Gallbladder removal (laparoscopic cholecystectomy)
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1 Patient Information Gallbladder removal (laparoscopic cholecystectomy) Author: Surgery Produced and designed by the Communications Team Issue date Mar Review date Mar Expiry date Mar 2019 Version 1 Ref no. PILCOM1391
2 Your surgeon has recommended that you have your gallbladder removed. This is called a cholecystectomy (pronounced co-lee-sist-ect-omy). This booklet will provide you with information and advice about your operation. Please read this before you come into hospital and make notes of any questions that you would like to ask. What is the gallbladder? The gallbladder is the small, pearshaped pouch in the upper right part of your abdomen which stores bile produced by the liver. Bile (digestive fl uid that helps to break down fatty food) is carried from the gallbladder to the intestine through a tube called the common bile duct. After the operation to remove your gallbladder your liver will continue to produce bile. What is a laparoscopic cholecystectomy? This is an operation to remove your gallbladder using a small telescopic camera (laparoscope) and instruments. This is also known as keyhole surgery. The operation is performed through small cuts made in your abdomen (tummy). The operation is performed under a general anaesthetic. 2
3 Illustration of laparoscopic cholecystectomy Created by Basildon and Thurrock Hospitals NHS Foundation Trust Medical Photography This diagram is for your surgeon to use to explain your procedure: 3
4 What happens before the operation? Before your operation you will be seen in the pre-assessment clinic. It is very important that you attend this appointment. If you do not attend your operation may be postponed or cancelled. At this clinic you will be checked to see if you are fi t for your operation. You will be seen by a doctor and nurse, who will examine you and then decide if you need further tests, for example blood tests or a heart tracing, before your admission. At the pre-assessment clinic you will also be seen by a member of staff from pharmacy to discuss any medication that you may be taking or are allergic to. This includes any herbal, homeopathic or alternative remedies. It is very important that you bring these with you to the preassessment clinic and then again when you come to the hospital for your operation. If you are taking the oral contraceptive pill, you may be advised to stop this 4-6 weeks before your operation. This is due to the slight increased risk of a blood clot forming. You will need to use an alternative method of contraception during this time. You will be able to go back on the pill following your operation. If you think you may be pregnant please tell us so that we can arrange a test. This is very important as a general anaesthetic and x-rays may harm your baby. You will be sent a letter confirming the date you will need to come to hospital for your operation, and the details of the ward you will be staying on. You will also be advised when you should stop eating and drinking before your operation. If you are unsure please ask during your pre-assessment appointment. 4
5 Day patients Your letter will tell you what time to arrive. If you are having your operation in the morning, you should be ready to go home early to mid-afternoon. If you are having your operation in the afternoon, you should be ready to go home early to mid-evening. Your surgeon or anaesthetist may decide that you need to stay overnight so please bring a small overnight bag, just in case. You will need to arrange to have an adult escort you home. You must not drive or take public transport. A member of staff will telephone your carer, family or friend half an hour before you are ready to go home. You must have a responsible adult at home with you for the fi rst 24 hours after your operation. Inpatients Your letter will tell you what time to arrive. A bed may not be immediately available but we will settle you in as quickly as possible. Please be aware that your operation may be cancelled if there is the need to treat another patient as an emergency. However every effort will be made to fi nd you a bed, so please do not eat or drink anything until you are told. As an inpatient you will need to stay in hospital for one - three days. Please bring enough clothing with you, or arrange for a visitor to bring you some in. You must have a responsible adult at home with you for the first 24 hours after you go home. If you live alone you should make arrangements for someone to stay with you. 5
