix it. The risk of this happening is about 1 in 1000 operations.

Q. What can I expect to do after the operation?

You should gradually resume your normal activities, as you feel able.
You can shower, bathe and get the wounds wet after 24 hours.
Don’t soak for too long and gently dab the wounds dry for a few days.
Most people return to work within one or two weeks of surgery depending on your job.
You can drive as soon as you are safe to do so and for most people this is about 7 days after surgery.

Q. Do I need to alter my diet after the operation?

A. There is no restriction on your diet after your gallbladder is removed. A small number of people experience diarrhoea if they eat a particularly fatty meal. This usually settles over a few months.

Q. What should I look out for after the operation?

A. You should contact the ward where you had the operation or my secretary if you develop:

a persistent temperature (>38ºC)
worsening abdominal pain
worsening nausea or vomiting
jaundice (yellowing of the skin or the eyes)

If you don’t get a response from them then you may need to contact your GP. You shouldn’t need to see your GP routinely.

For a clear explanation about gallstones and their treatment I would recommend this video by Mr Nick Markham from North Devon Healthcare NHS Trust.