Laparoscopic Cholecystectomy

So laparoscopic cholecystectomy is a keyhole operation to remove your gallbladder. It's very routine surgery now. It's done through four ports. One port just above the umbilicus, one port just below the ribcage, and two on either side, 5mm ports. We put gas inside your tummy to open up the space so we can see the gallbladder and all the structures around. What we do then is we grab the gallbladder and we push it up and this what exposes the small duct from the gallbladder which joins on to the major bile duct and it also exposes the artery as well. That supplies the gallbladder. We dissect then the area around the neck of the gallbladder which contains a duct called the cystic duct which joins on to your common bile duct and then we also dissect the cystic artery which is the blood supply to your gallbladder. With careful dissection then we will then clip that with titanium clips and then divide the cystic duct which supplies to the gallbladder and also the cystic artery will clip that and divide that too. Once we've done that we'll divide the gallbladder peritoneum it's called which is the structure which fixes the gallbladder onto the liver and then we remove the gallbladder very carefully. Once we've done that the gallbladder is taken out, usually through the umbilical port because it can make that slightly bigger. The risk of the operation is such that we have to be very careful that everything is dissected out very nicely and if you have no real episodes of acute cholecystitis and it's just due to biliary colic, the majority the time, it will be a very straightforward operation. Those cases that have run into problems with acute cholecystitis, where you have inflammation of the gallbladder and the wall, sometimes that operation can be very difficult. With 99% of the time, the gallbladder can be taken out, keyhole surgery. With acute cholecystitis, I would always tell patients there's a 10% risk of having to open up the tummy. The reason why you have to do that is because you're not quite sure of the anatomy and I will never put you into a situation where this operation is not safe, so we have to make sure we can dissect out the anatomy. If we can't and we're not sure what the anatomy is, then I will without hesitation open the tummy up and do it by visual method and using my fingers to feel where all the structures are. The other issue is that sometimes when we do this operation and we get some bleeding and the bleeding can be such that it becomes not safe for you to continue having done keyhole surgery so the operation is then stopped and your abdomen is then opened and then we will stop the bleeding and then take the gallbladder out via this technique. Post-operatively if it all goes well with the keyhole technique then we can do it as a day case and you can go home in the evening with adequate pain relief, normally paracetamol or neurofen, and over the next two to three days you just want to take it very gently at home, not doing too much and hopefully you'll be able to get back to work in about three days. There's some dissolvable sutures that will come out in about a week or so's time and we'll get your doctor to take those out for you. The only real complications that can arise from this is that you can get a bile leak and the bile leak can come from the gallbladder bed, it's very rare but it does occur and so we're very careful when we take the gallbladder out. These ducts are called ducts of luschka and very occasionally we don't see those and if you have any problems at all after 48 hours, you don't feel well, then you need to come back into the hospital straight away or go to the emergency department because it could be one of those small ducts which is leaking some bile and we don't want you to stay at home with that. term outcome that hopefully once you've had the gallbladder removed and all your stones removed you'll be able to eat normally.