6 What happens during the operation? Once you are asleep under a general anaesthetic, carbon dioxide gas is put into your abdomen to give the surgeon space to operate. Instruments are inserted through the small cuts to perform the operation. Clips are put across the cystic duct and the artery to close them off before the gallbladder is removed. The gallbladder is separated from the bile duct and liver bed and is taken out through one of the small cuts. The wounds are closed with stitches. Some patients need to have an x-ray taken during the operation. This is called an on-table cholangiogram. The x-rays are taken of the ducts that drain bile from the gallbladder to the intestines, to make sure that no stones have escaped from the gallbladder. In these cases, a bigger cut is made. This will mean a longer stay in hospital. If your surgeon has had to proceed to performing an open procedure, you will be given stronger pain relief to ensure that you have a comfortable recovery. What happens after the operation? You may be given oxygen through a mask which is placed over your mouth and nose, until you are fully awake. You may have a drip going into the back of your hand. This is normal and only temporary until you are drinking enough. You may have a wound drain in place. If you have your operation as a day patient, then the drain will be removed later that day. Otherwise, the drain will normally be removed the day after your operation. Occasionally (1 in 20 patients) the surgeon will not be able to perform the operation laparoscopically. In this case the surgery is changed to an open procedure. 6
7 Are there any side effects or possible complications? A laparoscopic cholecystectomy is a very effective and safe procedure. Although more than 95% of patients do not have any problems associated with the operation, there are some risks and complications you should be aware of. Bile duct injury The bile duct can be damaged during the operation (1 in 250 cases). This may need a major operation to repair it, in a specialist centre. Bile leak Some patients (approximately 1 in 100) may leak bile into their abdomen following surgery. This may cause pain, nausea and fever. You may need a drain inserted through the abdominal wall. An ERCP may also be required. This is where a small camera is passed through you mouth, into your stomach, and an internal drain (stent) inserted in the bile duct. This is carried out under sedation. You may need more surgery. Escape of stones Sometimes gallstones can move from the gallbladder to the bile duct during the operation. This can cause jaundice, pain and fever. A camera test (ERCP) may be needed, and the stones removed. Damage to other organs If you have had previous operations on your abdomen, this may have caused scarring inside, which can make the laparoscopic operation more diffi cult. Occasionally other organs within the abdomen e.g. small or large bowel may be damaged because of this. This can lead to further operations. Thromboembolism: Deep vein thrombosis (DVT) blood clot in legs / Pulmonary embolism blood clot in the lungs To try and prevent this you may be asked to wear special stockings and be given injections of a drug (heparin) to reduce blood clotting. We also encourage you to get up and about once the anaesthetic has worn off. 7
8 Wound infection To try and reduce the risk of a wound infection you are given antibiotics at the time of the operation. A wound can become red, hot and swollen and may need further antibiotics. Chest infection Getting up and about once the anaesthetic has worn off can reduce the risk of a chest infection. If you smoke, stopping two weeks before your operation will also help to reduce the risk. Bleeding You may bleed during the operation but this will have stopped by the end of the operation. It is normal for there to be a small amount of oozing through the wound following the operation. Rarely a blood transfusion and/or a second operation may be needed. Port site hernia Occasionally (approximately 1 in 100) a small weakness will remain where the small cuts were made. This may allow a hernia to develop, which may need to be operated on in the future. Adhesions Adhesions are internal scars that form after any abdominal surgery. They usually cause no problems, but the bowel can get twisted round them causing a blockage (obstruction). You may need to come to hospital in the future and may need further surgery. Persistent symptoms Some patients continue to have symptoms following their operation. If this occurs contact your consultant s secretary for an appointment. Heart attack Patients who have heart problems can be at increased risk of having a heart attack following their operation. This will be discussed with the anaesthetist. Very rarely patients can die following an operation. Gas embolism Another rare complication is the gas used to infl ate your abdomen can get into your blood stream and the bubble of gas can stop the fl ow of blood. If you experience any of these side-effects, please contact the ward where you were a patient. The contact numbers are at the back of this booklet. 8
