Laparoscopic gallbladder removal for gallstones: what to expect

The gallbladder is a small organ in the upper right part of the tummy that stores bile, a fluid that helps digest food (NHS). Gallstones form inside it, and most people who have them never get symptoms (NHS).

Trouble starts when a stone blocks the outflow. The result is biliary colic: severe, constant pain that lasts longer than 30 minutes and can go on for several hours (NHS). Blockages can also inflame the gallbladder or pancreas, or cause jaundice. Because stones keep forming while the gallbladder is there, the main treatment is to remove the whole organ, and you can live without it and keep eating a normal, healthy diet (NHS).

Removal is often recommended when gallstones cause severe or frequent pain, or when a blocked duct has caused jaundice or an inflamed gallbladder (NHS). Stones found by chance on a scan, with no symptoms, usually do not need an operation; follow-up may be enough (NHS).

Keyhole surgery suits most patients. An open operation is used when the gallbladder is severely inflamed, infected or scarred from earlier surgery (NIDDK), or when it cannot be removed safely by keyhole (NHS). Serious heart or lung disease, a bleeding disorder or advanced liver disease change the risk balance and are assessed with you before any decision.

Sometimes a stone leaves the gallbladder and lodges in the common bile duct, the tube that carries bile to the intestine. It can cause jaundice, with yellow skin or eyes, and inflammation of the pancreas (NHS).

These stones are often removed with ERCP: a long, thin tube with a camera is passed through the mouth into the stomach, and the opening of the bile duct is widened so the stones can pass (NHS). ERCP clears the duct but leaves the gallbladder in place, so it is usually followed by gallbladder removal; the order and timing are planned around your scans and blood tests.

The operation is done under general anaesthetic and usually takes about an hour (NHS). The steps are:

1. A small cut is made near the belly button and a few more on the right side of the tummy; some surgeons use a single cut.
2. The tummy is filled with gas so the surgeon can see clearly, and a camera on a thin tube is passed inside.
3. The gallbladder is separated with small instruments and removed through one of the cuts.
4. The gas is let out, the cuts are closed and you wake up in the recovery room (NHS).

If keyhole removal is not possible during the operation, the surgeon switches to an open cut, a safety step that may mean more pain and a longer recovery (NHS).

A few weeks before surgery you are usually seen at a pre-admission check, where your medical history and medicines are reviewed and you may have blood tests, an X-ray and an ECG (NHS). Tell the team about blood thinners and diabetes medicines; you will be told which to pause and when to stop eating and drinking.

If you smoke, stopping at least 6 weeks before surgery helps, and losing weight beforehand is advised if you are overweight (NHS). Arrange for someone to take you home and stay with you for the first day or so.

Most people go home the same day, and painkillers are given for the first few days (NHS). Small meals are often easier for the first few days, and you can usually remove the dressing a few days after surgery (NHS).

Start light activity early and build up gradually, avoiding strenuous exercise at first. You may be able to return to work 1 to 2 weeks after the operation, later if your job involves heavy lifting, and you should not drive until you can do an emergency stop without pain (NHS). Most people return to normal physical activity in about a week (NIDDK).

Serious problems are uncommon, but you should know them before you agree. A wound infection is a small risk and is usually treated with antibiotics (NHS).

Injury to the bile duct or a nearby organ is uncommon but may need further surgery, and a bile leak, which is rare, needs another procedure to drain the bile (NHS). As with any keyhole operation, rare risks also include bleeding from a blood vessel and blood clots in the legs or lungs (NHS).

Some people have nausea, indigestion, tummy pain or diarrhoea after the operation, sometimes called post-cholecystectomy syndrome; these usually improve soon, but tell your surgeon if they persist (NHS).

Contact the surgical team the same day if you have any of the following after the operation (NHS):

• severe or worsening pain that does not go away
• yellowing of the skin or the whites of the eyes
• pus oozing from a wound, or wounds that are red, swollen and tender
• a very high temperature, or feeling hot, cold and shivery
• pain, swelling or throbbing in one leg

Go to the nearest emergency department straight away if leg pain or swelling comes with difficulty breathing or chest pain, which can mean a clot in the lungs (NHS). Do not drive yourself.

Removing the gallbladder treats the cause of gallstone attacks, and you can continue to eat a normal, healthy diet without it (NHS). It can still take several weeks to feel fully recovered.

A small number of people have softer and more frequent stools after removal, and these bowel changes are usually temporary (NIDDK). If pain like your old attacks returns, or you notice jaundice, it needs checking, because a stone can occasionally remain in the bile duct.

Surgery is the main treatment for gallstones that cause symptoms (NHS), but it is not the only path. The table sets out the options and where each fits.

While waiting for surgery, painkillers and avoiding foods that trigger your pain, sometimes with a low-fat diet, can help (NHS).

The price of laparoscopic cholecystectomy in Cairo depends mainly on the hospital and its room class, the surgical and anaesthetic team, whether the stay is a day case or overnight, and the tests needed beforehand, such as ultrasound and blood work. An ERCP, an emergency admission or a complicated, inflamed gallbladder add to the total.

Ask for a written quote that lists the surgeon, anaesthesia, hospital stay and follow-up visits. Dr. Yasser trained in laparoscopic cholecystectomy at King Fahd University Hospital in Al Khobar in 1999 and also performs laparoscopic hernia repair and hiatal hernia surgery. You can book a consultation with Dr. Yasser to review your scan and get a current written quote.