The Gall bladder and you
- Part 2 -

Dr Jugindra S *

Gallbladder and hepatic artery :: Pix - Wikipedia/Anatomist90

What are the risks of the operation?

Although recovery for the patient is radically different from traditional open surgery, the operation on the inside is still the same. This is still major surgery with potential complications associated with major surgery. Because the approach is different, some complications become rare, but others become more likely.

What other unpleasant side effects might I experience?

Some patients experience pain in the right shoulder for a few days. This comes from irritation of the diaphragm by gas, blood or bile at the time of surgery. Patients with small stones may have passed a few silently into the bile duct. These may cause "typical gallbladder pain" when they pass into the bowel. Occasionally additional procedures (usually not surgical) may become necessary to clear the duct. There may be a little oozing from your wound or bruising around it. This is minor natures and resolves in time.

Can I be sure of avoiding open surgery?

Occasionally a laparoscopic procedure may have to be changed to open for the patient's safety. This is called 'conversion' and is not a complication of laparoscopic surgery.

What would make a surgeon change to open surgery?

Sometimes there is too much inflammation of the gallbladder. The tissues may be swollen or so scarred that recognition of anatomic landmarks is impossible. Rarely people are born with abnormal arrangement of the structures, so that they cannot be recognized on video screen.

How do you get the gallbladder out without opening?

We can drain the gallbladder while it is inside. Then it collapses like a balloon and slips out easily.

Do you have to open if my stones are big?

No. Big stones can be crushed within the gallbladder and removed piece-meal.

Is it true that key-hole surgery can sometimes leave behind stones?

This is absolutely false! The surgery inside the abdomen is literally the same as in open surgery.

But what about concomitant stones in the common bile duct?

Common bile duct (CBD) stones are best removed by endoscopic method (ERCP) before or after laparoscopic cholecystectomy. However CBD stones can be explored both in the open as well as in laparoscopic surgery with equal benefit.

How long is the operation?

Operating time differs with the amount of difficulty, unexpected findings, inflammation. It varies as well with the surgeon. In most hands the average time is considerably less than one hour.

Do I need a general anesthetic?

Yes. Even though the incisions are small, the operation cannot be done with local anesthesia.

How long do I need to spend in the hospital?

Experience with thousands of patients in Canada and the USA has proven this to be a safe out-patient procedure. In India few centres have started practicing this as a day care procedure. Most of the patients in Manipur are happy to return home after 48 hours though about 25% volunteer to return the next day.

Is the operation safe in diabetic or hypertensive patient ?

Since this operation is very less traumatic and the recovery is fast, patients with associated with other disease (diabetes, hypertension, asthma, cardiac disease, abdominal or chest deformity, etc.) laparoscopic cholecystectomy is the recommended surgery as open surgery with delayed recovery makes the routine operation a relative contraindication.

How soon can I do my routine activity ?

Starting the next day, you may be as active as your discomfort allows. There is no way you can generate enough strength to do yourself any harm. You may drive, carry half a bucket of water, walk up stairs, etc. The more active you are, the quicker you recover and the less chance you have to develop complications.

What can I eat after my surgery?

Fried and fatty food foods make the gallbladder contract and can cause pain if you have stones. For this reason it is wise to avoid them before surgery. After surgery you no longer have a gallbladder, so such foods cannot upset your gallbladder and cause pain any more. Therefore you may eat anything you wish, unless contraindicated for other reasons. But please remember that some foods may not agree with you, as they don't with many people, regardless of gallbladder problems. Also remember that there are many other health reasons to avoid fats in your diet beside gallstones.

When do I get back to work or back to my normal self?

Pain is a very individual thing. In very few individuals discomfort may last for some time. This is difficult to predict beforehand. However, experience with thousands of patients has shown that 90% of people can return to full work within one week of their surgery. They may not be totally comfortable, but most can carry out their duties, even if these involve strenuous physical activity.

When can I bathe?

You can start bathing one or two days after surgery.

How do I look after my wounds?

You will leave hospital with four band-aids. Take these off in five days and leave the wounds open. The stitches in your skin will melt, so these need no attention.

How costly is the procedure?

Laparoscopic surgery requires several computerized gadgets and other sophisticated instruments which are very costly to install. Maintenance of these instruments is also costly. Hence the overall cost of the operation is definitely more than the conventional open surgery. But there is paradoxical less expenditure in laparoscopic cholecystectomy because of the following facts.

1. Decreased hospital stay, 1 to 2 days, compared to 7 to 10 days for open surgery.

2. Less medicine required.

3. Patient can start earning one week to 10 days after laparoscopic cholecystectomy. After open surgery patients can start work 3 to 6 weeks later.

Because of the economic benefits at national level laparoscopic cholecystectomy is the officially recommended operation for gall stones in most of the European countries, Japan and America.

Though laparoscopic cholecystectomy began only two decades ago, it has become the gold standard treatment for gall bladder disease and is likely to remain so. The only change likely to come up is more refinement of instruments which will become narrower and thereby leaving smaller scars.

Nowadays, this procedure can be performed through a single incision in the patient's umbilicus. This advanced technique is called Single Incision Laparoscopic Surgery (SILS). The procedure is identical to traditional laparoscopic gallbladder removal except that the surgeon makes just one tiny incision instead of four. In single-incision surgery, the laparoscope (optical instrument) and all of the instruments are inserted through one 1.5-2 cm incision within the navel. Thus, the patient recovers with a single, almost invisible scar in the umbilical area.

Concluded..