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Keyhole gallbladder surgery is today the "gold standard" treatment for gallstones. Several thousand gallbladder operations are performed in Victoria each year. Although the surgery is sometimes considered minor, this is not the case and severe complications, although very uncommon, can occur.
LapSurgery Australia surgeons have a major interest in the management of patients with gall stone disease. We offer ALL of the procedural options that are required for complete management of gall stones and their possible complications including ERCP. LapSurgery Australia surgeons were among the first in Australia to perform keyhole surgery to remove the gallbladder and now have experience of over several thousand such operations. LapSurgery Australia surgeons specialise in advanced laparoscopic operations well beyond the complexity of gallbladder surgery. It's nice to know that these skills and experience are available to you for your gallbladder surgery.
There is no waiting list. If you wish, your operation can usually be performed within a week or two or planned at a time of your choosing. For most patients with full private health insurance there will be some extra costs not covered by Medicare or your health fund. The cover provided by your health fund will vary according to which fund and which table you are on and in some cases you may have to pay an "excess". It is your responsibility to check with your health fund prior to surgery. Full financial details will be provided to you prior to surgery unless the surgery is done as an emergency. Occasionally other tests, procedures or specialist consultations may be necessary and some other costs incurred.
Public hospital waiting lists are very long and the surgery is usually carried out by trainee surgeons under the supervision of one of the specialist surgeons appointed by the hospital. There is no choice of surgeon in the Public Hospital and your LapSurgery Australia surgeon may or may not be involved in your operation.
Hospitals used by LapSurgery Australia for Keyhole surgery are:
The gallbladder lies underneath the liver which is situated in the upper part of the abdomen on the right side protected by the ribs.
The diagram shows the relation of the gallbladder to other structures. Run your mouse over the diagram to identify the various structures.
The liver secretes bile which travels down the bile ducts to the sphincter (of Oddi) which is normally closed. Bile then flows into the gallbladder which absorbs water from the bile, thereby concentrating the bile. When food moves from the stomach into the duodenum a hormone (cholecystokinin or CCK) is released which causes the gallbladder to contract, the sphincter to open and thus concentrated bile flows into the duodenum. This allows digestion of fat, even very large amounts of fat which, in hunter/gatherer times was a very important part of the diet because of it's very high caloric value.
Gall stones are formed in the gallbladder and vary in size, shape and colour. Some stones contain a large amount of cholesterol and these stones tend to be yellowish in colour. Others are dark green or black in colour and these are pigment-type gall stones.
The liver manufactures bile which travels down the bile duct. Some of the bile is then directed into the gallbladder and concentrated. In susceptible people, the concentration of bile triggers the formation of crystals that slowly grow to form gall stones. This process usually occurs over a number of years, but can occasionally occur quite suddenly such as during rapid weight loss.
Gall stone prevalence increases with age and by the time we reach our later years, approximately 15% of the population will have developed gall stones. Females are more prone to developing gall stones than males. During pregnancy the function of the gallbladder is diminished and resulting bile stasis appears to make stone formation more likely. Excess weight is another factor that increases gall stone formation and this relates to increased cholesterol content in the bile. Gallstones sometimes run in families.
When you eat a meal, especially a fatty meal, a hormone is released which causes the gallbladder to contract and squeeze concentrated bile into the bowel. Bile is necessary for the digestion of fat which (when not in excess) is essential to health. Sometimes a stone jams in the outlet of the gallbladder and blocks the bile from getting out of the gallbladder. The gallbladder continues to contract against the stone and this is what causes the pain of a gallbladder attack. In many cases the gall stone will release spontaneously and symptoms disappear. Episodic attacks of pain ranging from mild to very severe are the most common symptoms of gallstones. The pain often occurs during the night or after a fatty meal.
The pain is usually situated in the upper part of the abdomen and under the right ribs. The pain often radiates around and into the back on the right side. Occasionally the pain is felt in the lower chest and the symptoms can be confused with a heart attack. If the gall stone fails to release, the gallbladder may become acutely inflamed and this condition is known as acute cholecystitis. In some cases, this may lead to a serious infection with gangrene of the gallbladder. Other symptoms such as nausea, flatulence (belching) and intolerance of fatty foods are often attributed to gall stones but these can be caused by other conditions and may or may not improve after the gallbladder is removed.
