Mr Charles Imber treats a range of abdominal conditions including gallbladder stones, gallbladder disease, pancreatic cancer, liver disease, hernias, liver cancer, appendicitis, bowel cancer and groin injuries. He also provides complex cosmetic procedures such as apronectomy for patients who have lost large amounts of weight and have excess abdominal skin.
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An operation to remove the gallbladder, known as a cholecystectomy, is the main treatment for gallstones that are causing problems.
You may not need surgery if you have gallstones that give you no symptoms, or if you have only very infrequent attacks of biliary colic. If you start to have more regular attacks, with gall bladder pain disrupting your life, the only option is to take the gallstones out, which means removing the gallbladder.
Having a gall bladder removal 30 years ago meant an open operation. The incision required was quite large – about 10 cm (4 inches). The muscles of the body wall were cut and that meant quite a lot of pain in the few days afterwards and a three- to four-day stay in hospital as you needed strong painkillers. Recovery was slow, with most people taking four to six weeks to get back to normal activities.
When keyhole surgery techniques were developed, these were applied to gallbladder removal very successfully. Laparoscopic gallbladder removal is now done whenever possible and has been shown to be just as effective as open gallbladder surgery. Because a laparoscope is used, only four small incisions are needed, so there is less pain, a shorter stay in hospital and most people are active again in about ten days.
If you have been diagnosed with uncomplicated gallstones, usually after reporting symptoms to your doctor and then having an ultrasound scan, you will be advised to have an elective operation. This means it’s not urgent, but it is planned to take place as soon as convenient.
You know when the operation will be, so you can plan for the time you will need for recovery. Knowing that your operation is imminent will help you cope with any further biliary colic attacks as you will know they are nearly at an end.
If you develop complicated gallbladder disease you will experience constant gall bladder pain, fevers and sweats. This indicates that you may have developed cholecystitis, which is inflammation of the gallbladder wall. This is an emergency situation and the operation to remove the gallbladder and the gallstones it contains needs to be organised without delay. There is a higher risk that an emergency operation on an inflamed gallbladder will need an open rather than a laparoscopic operation.
Prior to gallbladder surgery you will require blood tests including liver function tests as well as an ultrasound to confirm stones, and to show whether or not the bile duct is obstructed or dilated. The usual checks on your general health, heart, lungs and blood pressure are also done just before surgery.
The first step is to introduce the laparoscope, the tube containing the light and camera, into the abdomen. This is done through a central port near to the belly button. The other instruments are introduced through three other incisions at the side of the abdomen, some on the left and some on the right.
The surgeon uses the image projected by the laparoscope to use the instruments to cut away the gall bladder after pumping in some carbon dioxide to make room within the abdominal cavity. A small duct that connects the gallbladder to the bile duct (the cystic duct) needs to be clipped and divided, as well as the artery that supplies the duct with fresh blood (the cystic artery). The gallbladder is then carefully cut away from the liver surface and is removed through one of the smaller incisions in a bag. The bile duct is left intact.
The sutures used to close the small incisions used in laparoscopic gallbladder removal are dissolvable so you won’t need to have them removed. They dissolve away on their own.
The day after surgery you will be up and about and although you may be uncomfortable, you will not be in serious gallbladder pain. Oral painkillers will be enough and you will usually be allowed to leave hospital within 24 hours.
Recovering at home means not doing strenuous activity, but it is good to be quite mobile as this helps your digestive system recover faster. You should be able to return to work within a couple of weeks.