Why would a cholecystectomy be needed?
The cholecystectomy is the surgical removal of the gallbladder. This might be necessary if a patient has gallstones that are symptomatic and cause repeated gallbladder infection. Typical signs of symptomatic gallstones are right upper abdominal pain and nausea, especially after eating a fatty meal. The condition is more common in middle-aged female patients. Other indications for this procedure include polyps in the gallbladder > 5cm, thickened gallbladder wall ("porcelain gallbladder") and patients with an increased risk of gallbladder cancer or complications from gallstones although they are not symptomatic.
How is a cholecystectomy done?
A cholecystectomy is done to remove the gallbladder. Living without a gallbladder will mean that your liver will still produce bile to digest food, but now the bile will just drip straight into the small intestine and bypass the gallbladder. This surgery can be done using minimally invasive laparoscopic techniques, however, in some cases, this isn't possible due to repeated episodes of gallbladder infection and scarring from previous surgeries. Open surgery may be better suited in these situations.
Surgery may be done in the following way:
Under general anaesthesia, Dr Aikman will make a small puncture-like incision into the centre of the abdomen. Through this small hole, a laparoscope, which is a narrow tube with a camera, will be inserted giving him full view of the internal organs while he performs surgery. Other thin tools are then inserted into the abdomen to remove the gallbladder and cut off the blood supply to it. The gallbladder is then dissected of the liver and removed via one of the incisions made. The gallbladder bed is then inspected to ensure no blood or bile is present. All ports are then removed under vision. Finally, the small incisions are closed with absorbable sutures.
This procedure is rarely done in the modern era but might be necessary to do if clear visualization of all the anatomical structures is not possible during the laparoscopic procedure. For open surgery, under general anaesthesia, Dr Aikman will make a larger incision on the upper right side of the rib cage so that he may access the gallbladder. From there he will cut off the blood supply to the gallbladder and remove it under direct vision. He will then close the incision in layers and close the skin with absorbable sutures. This procedure is associated with more pain and longer hospital stay.
What will recovery entail?
How long your recovery will be after surgery will depend on whether the cholecystectomy was done laparoscopically or through open surgery. If done laparoscopically, the incisions should be much smaller and thus the pain and recovery time is much less. After a cholecystectomy the following symptoms are common and should not be concerning:
- Minimal pain in the upper abdomen.
- Transient pain in the right shoulder.
- Nausea and vomiting for the first 24 hrs.
- Pain when coughing, sneezing or laughing.
- Red skin around your incisions.
Symptoms to look out for include an unusually high fever, chills, vomiting, swelling and bleeding around the incisions, cramping, jaundice and excessive pain as these are not normal and may require additional intervention. In the ward Dr Aikman will ask you daily if your pain is getting better, worse or staying the same. A sudden increase of pain associated with already mentioned symptoms is worrisome and will require additional evaluation.
While you should be able to return to your normal lifestyle in a few days, you should be careful when doing physical activities. Avoid heavy lifting or vigorous exercise until you have been given the go-ahead form Dr Aikman. After 2 weeks, your general surgeon will check your incisions and give you instructions for care in the following few weeks.