Ultrasound of the abdomen is the standard way of diagnosing gall stones. This is a painless examination that allows the stones within the gallbladder to be seen in the majority of cases. Blood tests to measure the function of the liver and the pancreas may also be used to determine the likelihood of stone migration from the gallbladder into the bile duct. More complicated tests including imaging of the main bile ducts may be necessary involving CT or MRI scans. Occasionally ERCP is necessary to diagnose and remove stones from the bile ducts (ERCP is explained further down on this page).
Sometimes gallstones are diagnosed during tests for other conditions, but there have been no symptoms of gall bladder disease. In general we don't recommend removal of the gallbladder in this situation, but each person and situation is different. If, for example, you had gallstones without symptoms and planned to spend a year in the Outback, Antarctica or travelling the world there may be a place for removing the gallbladder even though you have no symptoms. We recommend careful discussion with your LapSurgery Australia surgeon before embarking on gallbladder removal in the absence of symptoms.
It is recognised that a very few people can have gall stone type symptoms without gall stones being found. This condition is challenging for both patient and doctor and requires very careful consideration and multiple diagnostic tests before going ahead with surgery. In the absence of gallstones no guarantee can be given about relief of symptoms by surgery to remove the gallbladder. LapSurgery Australia surgeons have the necessary experience to advise you in this situation.
Providing you have significant symptoms related to gallstones, in almost every case we will recommend keyhole (laparoscopic) surgery to remove the gallbladder. Exceptions are occasionally made for the elderly in whom the attacks are not frequent or severe or those with major illnesses which could make the operation more dangerous than the gallstones.
No. There are no satisfactory means of treating gallstones other than surgery. Both ultrasound disintegration and chemical dissolving of gallstones with tablets have been tried. In only a very few patients is the treatment successful, but even in these cases the stones almost always recur within months or a year or two.
Good question! Firstly, removing just the stones from the gallbladder is extremely difficult and much more dangerous than taking out the gall bladder. More importantly, even if you could just have the stones removed safely, they would almost certainly form again in the coming months or years and it would be back to square one!
Quite well actually! The function of the gallbladder is to concentrate and store bile. When you eat a meal, particularly a fatty meal, a large amount of concentrated bile is released into the duodenum. This enables a very large amount of fat to be digested at once. Eating large amounts of fats (which are very high in calories) was, in hunter/gatherer times, very important for survival. In the days of refrigerators and three meals a day this is no longer necessary and may be harmful. With the gallbladder removed, bile is released in small amounts continually into the duodenum. This is adequate for all normal eating situations. However if, after removal of the gallbladder, you were to eat a huge amount of fat at one sitting (which you should NOT do at any time), the fat may not be digested but will pass through the bowel and give you nasty diarrhoea.
For keyhole surgery four tiny (0.5 to 1.5 cm) cuts are made in the approximate positions shown on the diagram. If open (non-keyhole) surgery is required the cut is about 15-20 cm long under the right ribs as shown.
Unfortunately not. For routine surgery, where the gallbladder is not acutely inflamed, at least 95% of gallbladder operations can be performed safely using keyhole surgery. Sometimes, even in routine surgery, it is not possible to be sure exactly which structure is which. This can be related to scarring around the gallbladder from previous attacks of gallbladder pain or sometimes to unexpected bleeding during the operation. In this instance the major concern is that we do not cut the wrong structure. Cutting the main bile duct by error is something we avoid at all costs. If we are in any doubt about the exact anatomy we abandon the keyhole operation, make an incision under the ribs on the right side and safely complete the operation the old "open" way. Where the operation is performed as an emergency, up to 50% of operations will need to be done with the large incision. If you do wake up after the operation with a large incision instead of keyhole surgery you should be reassured that your surgeon placed your safety and long term health before the convenience of a keyhole operation.
Warning! This section is not and is not intended to be a comprehensive account of possible complications. Possible complications must be discussed with your surgeon prior to operation.
