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Your gallbladder is a small, pear-shaped pouch in the upper right part of your abdomen (tummy). It stores bile, which is a fluid made by your liver, and used to help digest the fats that you eat. Bile is made of cholesterol, bile salts and waste products, and gallstones can form when these substances are out of balance. Gallstones can give you abdominal pain (particularly after a fatty meal), make you feel sick and give you a fever (a temperature higher than 37.5°C). Your gallbladder may need to be removed if it becomes damaged by gallstones. If you have your gallbladder removed, bile dribbles continuously into your gut rather than only being released after meals.
Your GP may press gently with his or her fingers just below the ribs on the right side of your chest. This area may feel tender if you have an inflamed gallbladder. A blood sample may be taken from you for testing.
Your GP may send you for further tests including:
• ultrasound scan – this uses sound waves to produce an image of the inside of your body
• HIDA (hepatobiliary iminodiacetic acid) scan – X-ray images of the gallbladder are taken following injection of iodine dye
What are the alternatives?
If your symptoms are mild, or if surgery isn’t possible for medical reasons, there may be alternatives to having surgery to remove gallstones. Your surgeon will discuss any possible alternative treatments with you.
Preparing for your operation
A gallbladder operation is usually done using keyhole surgery (laparoscopic cholecystectomy), which means your surgeon won’t have to make a large cut in your abdomen.
Keyhole surgery is usually carried out as a day case, but you may need to stay overnight in hospital. The operation is done under general anaesthesia which means that you will be asleep during the procedure.
Your surgeon will explain how to prepare for your gallbladder surgery. For example, if you smoke you will be asked to try to stop as smoking increases your risk of getting a wound or chest infection and slows your recovery.
You will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.
At the hospital your nurse will explain how you will be cared for during your stay. Your nurse may check your heart rate and blood pressure, and test your urine.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.
Your surgeon and anaesthetist will visit you before your operation. This is a good time to ask any unanswered questions. Your surgeon will ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
About the operation
During the laparoscopic operation, your surgeon will make two or three small cuts (about 5 to 10mm long) through the skin of your abdomen. One cut will be above, or just below, your navel (tummy button), and the others on the right side of your abdomen.
Your surgeon will then inflate your abdomen using carbon dioxide gas to make it easier to see your internal organs. He or she will then pass a laparoscope (a long, thin telescope with a light and camera lens at the tip) through one of the cuts. This allows your surgeon to view your internal organs on a monitor.
Specially adapted surgical instruments help move the internal organs and allow your surgeon to cut and remove the gallbladder. X-ray images may be taken during the operation, so that your surgeon can see if any gallstones are blocking your bile duct.
Afterwards, the instruments are removed and the gas is allowed to escape through the laparoscope. The skin cuts are closed with dissolvable stitches and covered with a dressing.
The operation takes 60 to 90 minutes.
What to expect afterwards
You will be taken from the operating theatre to a recovery room, where you will come round from anaesthesia under close supervision. You will then be taken back to your room, where your nurse will check the wounds and record your heart rate and blood pressure at regular intervals.
You will need to rest until the effects of the general anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off. If you do have any discomfort, discuss it with your nurse.
Dissolvable stitches will usually disappear in around one to three weeks, but this can take up to six weeks, depending on the type of stitches you have. Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment. You may also be given special compression stockings to wear after surgery to decrease the possibility of blood clots forming in your legs.
Recovering from gallbladder surgery
General anaesthesia temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you’re in any doubt about driving, please contact your motor insurer so that you’re aware of their recommendations, and always follow your doctor/surgeon’s advice.
If you need pain relief, you can take over-the-counter (OTC) painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. Your surgeon may give you painkillers when you’re discharged from hospital.
You can return to your usual activities, including going back to work, after about a week. However, some people may need to rest for longer while others can return to work after a few days. Follow your surgeon’s advice about driving. You shouldn’t drive until you’re confident that you could perform an emergency stop without discomfort.
What are the risks?
Gallbladder removal is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
These are the unwanted but mostly mild and temporary effects of a successful treatment. An example of a side-effect is feeling sick as a result of the anaesthetic or painkillers.
You may feel some pain in your abdomen and shoulders. This is caused by the gas used to inflate the abdomen and usually disappears within 48 hours.
Many people have diarrhea after having their gallbladder removed, because the bile salts irritate your digestive system. Eating plenty of high-fibre foods such as brown rice, whole meal bread and pasta can help you absorb excess water and make your bowel movements firmer. Your GP may suggest the use of bulking agents such as methyl cellulose (Celevac) or Fybogel or may prescribe a medicine called colestyramine (Questran).
This is when problems occur during or after the operation. Most people aren’t affected but the main possible complications of any surgery are an unexpected reaction to the anaesthetic, excessive bleeding, infection or developing a blood clot in a vein in the leg (deep vein thrombosis, DVT). Most people are given compression stockings to wear during the operation to help prevent this.
There is a chance your surgeon may need to convert your keyhole procedure to open surgery. This means making a bigger cut on your abdomen. This will only be done if it’s impossible to complete the operation safely using the keyhole technique.
Possible complications include the following.
• You may have pain in your abdomen, bloating, wind and diarrhoea, which may need further investigation and treatment.
• Rarely, your bile duct or other organs may become damaged during surgery. If this happens you may need further surgery.
• Blockage of a blood vessel with a bubble of carbon dioxide gas may occur.
The exact risks are specific to you and differ for every person, so we haven’t included statistics here. Ask your surgeon to explain how these risks apply to you.