This is the most common type of operation to remove the gallbladder. It involves using a tiny camera and surgical instruments that are inserted through small incisions in the abdomen. Removal of the gallbladder (cholecystectomy) is a relatively quick and safe procedure, but, like all operations, there is a small risk of complications. In around less than 3% of cases conversion to open surgery is required.
Standard risks include the following:
An infection can occur after any type of abdominal operation and occurs in around 1 in 15 cholecystectomies. Both simple wound infections and infections inside your abdomen can be treated with a short course of antibiotics. This more commonly affects the wound near the belly button which is normally slightly larger for the camera and is where the gallbladder is removed.
Bleeding (haemorrhage) can occur during or after your operation, although this is rare.
When the gallbladder is removed, special clips are used to seal the duct that connects the gallbladder to the main bile duct, draining the liver. However, bile can occasionally leak out. Sometimes bile can be drained off by a radiologist inserting a drain guided by ultrasound. Occasionally an operation is required to drain the bile and wash out the inside of the abdominal cavity. Bile leakage occurs in less than 1% of cases.
Injury to the bile duct
The most serious complication of gallbladder surgery is injury to the bile duct, which occurs in about 1 in 500 cases. If the bile duct is injured during surgery, it may be possible to repair it straight away. In some cases, complex and major corrective surgery is needed after your original operation. This is one of the reasons you ensure that your gallbladder operation is carried out by a specialist surgeon who has the skills to avoid this rare complication.
Injury to intestine, bowel and blood vessels
The keyhole instruments used to remove the gallbladder can injure surrounding structures, such as the bowel and blood vessels. The risk is increased if the gallbladder is inflamed. This type of injury is rare and can usually be repaired at the time of the operation. Very rarely, injuries are noticed afterwards and a further operation is needed.
A cholangiogram is a special X-ray dye test performed during cholecystectomy. This is normally performed either because the surgeon suspects stones in the main bile duct or to clarify the anatomy of the bile ducts. Some patients like the knowledge that the bile duct system has been checked at the time of surgery to avoid the risk of stones in the main bile duct needing treatment at a later date.
Luckily, the majority of patients can be treated with keyhole surgery, which shortens recovery time and allows early return to work. In approximately 3% of patients it may be impossible or unsafe to perform keyhole surgery and a traditional open approach may be necessary. This involves a 15-20cm incision under the ribs on the right side of the abdomen. Because a larger incision is used, it is generally more painful and a period of recovery in hospital of between 5-10 days may be required, depending on circumstances.
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY (ERCP)
This is a minimally invasive technique that involves passage of an endoscope (camera) through the mouth and stomach in order to gain access to the lower bile duct as it enters the duodenum (small intestine). From here the surgeon can remove gallstones that have migrated into the bile ducts. This procedure can be used to treat complications of gallstones such as jaundice and pancreatitis without the need for abdominal surgery. The procedure may be performed using simple sedation or general anaesthetic and patients are typically discharged the same day. The procedure is very safe but is associated with a small risk of bleeding, pancreatitis (10%) and perforation (0.5%).
COMMON BILE DUCT EXPLORATION
10-20% of people with gallstones in their gallbladder are also found to have stones that have migrated into their common bile duct. In the majority of cases these can be removed by a minimally invasive procedure called ERCP. Very rarely it may not be possible to retrieve all the stones by this method and therefore your surgeon may recommend common bile duct exploration. This can be performed by laparoscopic (key hole) or open surgery and involves incision of the bile duct in order to retrieve the stones directly. Following common bile duct exploration you will have at least one drain in your abdomen. Sometimes it may be necessary for you to go home with a drain which will be removed a few weeks later in the outpatient clinic.