Gallstones
What are gallstones?
Gallbladder
The gallbladder lies beneath the liver and is responsible for the storage and release of bile, which is produced by the liver. The constituents of bile can vary between individuals and in some can lead to the formation of gallstones. These stones may obstruct the outflow tract of the gall bladder leading to colicky pain (biliary colic) and inflammation (cholecystitis). Sometimes gallstones do not cause symptoms and therefore do not need any treatment.
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What are the symptoms?
Patients can have recurrent pain on eating fatty foods, which settles spontaneously after a relatively short period of time. This is known as ‘biliary colic’ and if recurrent is best treated by removal of the gallbladder.
The stones can cause inflammation of the gallbladder leading to severe pain in the right upper part of the abdomen. The pain can last for several hours and is associated with fever and vomiting. This is initially treated with a course of antibiotics. Surgery can be performed to remove the gall bladder in this acute setting or may be delayed until the symptoms have settled.
How are gallstones detected?
If gallstones are suspected, an ultrasound scan will detect them in the majority of cases. Occasionally an MRI scan is required to assess for gallstones in the bile duct and to assess biliary anatomy.
When is surgery indicated?
The LSG specializes in gallstone surgery in London. If gallstones are causing symptoms then surgery should be performed to remove the gall bladder. Treatments to dissolve or fragment the gallstones are not particularly successful and stones will return if the gallbladder is left.
Surgery is also indicated for patients who have developed pancreatitis or an obstruction to the biliary system (obstructive jaundice) as a result of gallstones passing into the main bile duct.
What happens prior to surgery?
The secretary and hospital will liaise directly to organise a date and time for the procedure and then discuss the admission details with you to ensure this is convenient. Routine blood tests and a heart tracing (ECG), maybe required before admission. You will be asked not have anything to eat up to six hours prior to surgery. Water can be taken up to 2 hours prior to the surgery. The surgeon will go through the procedure again with you on the day and take your consent. The anaesthestist will also visit to discuss the general anaesthetic and your post surgery pain relief. It is also not uncommon for patients to require anti-sickness medications after a general anaesthetic.
How is the surgery performed?
The procedure is performed under a general anaesthetic. This means you will be asleep and completely unaware of the operation. The abdominal cavity is firstly filled with gas to allow the surgery to be performed. Small cuts in the skin (only 5-10mm) are then made to allow the instruments into the area to free up the gallbladder. The gall bladder is usually removed via the incision / cut underneath the belly button. The incision /cuts are repaired with dissolvable stitches. A waterproof dressing is placed over the sites so you can shower straight away. These should be left for 3 days. On removal if the wound is not dry another dressing should be applied for a few more days. Redness or discharge may indicate infection and the consultant should be contacted.
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Where is gallstone surgery performed
The LSG performs gallstone surgery in London (London Bridge), Surrey and Hampshire (Clare Park hospital). Please contact the practice secretary for details.
Which medications will I require after surgery?
You will be discharged from hospital with a supply of simple painkillers with instructions on how to use them. Regular paracetamol is particularly effective and can be combined with an anti-inflammatory drug (ibuprofen) or a codeine based drug (dihydrocodeine). Anti-inflammatories are not suitable for all patients and should be taken with food. The codeine-based drugs can cause constipation and should be taken with plenty of fluids. Most patients do not require painkillers after 5 days.
How long will it take to recover from the surgery?
The procedure can often be performed as a day case. This is usually when the procedure is performed in the morning and you can be discharged late in the afternoon. Surgery performed in the evening will often require an overnight stay. The wound sites will have local anaesthetic injected into them at the time of surgery. This will wear off about 6 hours after the procedure. To stop the sites becoming sore you should take the regular painkillers as instructed. Shoulder tip pain is not uncommon and is due to gas underneath the diaphragm. This should not last longer than 24 hours. You will not be discharged until you are comfortable and eating and drinking. On discharge you should be independent and able to climb a flight of stairs.
When can I return to work?
Generally it is recommended to take two weeks off after surgery. Your ability to return to work will depend on your job and varies between individuals. Patients can often return to work a week after surgery if required. We would not recommend flying immediately after surgery. This should be discussed on a case-by-case basis with the consultant.
When can I drive?
Driving should be avoided in the first week after surgery. Once you can perform an emergency stop in a stationary vehicle and turn to view your blind spot then driving should be safe. It is preferable to contact your insurance company to check for any specific instructions they may have.
What are the risks of have your gall bladder removed?
Cholecystectomy is one of the most common operations performed in the developed world. The procedure carries approximately a 5% risk of not being performed with keyhole surgery and a 1% risk of a bile leak occurring after the operation. Injury to the main bile duct can occur in around 1 in 1000 patients. This would require further surgery to fix. These risks are approximate only and will vary depending on the severity of the gall bladder pathology and factors such as previous operations in the area.
If complications occur, these can be dealt with easily if detected quickly. Recovery should be short and patients should be well and comfortable the day after surgery. Fever, vomiting, high pulse rate are all indications to return for urgent reassessment.
Long-term risks are minimal. Patients occasionally report looser bowel motions as a result of the constant release of bile into the gut. This can be resolved with medication.
Who do I contact if there are concerns?
The group practice telephone is answered in working hours and messages can be left out of hours. Any concerns will be relayed directly to one of the consultant surgeons on receipt. The hospital ward also provides a 24/7 means of contact. They will contact the consultant about any concerns and are able to give advice if required.
For more information on gallstone surgery in London or gallstone surgery in Surrey, please contact us on info@londonsurgicalgroup.
