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PATIENT INFORMATION GUIDE

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The doctors and staff at Apollo hospitals are pleased that you are considering us for your Laparoscopic Cholecystectomy. We would like to take the time to briefly discuss the process of undergoing Laparoscopic Cholecystectomy. Your physician has discussed the indications for surgery and the criteria that must be met prior to your Laparoscopic Cholecystectomy. This information is designed to offer additional information on your preparation before surgery, the surgery itself, and the road to recovery after your procedure.

What is the Gallbladder?

  • The gallbladder is a pear-shaped organ that rests below the right side of the liver.
  • The main purpose of the gallbladder is to collect and concentrate a digestive liquid (called bile) produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile moves through tapered tubular channels (bile ducts) into the small intestine.
  • Removal of the gallbladder is not associated with any impairment of digestion.

Gallbladder Stones

  • Gallstones are made from cholesterol and other substances found in the bile. They can be smaller than a grain of sand or as large as a golf ball.
  • People who are obese or who are trying to lose weight rapidly are more likely to get gallstones.
  • Presence of gallstones in the gallbladder may lead to a condition called Acute Cholecystitis which means inflammation of the gallbladder. This can cause symptoms such as abdominal pain radiating to the back, vomiting, indigestion and occasionally fever.
  • It is uncertain why some people form gallstones
  • If the gallstone blocks the common bile duct, jaundice (yellowish discoloration of the skin) can occur. If this is not detected promptly and treated, patients can develop a condition called cholangitis which can cause high grade fever with rigors.

How is gallbladder disease diagnosed and treated?

Ultrasound is the most commonly used test to find gallstones, though more complex investigations like MRI or endoscopic ultrasound (EUS) may be done. You will also need some blood tests done to ensure that the liver function is normal.

  • Gallstones do not go away on their own. Some can be temporarily treated with the help of drugs or by making dietary adjustments, such as reducing fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue unless the gallbladder is removed.
  • Surgical removal of the gallbladder is the time honoured and safest treatment of gallbladder disease.

Who needs a Cholecystectomy?

Patients with gallstones and symptoms as mentioned above should have a Cholecystectomy, before they develop severe complications. Occasionally patients without gallstones, who have significant symptoms, will require a Cholecystectomy. Rarely, patients with large gallbladder polyps (growths) will have a Cholecystectomy because of the possibility of developing gallbladder cancer.

How is the gallbladder removed?

The most common method of removing the gallbladder is by Laparoscopic (keyhole) surgery.

A camera, known as a Laparoscope, connected to a high intensity light is introduced through a small incision through your umbilicus (belly button). Three little puncture wounds are made (one in the upper abdomen and two under your ribs on the right hand side) to allow the surgical instruments to be introduced. To provide space for the surgery to be performed, your abdomen is filled with carbon dioxide. Once the gallbladder is dissected off the liver and the connections to the bile ducts and blood vessels are clipped, it is removed through the umbilical incision.

In about 3-5% of cases the gall bladder cannot be safely removed laparoscopically and a traditional open technique is required (laparotomy). This requires a 15 cm incision in your upper abdomen parallel to your right rib cage. This is a bigger procedure and will result in a longer hospital stay.

The choice to go ahead with the open procedure is a decision made by your doctor either before or during the actual operation. When the surgeon feels that it is the safer to convert the laparoscopic procedure to an open one, this is not a complication, but rather should be viewed as sound surgical judgement. The choice to convert to an open procedure is strictly centred around patient safety.

The gallbladder is more a storage organ which contracts at regular intervals and helps propel the bile into the small intestine. Even in the absence of gallbladder, bile would be continuously produced by the liver and will continue to pass into the small bowel. The bile ducts will store all the bile necessary for healthy function.

What can I expect after Laparoscopic Cholecystectomy?

How long will I be in hospital?

