Having a Cholecystectomy Surgical removal of the gallbladder

Transcription

1 Having a Cholecystectomy Surgical removal of the gallbladder Department of Surgery

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3 What is a Cholecystectomy? Cholecystectomy is the surgical removal of the gallbladder. This booklet has been prepared to tell you about the operation, the conditions leading to it and why your doctor has recommended that this is the best treatment for your condition. The Gallbladder The gallbladder is a small organ that is about 3 or 4 inches in size and lies on the underside of the liver. It is connected by ducts to the liver and to the small intestine. The liver produces bile (a substance essential for digesting fats) and secretes it into the gallbladder where it is concentrated and stored. When food is eaten, especially fatty or greasy food, the gallbladder contracts and forces bile out of the ducts into the intestine. When the gallbladder is removed this function is taken over by the liver and its ducts. 3

4 Gallbladder disease Occasionally stones may form within the gallbladder and this may result in the gallbladder becoming infected. Anyone can develop gallbladder disease, but it is more common in people who are overweight between the ages of 35 and 55. Women are more likely to suffer from gallbladder disease than men. Symptoms of gallbladder disease Not all people who have stones in their gallbladder have any symptoms. As symptoms develop they would include the following: 1. Bouts of indigestion, especially after eating fatty or greasy foods. 2. Nausea and bloating. 3. Attacks of sharp pains in the upper part of the tummy. This may last for under half an hour or may continue for a couple of days. 4. Rarely yellowing of the skin or jaundice may occur. This occurs when a stone escapes from the gallbladder and blocks the duct leading to the intestine. Diagnosis of gallbladder disease The most common way of diagnosing gallstones is to use a technique of ultrasound. This is a safe, painless and non-invasive technique that uses high frequency soundwaves to create an image of the gallbladder and gallstones. Occasionally this is not helpful and other diagnostic methods may be used such as x-rays and other scanning methods. 4

5 Treating gallbladder disease The only treatment that cures gallbladder disease is surgical removal of the gallbladder. Generally, this is indicated when stones are present causing symptoms or when the gallbladder is infected and inflamed. When the gallbladder is removed the surgeon will examine the bile ducts, sometimes with x-rays, and remove the stones that may be lodged there. The ducts are not removed so the liver can continue to drain bile into the intestine. There are two commonly performed procedures for removal of the gallbladder; these are called laparoscopic cholecystectomy and open cholecystectomy. The operation In both types of operation, the gallbladder is identified underneath the ribcage on the right. The gallbladder is removed and the stones contained within it, and sent to the laboratory for analysis. The surgeon may also pass some dye down the duct system to make sure that no stones have escaped and are lodged within the duct system. The difference between the two operations is the size of the cut needed to remove the gallbladder. Open cholecystectomy requires a cut of around six inches underneath the rib cage. Scar for Open Cholecystectomy 5

6 In laparoscopic cholecystectomy, using a series of small cuts to allow a camera to be inserted into the tummy, the whole operation can be performed without the need for a big incision. This is called keyhole surgery. The largest of these incisions will be less than an inch. Speed of recovery is dependent on the size of the cut. The actual surgery on the inside is the same in both procedures. Laparoscopic cholecystectomy has the advantage of a much quicker recovery and small scars that are barely noticeable. Scars for Laparoscopic Cholecystectomy It is not always possible to complete the surgery using the keyhole method and in 1/20 operations, surgery has to be completed by open cholecystectomy. How safe is cholecystectomy? Unfortunately, no operation performed is free of complications. Cholecystectomy has to be performed using a general anaesthetic (being put to sleep by an anaesthetist), and this procedure itself has a small risk associated with it. If you would like a more detailed discussion about the risks of a general anaesthetic, you can discuss this with your doctor when he is talking about the operation. 6

