LAPAROSCOPIC CHOLECYSTCTOMY
 

1. What is the function of the Gallbladder?

The gallbladder is a small pear-shaped organ under the liver on the right side of the upper abdomen. It stores bile produced by the liver cells during resting state and squeezes it into the intestine via the bile duct to aid in digestion during a meal.

2. What are Gallstones and how are they detected?

Causes of gallstones formation is multi-factorial, involving bacteria infection of the bile, precipitation of constituents of the bile such as bile salt, calcium, bile pigment and cholesterol. The stones can be hard stones of varying sizes or they can be in the form of soft cholesterol stones or mid-like sludge. Ultrasound scan of the abdomen is the commonest method used in detecting gallstones, it is non-invasive and very accurate. Other methods in detecting gallstones include computerized tomography (CT) scan and oral cholecystography.

3. When do I need an operation to remove the Gallbaldder?

Gallstones disease is a common occurrence in the population but majority of people are symptoms free and therefore unaware of their existence. An operation is recommended when the gallstones cause problems such as pain, jaundice (yellowing of skin) or infection. The current standard treatment entails removal of the diseased gallbladder together with gallstones.

4. What is Laparoscopic Cholecystectomy?

Laparoscopic cholecystectomy (removal of the gallbladder via key-hole operation) is conducted under general anesthesia. The procedure is carried out after distending the abdomen cavity with carbon dioxide insufflation to create space for the operation. A 10mm diameter telescope is then place through a small incision at the umbilicus for visualization. The actual operation on the gallbladder is performed with three slim instrument 3-5mm in diameters placed just below the right ribcage. Tiny clips are used to seal the blood vessels around the gallbladder and the cystic duct that connects the gallbladder to the bile duct. The gallbladder and the stones inside will be extracted at completion of operation as in conventional open operation.

5. What are the benefits of Laparoscopic Cholecystectomy?
 
The benefits include: -
 
• Less pain
• Shorter hospitalization stay
• Faster recovery and return to work
• Reduce overall hospitalization cost
• Better cosmetic outcome
 
6. What to prepare for the operation?

You will be review by an anesthesiologist before the operation to ensure that you are healthy and fit for general anesthesia. Routine blood tests, chest X-ray and ECG will be done when necessary.

The operation is generally a straightforward one. You can be admitted on the day of the operation but you need to fast for at least 6-8 hours prior to the operation. You should not have any food or liquid after midnight if your operation is scheduled in the morning. You can have a beverage early in the morning if your operation is scheduled for later in the afternoon.


7. What to expect after the surgery?

When you wake up from the surgery, you will find¡­
 
• Bandages on the incisions
• A tube that was inserted in your vein to give you fluids and medications
 

Post-anesthetic nausea, headache and sore throat are common symptoms experience by many patients. You will be prescribed medications to counter these symptoms. You can take liquid orally after you wake up fully from the general anesthesia and should be able to progress to diet in the evening if you tolerated the liquid well.

Pain from the small laparoscopic wounds is usually well tolerated. Majority of patients required only oral medication for adequate pain relief. Patient control analgesia will be available if you need.
Majority of patients recover from the operation very quickly and are ready to go home after a night rest in the hospital.

8. Are there potential complications associated with the operation?

Laparoscopic cholecystectomy is generally a safe operation and complications are rare, these include -
 
• Risks of anesthesia
• Wound infection
• Slight numbness around the incision
• Small risk (less than 1%) of Injury to the bile duct.
 

9. Are there any side effects after operation?

The gallbladder is not an essential digestive organ and its removal does not carry significant long-term side effect. Some patients experience loose stool and bloating with fatty food in the early period after the operation. This usually improves and resolves after a few weeks.

10. Care after discharge
 
• Care of the wound - dressing of the wound can be removed after couple of days. It is perfectly safe to leave the wound exposed and shower with soap and clean running water.
• Wound infection occurs rarely, this usually presents with discharge from the wound or redness and persistent pain at the wound. When this happens, please contact your surgeon or your family doctor for advice.
• Stitches will be removed after a week at the clinic
• Bloated sensation and occasional loose stools will be expected for a few days and up to a few weeks. Avoiding fatty food can help to lessen the problem.
• You should be able to resume normal daily routine at home or desk job at the office by the end of first week. You can do light exercises such as walking and swimming as long as the wound pain is tolerable. Strenuous exercises or lifting heavy objects is not advisable and should be delayed to at least 4-6 weeks later.
 

11. Are there any dietary restrictions?

Generally no. But preferably avoid fatty and oily food, avoid overeating and have more portions of fresh fruits and vegetables in your diet.

12. Please seek medical attention

If you have the following signs and symptoms, please do not hesitate to get help.
 
• Fever >38 C
• Severe pain, redness or discharges from at the wound site
• Jaundice (yellowing of skin)
 
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