Gallstones Keyhole surgery - uk - Aleris-Hamlet
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Patient guidance
uk
Gallstones
Keyhole surgery
Bile is produced in the liver. It helps digest food.
The gall bladder is located underneath the liver and
functionsas a storage space for bile until it is needed
in connection with a meal. As you eat, the gall
bladdercontracts and expels bile into the duodenum.
What is a gallstone – Some gallstone patients develop
jaundiceif one or more gallstones
and why do we get move(s) down into the deep bile
them? ducts,causing a blockage.
A gallstone is formed in the gall
bladder when the substances in In most cases gallstones remain in the
bile (cholesterol,calcium and bile gall bladder.
pigments)are imbalanced. These
substances precipitate to form stones.
Gallstones vary in appearance and
size. They may measure from a few
Treatment of gallstones
millimetres (called gravel) to stones of There is no effective medical
up to 2-3 cm in diameter. Doctors do treatmentfor gallstones. Gallstones
not know exactly why some people are therefore removed by means of
develop gallstones. Even though there keyhole surgery, where gallstones and
is no clear evidence that the condition the gall bladder are removed. Most
is hereditary, it is not uncommon for patients’ symptoms disappear when
several members of the same family their gall bladder is removed.
to suffer from gallstones.
In rare cases gallstones may form
later in the bile duct. This is probably
due to gravel passing through from
Symptoms of gallstones the gallbladder to the bile duct,
Stones in the gall bladder can cause where it subsequentlygrows to form
violent bouts of pain resembling colic, gallstones.
which may last for several hours. The
pain is localised under the lower edge
of the rib cage, sometimes radiating
towards the spine. Attacks are often
accompanied by nausea and vomiting.
2Preliminary You will be informed of operative
and post-operative procedures,
examination and potentialside-effects and
Before surgery, you will be invited complicationsassociated with the
to attend a preliminary examination surgery.
by our specialist in gastro-intestinal
surgery. You explain your symptoms. You help determine the date of
The specialist will examine you and surgeryto fit in with your plans.
review the results of blood tests and
ultrasound scanning (if any). In some Prognosis
cases, more examinations will be In the vast majority of cases, when
required to rule out the possibility of the gall bladder – an organ you can
other disorders. easily do without – is removed, the
symptomswill disappear. Patients who
The specialist will then let you know have had their gall bladder removed
of the treatment options available very seldom suffer from gallstones
to you. The specialist will discuss again.
whether a surgical procedure is the
best treatment for you.
Liver Gullet (oesophagus)
Stomach
Gall bladder
Bile duct Pancreas
Duodenum Small intestines
3Without the gall bladder, there is a Open and keyhole
more constant flow of bile into the
intestinesand this does not usually surgery
have any effect on the digestion. The surgical procedure lasts about 1½
Some patients get more frequent hours.
diarrhoea.
Air is pumped into the abdominal
cavity via a fine-gauge cannula, raising
the abdominal wall to create enough
Preparation space to operate in the abdominal
Before surgery, we recommend that cavity.
you read this brochure carefully,
along with ”General guide for surgical In keyhole surgery, four small incisions
patients”. are made in the abdominal wall: One
under the navel and three higher up
Fasting to the right of the stomach. A fifth
The surgery is performed under incision may be necessary on the left
generalanaesthetic, which means that of the stomach. Four small pipes (½-1
you must fast before the surgery. cm in diameter) are inserted through
the peritoneum(abdominal wall). A
Pause from medication camera is inserted into one of the
See about this in the booklet ”General pipes.The camera is connected to a
guidance regarding your surgery” or TV screen. The specialist has a very
”Regular medication in connection clear picture of the gall bladder and
with surgery.” other organs in the abdominal cavity.
Bathing The procedure is performed using
On the day of your operation, you long instruments inserted into the
must shower. Make sure that you remaining pipes. The gall bladder is
wash your navel well. Do not apply removed from the underside of the
cream or lotion after your shower. liver. The small exit duct from the gall
bladder and the blood supply to the
gall bladder are closed with clips and
Same-day surgery then separated. The gall bladder is
then removed through the largest of
(out-patients) the incisions (the incision close to the
The operation will be performed as navel).
same-day surgery. You can expect to
be discharged on the same day just a Sometimes, a drain (a fine plastic pipe)
few hours after surgery. is inserted to remove excess blood
and fluids from the abdominal cavity.
4Antibiotics are administered in You may need to take painkillers after
connectionwith the procedure to surgery. You are welcome to talk to
preventinflammation in the wounds. the nurse about this.
A local anaesthetic will be applied
to the wounds at the end of the
procedure.
After discharge
Pain
The skin is stitched and closed with You should expect to feel mild to
clips or sutures. Absorbable sutures moderate pain after surgery. You
may be used. may take ordinary, non-prescription
painkillers. After keyhole surgery, you
Open surgery should expect to feel pain in your right
In isolated cases, the surgery cannot shoulder for a day or two. This is due
be performed as keyhole surgery. to air having been pumped into the
In this case, while the patient is still abdominal cavity.
under anaesthetic, open surgery will
be performed, with a larger incision Bandages
(about 10-15 cm long) under the lower Do not remove the bandages until 24
edge of the rib cage on the right-hand hours after surgery. If the bandages
side. are soaked in blood or fluid, they must
be replaced. When the wounds are dry
After open surgery, the patient must after a couple of days, the bandages
remain in hospital for slightly longer may be removed.
than after keyhole surgery.
Bathing
The day after surgery (24 hours
later) you may take a shower
After surgery withoutbandageson your wounds.
After surgery the specialist and nurse Swimmingpool and bathtub: Wait
will talk to you about what happens until the wounds have healed.
next and any precautions you need to
observe after the operation. Diet
You can eat and drink normally.
Before you are discharged, you will
be given an injection of anticoagulant Daily activities
medicine to reduce the risk of You can resume regular daily activities
inflammationin veins and arteries from the day after surgery.
(thrombophlebitis) and blood clots
(thromboembolism). Restrictions
Avoid heavy lifts during the first week.
5Time off work The patient has to be admitted to
You may return to work 2-4 days after hospital for treatment. Often a small
surgery, but later if you have any pain plastic drain will be inserted in the
– or if your work involves strenuous bile duct. This can be performed
physical activity. As a general rule, using an endoscope with a camera.
you may do what you like as long as The endoscopeis inserted into the
it does not cause you any pain. If you gulletand down to the bile ducts. This
have undergone open surgery, you procedureis known as an ERCP.
should expect to remain off work for
2-3 weeks. Damage to the bile duct
On very rare occasions the bile duct
Removal of clips/stitches and may be damaged during surgery to
post-operative care remove the gall bladder. If so, the
Your GP may remove stitches or clips patientmust undergo further surgery.
8-10 days after surgery. If the wound
is clipped, special pincers will be
suppliedfor this purpose
If you have been stitched with
absorbablesutures, the sutures do not
have to be removed.
No further out-patient care is required.
Potential side-effects
and complications
Infected wound
Superficial inflammation may occur
in a wound. About 2% of patients
experiencethis. The clips/stitches
may have to be removed in order to
remove infected tissue.
Bile leaks
Following surgery, in fewer than 1%
of patients, bile is found to leak from
the tiny exit in the abdominal cavity.
The leak causes increasing abdominal
pain, discomfort and (possibly) fever.
6For your own notes
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Aalborg Esbjerg
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www.aleris-hamlet.dk
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14th edition Marts 2021. Prepared by PJU/KJK/BMI.
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