Gallbladder Surgery (Cholecystectomy)

What is the gallbladder, and what are gallstones?

The gallbladder is a small, pear-shaped organ located under the liver, on the right side of the upper abdomen. It stores and concentrates bile produced by the liver, releasing it into the small intestine to aid digestion of fats.
Gallstones are hardened deposits of bile components (cholesterol, bilirubin, calcium salts) that can form in the gallbladder. Many people have gallstones without symptoms.

Gallbladder removal is considered if gallstones or gallbladder disease cause symptoms or complications, including:

Recurrent biliary colic: intense abdominal pain, often triggered by fatty meals.
Cholecystitis: infection/inflammation of the gallbladder.
Jaundice or bile duct obstruction: when gallstones block bile flow.
Pancreatitis caused by gallstones.
Occasionally for certain gallbladder polyps, or if cancer is suspected.

Laparoscopic (keyhole) cholecystectomy: This is the most common method. Several small incisions are made; a camera and instruments are inserted to remove the gallbladder. Benefits: less pain, smaller scars, shorter hospital stay, faster recovery.
Open cholecystectomy: Larger incision, used in cases where keyhole surgery is not feasible (e.g. severe inflammation, prior surgeries, scar tissue). Recovery tends to take longer.

Here are typical steps and things to discuss/do before your operation:

Medical assessment: review your general health, medications, allergies.
Imaging/tests: ultrasound, blood tests, possibly more advanced imaging (MRCP etc.) if bile duct stones or complications are suspected.
Fasting instructions: you’ll be asked not to eat or drink for several hours before the anaesthetic.
Medication adjustments: some medicines may need to be stopped before surgery (blood thinners etc.). Siobhan or anaesthetist will advise.
Pre-surgery guidance: quitting smoking (if applicable), optimising weight or nutrition.

You’ll receive general anaesthesia.
For laparoscopic surgery: small incisions, insertion of ports, inflation of abdomen with gas to improve visibility, removal of gallbladder through one of the ports, possibly an intraoperative cholangiogram (an imaging test) to check bile ducts.
If open surgery is needed, a larger incision is made and recovery takes longer.

While this surgery is generally safe, there are some risks, including:

General surgical risks: bleeding; infection; reactions to anaesthesia; blood clots.
Specific to cholecystectomy: bile duct injury; bile leakage; retained stones in common bile duct; injury to adjacent organs; wound complications; need to convert from laparoscopic to open surgery; persistent pain; sometimes digestive changes.

After laparoscopic surgery, some patients spend 1 night in hospital; open surgery may require longer stay.
Pain control: you’ll have medications; some discomfort around the incision sites; sometimes shoulder tip pain from the gas used.
Diet: you’ll begin with fluids, then gradually return to normal diet as tolerated. Fatty foods may be harder initially.
Activity: gentle walking soon; avoid heavy lifting for several weeks.
Driving: usually can resume when off strong pain medications and able to move safely.

Most people recover well, are free from pain, and return to a normal diet.
Some digestive changes are possible: looser stools, more frequent bowel movements, especially when large fatty meals are eaten. These often settle over time.
Follow-up: Siobhan will ensure you are progressing well and review your pathology (if gallbladder was examined).

In some cases, if the gallstones are not causing symptoms, watchful waiting may be possible.
Medications to dissolve gallstones (not standard practice and are rarely effective and have high recurrence rates).
Additional procedures like ERCP (endoscopic removal of stones in the bile duct) may be necessary if stones have migrated.