Gallstones

Surgery is not necessary in most cases without symptoms as the risk of the surgery is more than the risk of developing symptoms and complications from the gallstones. Once gallstones become symptomatic, they tend to recur and can become worse. Thus surgery is advocated when symptoms develop, or when the patient develops complications from the gallstones such as infection of the gallbladder, obstruction of the bile duct or inflammation of the pancreas due to a stone that had blocked the pancreatic duct.

Surgery to remove the gallbladder is the standard treatment for gallstones. Surgery to remove just the gallstones and leave the gallbladder intact is not recommended as it does not treat the underlying diseased gallbladder.

Laparoscopic cholecystectomy for Gallstones

A laparoscopic cholecystectomy is the procedure of choice for removal of the gallbladder. This is a procedure in which the gallbladder is removed using keyhole (laparoscopic) surgical techniques. In 5-10% of patients undergoing the laparoscopic procedure, there may be a need to convert to the open procedure due to circumstances encountered during the surgery. Such a decision will be made during surgery in order that the surgery proceeds safely and this is not considered a complication.

The operation is performed under general anaesthesia through small incisions in the abdomen. The gallbladder is detached from the liver and clips are applied to the artery that supplies the gallbladder and the duct that drains from it. The gallbladder is then extracted out of the body through one of the incisions.

Occasionally an X-ray, called a cholangiogram, may be performed during the operation to check for any stones in the bile duct or to visualize the anatomy of the bile duct. If there are one or more stones in the bile duct, the surgeon may remove them during the surgery itself or he may choose to have them removed later through an endoscopic procedure called ERCP, or he may convert to an open operation in order to remove all the stones during the operation.

Open cholecystectomy for Gallstones

This is a procedure where the gallbladder is removed through a longer incision on the abdominal wall. This incision is usually oblique and lies below the rib cage.

Risk of gallstones surgery

This is a safe operation with very low complication rates. The risks of surgery include wound infection, bleeding and rarely blood clots in the legs or lungs. The risks specific to cholecystectomy are as follows:

• Small risk (less than 1%) of an injury to the bile duct, bowel and/or blood vessels, which may require further operative repair of the injury.
• Hernia may form at the incision sites, especially in obese patients. This may require operative repair.
• Small risk (less than 5%) of an undiagnosed stone or stones in the bile duct which may require subsequent procedures to address.

In the event of conversion of the laparoscopic approach to an open procedure, the risks will remain the same as above. However patients may experience more pain and may have a slightly longer stay in hospital.