- Removal of gallbladder by keyhole surgery
(i) Symptomatic gallstones - Pain, nausea and vomiting from gallstones
(ii) Complications from gallstones - infection, pancreatitis, jaundice
(iii) Polyps/suspicion of cancer of gallbladder(eg porcelain gallbladder)
General anaesthesia. Usually 4 small cuts on abdomen. Telescope passed in. Carbon dioxide gas insufflation to lift abdominal wall up for view. Dissection to see gallbaldder and cystic duct and artery. Metal clips to gallbladder artery and cystic duct. X-ray of bile duct performed after dye is injected to exclude stones in bile duct(Operative cholangiogram) Drain tube at end of case.
Blood thinning injections usually at end of operation to prevent blood clot in the legs.
Postop - the drain tube is removed the following day if there is no bile leak. Discharge usually on the next day if able to mobilize comfortably and tolerate food.
Stone in bile duct - may need exploration of bile duct during operation or further surgery(ERCP)
Bile leak(1 in 200)/bile duct injury(1 in 230)
Spillage of stones out of gallbladder
Need for open surgery(1 in 20) - especially if acutely inflammed
Damage to other organs, adhesions
Wound infection, scar, hernia at port site
Heart attack, stroke, anaesthetic reactions, chest infections, blood clots in legs/lungs, death
Persisting symptoms despite surgery
Oral dissolution therapy - risks of gallstones recurring/poor outcome for large gallstones
Cholecystostomy - removing the stones alone : usually in patients who are too sick for the whole surgery to remove the gallbladder
Lithotripsy - shattering the stones smaller but this may cause more symptoms/complications
Operative Cholangiogram - X-ray of the bile duct with contrast
This is usually performed during the gallbladder surgery.
1. Can detect stones in bile duct(4%)
2. May help avoid bile duct injury