Keyhole surgery for gallstones (laparoscopic cholecystectomy)

This procedure is performed under general anaesthetic either as a day-case procedure or with one night’s stay in hospital. During the operation, the surgeon introduces a camera into the abdominal cavity and via three further small cuts, dissects the gallbladder from the liver using long thin surgical instruments. The pipe connecting the gallbladder to the bile duct (a pipe leading from the liver to the intestine) is located, clipped and then cut (see diagrams). The small artery that takes blood the gallbladder is dealt with in the same fashion. The gallbladder containing the stones is then peeled off the liver and removed via one of the small cuts. The incisions are then closed with dissolving stitches and covered with dressings.

Recovery from keyhole surgery

Patients undergoing keyhole removal of the gallbladder usually require painkillers for the first 5-7 days after surgery but recovery is usually rapid thereafter and by 2 weeks, most normal daily activities are possible including driving. By 4 weeks, most patients are back to normal.

Complications

Keyhole gallbladder surgery is very safe in the vast majority of patients and only occasionally is it associated with problems or complications.

Scars: These usually heal well but occasionally infection occurs at the belly button. This usually settles with antibiotics.

Conversion to open surgery: Sometimes it is not possible to successfully perform the surgery with the keyhole method. In this scenario, the surgeon will switch to standard open operation (an incision sloping under the ribs on the right of the abdomen). The risk of this in my hands is around 2%.

Bowel or blood vessel Injury: This may occur with keyhole surgery but the risk is very small risk (1 in 200). The structures at risk include the intestines and blood vessels near the liver, and open surgery may be required to rectify these problems.

Bile leakage or bile duct injury: Leakage of bile may occur if the metal clips on the gallbladder duct come off post-operatively. This may occur if there is increased pressure in the bile duct due to an undiagnosed gallstone causing a blockage. Bile leak may cause pain, abdominal swelling or nausea and vomiting and may require further surgery and a special endoscopy (ERCP) to correct it. The risk is <5%. Injury to the bile duct is much less common (around 0.3%) and is usually seen at the time of surgery. It often requires an open operation to repair the problem. Fortunately with careful dissection and experience, the problem is very infrequent.