Laparoscopic cholecystectomy is a ‘keyhole’ operation where the gallbladder is removed. Due to the fact that gallbladder diseases (mainly gallstones) are so prevalent in Australian society, laparoscopic cholecystectomy is one of the most common operations performed. The procedure is done under a general anaesthetic (fully asleep). A 1-2cm incision is made through the umbilicus (belly button) and a port placed. Carbon dioxide gas is insufflated into the abdominal cavity. A laparoscope (telescope) is inserted through a port. Three further 5mm incisions are made. One is just beneath the sternum (breast bone) and two are on the right abdominal wall. The dissection involves exposing the cystic duct (joining the bile duct to the gallbladder) and the cystic artery (the blood supply to the gallbladder). Both of these structures are ligated with clips (cut and clipped). The gallbladder is then dissected off the liver bed, placed in a bag and removed through the umbilicus. Occasionally, an x-ray (operative cholangiogram) is taken of the bile duct to check anatomy and to look for gallstones that may have moved out of the gallbladder. A intra-abdominal drain is sometimes left to drain fluid from the operative bed.
What to expect post–operatively
Most people spend one night in hospital and can be discharged in the morning following the surgery
Most people recover well and reasonably quickly and feel almost back to normal within 1 – 2 weeks. Usually, people require 1 week off work but this can be longer if one has a physical job.
Pain is usually well controlled with simple pain killers. You should take regular analgesia in the first 48 hours including paracetamol (Panadol) 1g (2 tabs) every 4-6 hours (max 8 tabs per day) and an anti-inflammatory such as ibuprofen (nurofen) 400mg every 4 – 6 hours. You may be given a prescription for a stronger pain killer such as oxycodone (endone) or tramal (tramadol) to use in addition as well. After 48 hours, use the painkillers only if needed.
The wounds will be closed with dissolvable stitches that are underneath the skin and therefore don’t need removing. The stitches can take months to fully dissolve. A dressing will be placed over the wound. Leave this on for at least 48 hours. You can wash or shower with these water-proof dressings. Once removed, there will usually be steristrips on the wound. These usually remain for a week. If they haven’t fallen off by a week, peel them off.
It is a good idea to stay on a low fat diet especially for the first few months. Most people do not have any changes to teir digestion after the gallbladder is removed. Some people do get some diarrhoea especially after a fatty meal.
Don’t do any strenuous activities for 2 weeks. Don’t lift anything over 1-2kg during this time. Walking and normal activities around the house is encouraged if you feel comfortable enough. From 2 -4 weeks you can jog or swim if there is no discomfort. Don’t do any abdominal exercises for at least 4 weeks and then start slowly and continue if you don’t feel any discomfort.
Most people recover without any problems. The most important complications include
Bile Duct injury – this occurs in approximately 1 in 500 cases. It is a major complication usually requiring reconstructive surgery.
Bile leak – this can be from the liver bed or a small accessory bile duct. It may require drainage.
Conversion to open surgery – this occurs in 1 in 50 cases.