All surgery involves some risk. Risks can be broken down into two groups, those related to surgery in general and those specific to the operation being performed. Risks of surgery in general include risks of anaesthetics, infections inside the abdomen and in the wound, lung problems, blood clots in the leg or lungs and even death. Death from routine gallbladder surgery is exceptionally rare but has happened. If you have other health problems such as heart or lung problems, diabetes, smoking or excess weight the general risks of surgery are increased.
The major risk specific to the laparoscopic cholecystectomy operation is damage to the main bile duct system. This is a very major complication with potentially serious long term problems. In the event of accidental damage to the main bile ducts you may experience a bile leak. Other possible complications specific to the laparoscopic cholecystectomy along with a bile leakage are infection forming under or around the liver and bleeding. LapSurgery Australia surgeons are able to deal with these issues if such complications occur to ensure recovery is complete. Please note that these risks mentioned are not all inclusive and a thorough discussion with your surgeon will occur.
Stones can escape from the gall bladder into the bile ducts which carry bile from the liver and gallbladder to the bowel (duodenum). Sometimes these stones can pass harmlessly through the bile ducts and into the duodenum causing either no symptoms or some short lived pain rather like a gallbladder attack. If we suspect gallstones in the main bile ducts before operation we will arrange either a special CT or MRI test to confirm this or will perform an X-Ray of the bile ducts during the keyhole operation to remove the gallbladder. Depending on individual circumstances we may recommend pre-operative ERCP (see below) to remove the stones Alternatives are removal of the stones at operation (either keyhole or through a larger incision) or ERCP after the surgery. If we find bile duct stones unexpectedly at operation we will usually leave these and arrange ERCP in the early postoperative recovery period. LapSurgery Australia surgeons will decide which of these options is best for each individual and to undertake the best and most appropriate treatment.
The standard ultrasound test is very accurate for diagnosing stones in the gallbladder, but is a very poor test for stones in the main bile ducts. An X-Ray of the bile ducts taken during surgery is very accurate. If stones are present these are usually removed later by ERCP but may be removed laparoscopically at the same time as the gallbladder surgery in some circumstances. Occasionally a very small solitary stone may be left to pass spontaneously if the risk of the stone is judged less than the (very small) risk of ERCP.
Where the operation is completed laparoscopically (keyhole surgery) more than 90% of patients will be able to go home on the day after surgery. Return to normal activities (other than very heavy occupations) is usually possible in 7-10 days. If you needed the open operation (large incision) then hospital stay would be around 4-5 days and return to normal activities in 4-5 weeks.
Ask your family doctor for a referral to one of our surgeons. Under Medicare legislation and medical ethics, we cannot see you without a valid referral. Consultations are available in Mulgrave, Boronia, Mornington, Rosebud and Berwick. Please note that not all of our surgeons consult at all of these locations. Please call (03) 9760 2777 for any enquiries or see our contact page.
The major risk specific to the laparoscopic cholecystectomy operation is damage to the main bile duct system. This is a very major complication with potentially serious long term problems. Other possible complications specific to the laparoscopic cholecystectomy include bile leakages, bleeding and infection forming under or around the liver. LapSurgery Australia surgeons are able to deal with such complications to ensure recovery is complete. Please note that all risks mentioned are not all inclusive and a thorough discussion with your surgeon will occur.
The stone gets stuck in the outlet of the gallbladder and does not release. First there is a chemical reaction of the bile literally starting to digest the gallbladder causing inflammation and unremitting pain. Then the bacteria naturally occurring in the gallbladder get into the act and the resulting infection makes the situation worse and can lead to gangrene of the gallbladder. Emergency surgery is usually recommended and keyhole surgery may not be possible.
This occurs when a stone gets stuck in the main bile duct and blocks bile going from the liver to the bowel. There is a backup of bile into the liver which then cannot function properly. Bile is absorbed into the bloodstream and this stains the skin and other organs a yellow colour. Secondary infection of the bile ducts can occur (cholangitis) which can be life threatening. The stone(s) must be removed from the bile duct urgently by ERCP or surgery.
A stone in the main bile duct can interfere with the pancreas and cause pancreatitis. This is potentially a life threatening illness and requires hospital treatment.
Although rare, cancer of the gallbladder can occur and may be fatal. Cancers usually occur when gallstones have been present for 20 years or more.
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