7 There are more specific risks associated with cholecystectomy. There is a risk of bruising and developing infections in the surgical incisions. There is a small risk of damage to the ductular system the gallbladder is attached to (risk is less than 1/300), of damage to other organs within the tummy and of internal bleeding. It is not always possible to perform a laparoscopic cholecystectomy for technical reasons and if this were the case the surgeon would convert the operation to an open cholecystectomy. This occurs in 5% (1 in 20) of laparoscopic cholecystectomies performed. Although these risks are present, the risks are small, but should you be concerned you should discuss them with your doctor. Before the operation You will be contacted 1-2 weeks before the operation and asked to attend a pre-admission clinic. The clinic is located on Level 6 of Yeovil Hospital. If you are having a day case operation this clinic will be in the Day Surgery Unit on Level 3. The aim of the clinic is to do routine assessments so that surgery can progress smoothly. The assessment will last for 2-3 hours and involve talking to doctors and nurses about your current and previous medical problems, a physical examination, having some blood tests, having a tracing of your heart (ECG) and lastly explaining how the wards in the hospital work. There will be time to answer in detail any questions you may have. Fasting and taking your medicines This will be discussed with you at the pre-assessment clinic. Could you bring all your medicines with you to the clinic. In particular could you let the staff know if you are taking medication for diabetes or are taking warfarin. We will give you individual advice on stopping HRT and the oral contraceptive pill. Lastly depending on the time of your operation you will be advised when to start fasting. 7

8 Recovering from cholecystectomy Keyhole surgery has the advantage of making small cuts in the tummy, which heal up quickly and greatly speed recovery after the operation. However, recovery is a highly individual thing and will depend on how you feel. It is possible to be back at work within three days of having a cholecystectomy but most people will take longer. Some people are suitable for a day case laparoscopic cholecystectomy in which they would have their operation in the morning and go home later that day. Mostly you will have your operation in the hospital and stay for 24 hours afterwards. Any discomfort? Cholecystectomy commonly causes discomfort or pain in your tummy. Surprisingly it also causes pain in your shoulder tips. Your doctor will have given you medicines to control this pain during the operation, but you will require to take oral painkillers over the next three to four days until the pain settles down completely. Generally the pain is no worse than having a bad period, and you should be able to get up, walk around and eat and drink normally. Any sickness? Operations can make you feel sick and you will be given medicines to prevent this during the operation. If you do feel sick when you are recovering from an operation, would you tell a member of the nursing staff and they will give you extra anti-sickness medicines. 8

9 Eating and drinking? Although not always possible, we would encourage you to begin drinking soon after the operation. We would expect you to be on a normal diet by the following morning. Looking after the cuts? The cuts for laparoscopic cholecystectomy are small (under 10mm). The surgeon will generally put a small stitch underneath the skin that does not have to be removed. On the surface of the skin there will usually be a dressing which can be removed at three days and there may be a butterfly dressing (a piece of paper that holds the wound together). This can be removed at three days as well. Generally the best way is to get into a bath and to soak the dressings off. The wounds normally seal up in the first 24 to 48 hours and should heal quickly. If there is any redness or pain that develops after the first two to three days, you should contact either the hospital or your local doctor. Getting back to normal activities? Most people feel tired for a few days after surgery. This is very variable and some people feel confident enough to go back to work within the first week. Others will take a little bit longer. Most people will be able to return to normal daily activities and work within two weeks. Driving will depend upon your ability to safely control a car and do an emergency stop. You should let your insurance company know you are having a laparoscopic cholecystectomy and decision to start driving will depend on your GP s approval that you are safe to drive. All other activities including sex can be carried out as pain allows. 9

10 You can use this space below for notes or to jot down any questions you may have: 10

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12 Contact numbers If you have any questions or require further information or advice, please contact: Mr J Ockrim s office Mr N Francis office Ward 7A Day Surgery Unit (8am-7pm) If you need this leaflet in another format, eg. large print, please ask a member of staff or call Ref No: /14 Review date: 10/16 12