9 Will I experience sickness? Occasionally patients feel sick after a general anaesthetic. Please tell the nurse looking after you if you feel sick, so that you can be given medication to help to relieve this. Will I experience any pain? Some pain after your operation is normal. You will be given pain relief while you are asleep, and so you should wake up feeling reasonably comfortable. If you have pain please tell the nurse. You may experience some pain in your shoulder or back. Getting up and about will help this to ease. It usually settles within hours. You will be prescribed pain relief to take home with you. If you are in pain it is important to take these as instructed on the packaging. It is better to keep pain under control than to try and treat it when it has become unbearable. How should I care for my wound? You will have small dressings over your wounds, which you may remove 48 hours after your operation, providing they are clean and dry. A small amount of leakage is normal. After this time you may choose not to cover your wounds, although you can apply new dressing to protect your clothes. You may have a shower when you are at home, as it is safe for water to splash onto the wounds. If you have a bath, please ensure that the water is shallow. Please do not use bubble bath, bath oil, creams, lotions or talcum powder. Gently pat the skin dry around the wounds with a clean towel. The wounds may itch and there may be bruising. This is normal and will settle in the same way as any other bruise. If you have stitches that need to be removed, this will be arranged before you leave hospital. 9
10 How soon will I be up and about? It is very important to get moving soon after your operation. You must not get out of bed the fi rst time without the help of a nurse, as you may feel dizzy. What should I do once I return home? When you go home you should continue to walk around doing a little bit more each day. Please contact us as soon as possible (see back of booklet for details) if you experience any of the following symptoms: A temperature or fever Severe abdominal pain A swollen or distended abdomen Severe or uncontrolled vomiting Jaundice (yellowing of the eyes or skin). What happens when I go home? For the fi rst 24 hours you must not : drink alcohol operate machinery or kitchen appliances sign any legal or fi nancial documents ride a bike Can I drive? You must not drive for 24 hours after a general anaesthetic. It may be up to a week before you can safely drive. You should be able to perform an emergency stop and wear a seat belt. The fi rst time you drive you should have someone in the car with you in case you feel unwell. It is advisable to check with your insurance company that your insurance is valid. Once you have returned home following your operation, do not compare your recovery with other people who have had the same operation. We are all different and recover at different rates. 10
11 Will I feel tired? Most people feel tired for several days, sometimes weeks after their operation. Rest if you can. Do not expect too much too soon. When can I return to work? Most people return to work after two weeks, depending on their recovery and their employment. It may be as long as four weeks. If you need a sick note, please ask the ward staff before you go home. Can I have sex? You may resume normal sexual activity as soon as you feel comfortable. Can I exercise? Usually after two weeks you can start gentle exercise. Avoid heavy lifting, weight training and contact sports for at least four weeks. Do I need to change my diet? There are no restrictions on diet and you can start a normal diet as soon as you feel ready to eat. Some people fi nd in the long term, that eating fatty foods still produces some discomfort, in which case these foods should be avoided. In addition some people have diarrhoea following their operation. If this persists, please seek advice from your GP. Can I keep my gallstones? Many patients take their stones home with them. Please remember that gallstones may contain bacteria. If you decide to take your stones home with you do not take them out of the pot to handle them. Keep them away from small children. 11
12 Who can I contact if I need further information? Your consultant will decide if you need a follow-up outpatient appointment. If you have been a patient in the day unit and become unwell you can contact us for advice on: 8am - 7pm, after 7pm, ext 8390 Your consultant will want to know if you have experienced any problems so please call the ward where you were a patient. The telephone numbers are below. Day Unit ext 8181 Burstead Ward ext 4590 Surgical Assessment Unit ext
13 In an emergency please contact 13
14 14
15 your GP. Notes: Please fill this form in to confi rm that you have read and understood the information in this leafl et. If you have any questions please speak to a member of staff. Name: Hospital Number: Date: / / I have today received the information booklet Signed: 15
16 Not to be photocopied Basildon University Hospital Nethermayne Basildon Essex SS16 5NL Minicom Patient Advice and Liaison Service (PALS) E pals@btuh.nhs.uk W The Trust will not tolerate aggression, intimidation or violence directed towards its staff. This is a smokefree Trust. Smoking is not allowed in any of our hospital buildings or grounds. This information can be provided in a different language or format (for example, large print or audio version) on request.
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