Most patients get admitted the night before the surgery and get discharged on the first post-operative day (In-patient surgery). However, some patients come into hospital on the morning of their surgery, and get discharged the same evening (Day-care surgery). Your surgeon will decide on whether your surgery would be performed as an in-patient or day-care, depending on your age, symptoms, fitness and other medical illnesses, if any.

What happens before the operation?

  • Plan for your care and recovery after the operation, especially if you are to have general anaesthesia. Ask at work for time to rest. Try to find other people to help you with your day-to-day duties.
  • If you are taking daily aspirin for a medical condition, ask your doctor if you need to stop taking it before your surgery.
  • Be sure to tell your doctor what medicines you are taking.
  • You may be asked to undergo pre anaesthetic investigations such as blood tests, ECG, Chest X-ray and also be evaluated by the anaesthetic team to assess your fitness for anaesthesia.
  • Follow all pre surgery instructions that your doctor gives you. It may usually be recommended that you eat a light meal, the night before the procedure. Do not drink coffee, tea, water or any fluid after the time that the doctor asked you to stop fluids.
  • You may be given a laxative to take the night before the surgery or an enema the morning before the surgery.

What happens after the operation?

You will be woken in the operating room after the operation has been completed, and taken into the recovery area. You will have an intravenous line in your arm that is attached to fluid, and enables the staff to give you medication. You will have an oxygen mask over your mouth that will administer supplemental oxygen. A blood pressure cuff will be on one of your arms, and intermittently inflated to measure your blood pressure. Rarely, a drain will be left in your abdomen to drain any fluid that may collect if it has been a particularly difficult operation. You will normally be able to get out of bed a few hours after surgery although the nurses will assist you the first time.

How much pain will I experience post-operatively?

Most people only experience mild-to-moderate pain, which is readily controlled with oral analgesia (painkillers). You may experience some pain from your wounds, especially on movement. If you do, the nurses will give you medication to ease the pain. You may notice some shoulder pain that is referred pain from the gas insufflated into your abdomen during surgery. This gas will gradually disappear but the discomfort may persist for several days. At the time of discharge you will be given a supply of painkillers and postoperative instructions on what to take when. After about 3 to 5 days most of the discomfort should disappear.

When can I return to normal activities?

You can return to normal physical and sexual activities when you feel comfortable. It is normal to feel tired after surgery, so take some rest, two or three times a day, and try to get a good night's sleep. After a week or so, you should be able to resume most of your normal daily activities. You should avoid heavy lifting and vigorous exercises for at least two weeks.

What can I eat?

There are no dietary restrictions after removal of the gall bladder and you may resume a normal diet as soon as you are hungry. It may take a few days before your appetite returns. When you feel hungry start with light frequent meals and then increase at your own pace.

When will my bowel movements return to normal?

It may take three or four days to have a normal bowel movement.

What complications can occur?

Though there are risks associated with any kind of surgery, the vast majority of Laparoscopic Cholecystectomy patients have few or no complications and quickly return to normal activities. It is important to remember that before undergoing any type of surgery - whether laparoscopic or open you should ask your surgeon about the procedure and the post-operative stage as well as the complications and risks associated therewith.

Occurrences of concerns in Laparoscopic Cholecystectomy are infrequent, but include bleeding, infection, pneumonia, blood clots or heart problems. Unintended injury to adjacent structures such as the common bile duct or small bowel may occur and may require another surgical procedure to repair it.

Numerous medical studies show that the complication rate for laparoscopic gallbladder surgery is very low indeed when performed by a properly trained surgeon.

Get in touch with the hospital and your medical team or call 1066 if there is any of the following:

  • Persistent fever over 101 F (39*C)
  • Bleeding
  • Increasing abdominal swelling
  • Pain that is not relieved by your medications
  • Persistent nausea or vomiting
  • Chills
  • Persistent cough or shortness of breath
  • Purulent drainage (pus) from any incision
  • Redness surrounding any of your incisions that is worsening or not getting better
  • You are unable to eat or drink liquids

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