Cholecystectomy: An expert insight

A cholecystectomy, also known as gallbladder removal surgery, is a common procedure used to treat gallbladder problems such as gallstones.

Here to provide a comprehensive insight into a cholecystectomy is Professor Krishna Menon, renowned consultant hepato-pancreato-biliary and liver transplant surgeon in London.

What is a cholecystectomy, and why is it performed?

A cholecystectomy, in layman’s terms, is the surgical removal of the gallbladder. The commonest reason for why a cholecystectomy is performed is due to gallstones.

To a lesser extent, a cholecystectomy is performed for polyps in the gallbladder, tumours in the gallbladder, and inflammation without stones in the gallbladder.

Sometimes, there are difficulties with the emptying of the gallbladder (something called biliary dyskinesia). Biliary dyskinesia is another indication for the removal of the gallbladder.

What are the common symptoms that indicate a need for a cholecystectomy?

The commonest symptoms occur after having eaten a fatty food meal. A couple of hours later after the meal, patients experience severe abdominal pain which then radiates through to the back and is also associated with nausea or vomiting. This symptom is classically described as a biliary colic.

Typically, a biliary colic comes on and after two to four hours, the pain subsides. The biliary colic sets off again the next time a patient has a meal. Sometimes, when a biliary colic continues for a long period of time, it can become more of a constant pain rather than an intermittent pain. Other times, a biliary colic can happen even without having eaten a fatty meal.

Some patients may experience non-specific symptoms, which are bloating, discomfort in the upper abdomen, and sometimes nausea and vomiting associated with pain. These patients may have had an endoscopy to investigate their symptoms, not found a cause, and then went to see a hepato-pancreato-biliary surgeon. A scan would then show that these patients have gallstones.

Commonly, however, patients present with a biliary colic.

What are the different types of cholecystectomy procedures?

A cholecystectomy is the surgical removal of the gallbladder. The operation can be performed by keyhole (laparoscopy) surgery or by open surgery.

Typically, when a cholecystectomy is performed by keyhole surgery (called a laparoscopic cholecystectomy) there is a risk of conversion to an open procedure (called an open cholecystectomy). In a patient who is fit, this risk is probably around two to three per cent.

If a laparoscopic cholecystectomy is converted to an open cholecystectomy, this is often due to difficulties identifying the anatomy or difficulties controlling bleeding. However, these are rare.

Nowadays, between 95 to 98 per cent of cholecystectomies are performed using keyhole surgery. Patients will be able to go home very quickly and functionally recover very quickly as well.

Open surgery obviously requires a large cut. It is commonly performed:

• For a conversion: From a laparoscopic cholecystectomy to an open cholecystectomy.
• For a planned situation: When the surgeon anticipates there are going to be complications during surgery, either because of a tumour in the gallbladder or because of other adjacent organs involved due to the inflammation in the gallbladder. The operation is then performed using open surgery, as a planned open cholecystectomy.

What can patients expect during the recovery period after a cholecystectomy?

If a laparoscopic cholecystectomy is performed, it is a day-case procedure, so patients go home on the same day they are admitted. It is uncommon for patients to stay overnight. Following surgery, the functional recovery to get back to full fitness is somewhere between four to six weeks, but younger patients will recover within two to four weeks.

If the operation is converted to an open cholecystectomy or if it is performed as a primary open cholecystectomy in the first place, then the length of stay in hospital is longer, usually three to four days. Following surgery, the functional recovery to get back to full fitness takes about eight to 12 weeks.

Are there any long-term dietary changes or lifestyle adjustments needed after a cholecystectomy?

Initially, patients will need to make some changes. This is because the function of the gallbladder is to store bile and to push bile out into the bile duct and the intestines for the digestion and absorption of food. This chemical message still goes out to the gallbladder, even after the gallbladder has been removed. What the body thus needs is a bit of time for the bile to actually enter the intestines, as the muscle at the lower end of the bile duct has to relax. If patients rush after a cholecystectomy, eating too much fatty food, they will experience bloating and diarrhoea.

Hence, after a cholecystectomy, we always advise patients to stay off fatty food or gradually add fatty food to their diet in about four to six weeks time. Most patients will eventually go back to eating a normal diet without any problems.

If you require a cholecystectomy and you would like to consult your options with an expert, don’t hesitate to book an appointment with Professor Krishna Menon via his Top Doctors profile today.