GALLBLADDER SURGERY (CHOLECYSTECTOMY)

Summary

The gallbladder is a small organ in the upper abdomen responsible for collecting and storing bile needed to digest food in the stomach.  Surgery may be needed to remove the gallbladder if you have been diagnosed as having gallbladder disease. This may be caused by gallstones (cholelithiasis) or inflammation of the gallbladder (cholecystitis). The gallbladder may not work normally or become irritated when it is inflamed or if there are stones blocking the flow of bile out of the gallbladder. The inflammation may be chronic (lasting a long time) or acute (severe and lasting a short period of time). Gallbladder inflammation may happen because of foods that are eaten, infection or if stones block the cystic duct (opening out of the gallbladder).

Since you can live a perfectly normal life without a gallbladder, the treatment of choice of symptomatic gallbladder disease causing pain in the upper abdominal area, nausea, vomiting, bloating, belching, indigestion, heartburn and intolerance of fried, fatty or spicy foods, is a cholecystectomy (removal of the gallbladder).

A cholecystectomy is most commonly performed laparoscopically by making several small incisions in the abdomen so that tiny surgical instruments can access and remove your gallbladder, but may also be removed with traditional open surgery.

Reasons for Gallbladder Surgery

  • Treatment of gallbladder disease (cholecystitis)
  • For the removal of gallstones
  • Biopsy of benign and malignant tumours (cancer) in the gallbladder
  • Cirrhosis and Portal Hypertension management

Types

1Laparoscopic Cholecystectomy
As treatment of gallbladder disease, Dr Kavin may suggest removing the gallbladder under general anaesthesia. The vast majority of cholecystectomies are performed using a laparoscope (a thin telescope-like tube fitted with a camera) that is inserted through a puncture wound near the navel. Other instruments are placed through two or three other puncture wounds in the upper abdomen. These instruments and the camera allow you, surgeon, to visualise the inside of the abdomen and remove the gallbladder.

Sometimes, an intraoperative cholangiogram (x-ray of the bile duct) may be done at the time of surgery to see if stones have passed out of the gallbladder into the main bile duct. If stones are in the common (main) bile duct, a common bile duct exploration may be done through a larger incision into the abdomen to remove the stones.

If this was done and the gallbladder is severely inflamed, drains are sometimes placed down the gallbladder bed for recovery. This will be removed later during your follow-up with Dr Kavin.
2Open Cholecystectomy
A few people cannot have laparoscopic gallbladder removal. This may be due to scarring and inflammation of the gallbladder, scar tissue in the abdomen or bleeding problems. If at the time of the surgery, it is not safe to complete the procedure laparoscopically, or if deemed beforehand that open surgery is better suited and the safest option for you, an incision is made under the rib cage on the right side of the abdomen. During an open cholecystectomy through an incision in the abdomen, the liver and gallbladder are revealed, and the gallbladder is removed. Recovery is typically longer with open surgery and may take up to 8 weeks.

Risks:

  • Complications with anaesthesia. This may include nausea, vomiting, or in rare cases, death
  • Injury to the common bile duct which necessitates an open repair
  • Injury to the surrounding organs that require repair
  • Rare injury to the intestinal tract which may require repair or partial removal
  • Collection of fluid (bile or blood that might require drainage)
  • Bleeding in the abdominal wall where the tubes for the instrument are placed
  • Discovery of a stone in the common bile duct following surgery, which may require removal if they do not pass spontaneously
  • Long term complications can include stricturing of the bile duct which needs further surgery
  • Side effects that occasionally occur include diarrhoea and occasionally reflux gastritis, both usually treated with medications. These risks and side effects can occur in both LAPAROSCOPIC and OPEN surgery.
  • Risks or complications of the proposed treatment that is specific and unique to YOU:
  • Alternative Treatments:
  • Observation is the most common alternative to treatment. Occasionally, patients with gallbladder disease can remain symptom-free for long periods of time. The greatest risk of observation is the progression of the disease and increasing symptoms. Mechanical or chemical dissolution of gallstone has been proven to be unsuccessful and not an acceptable option.

Hospital

Operating from the new state-of-the-art, multi-disciplinary facility equipped with only the most advanced medical technology,

Equipment

As one of only two such robots in the Western Cape, Dr Kavin operates from a hospital boasting Robotic Surgery capabilities,

Technique

As a surgeon with adept skill in minimally invasive techniques, Dr Kavin opts for laparoscopic keyhole surgery whenever possible.

Expertise

Dr Bruce Kavin is a General Surgeon with particular expertise in Endocrine, Colorectal and Gastrointestinal Surgery and Surgical Oncology.

parallax background