Gall stones form in the gall bladder due to precipitation of cholesterol and bile salts. Many people with gall stones have no symptoms and for most of these people no treatment is required. The symptoms of gall stones include upper abdominal pain, nausea and vomiting, intolerance of fatty foods and indigestion. Ultrasound is the most sensitive test for gall stones.
Cholecystectomy
Surgery to remove the gall bladder is called cholecystectomy. It is recommended for most patients symptomatic gall stonesand is the most effective treatment available. Cholecystectomy is most often performed as a laparoscopic (keyhole) procedure. This involves four to five small incisions (0.5 to 1cm long) through which instruments and a camera are inserted to allow surgical removal of the gall bladder. Most patients stay in hospital one to two nights after laparoscopic cholecystectomy.
Occasionally open cholecystectomy (via an abdominal incision) may be required. This involves an incision beneath the rib cage on the right and a longer hospital stay. Surgery to remove the gall bladder will improve symptoms in approximately 95% of patients with symptomatic gall stones.
Intra-operative Cholangiogram
Many surgeons (including Dr O’Neill) will routinely perform an x-ray of the common bile duct at the time of cholecystectomy (a cholangiogram). This is performed by inserting a tube into the cystic duct (that joins the common bile duct) and injecting contrast dye. This x-ray allows any gall stones that may have migrated down the common bile duct to be identified.
Common bile duct stones are identified in 5-10% of patients who undergo cholecystectomy. In some cases Dr O’Neill may be able to remove these stones from the common bile duct at the time of cholecystectomy however in many cases an ERCP may be required on a separate occasion. This involves the use of a flexible telescope inserted via the mouth and removal of the common bile duct stones. An ERCP is performed under sedation.
Risks of Cholecystectomy
Cholecystectomy is generally very safe and serious complications are rare but can include:
- Bleeding
- Infection of the Wounds
- Leakage of Bile from the Bile Duct or Liver Bed
- Damage to the Common Bile Duct (that may require further major surgery)
- Injury to Adjacent Organs (bowel, bladder or blood vessels)
In addition to these risks any operation with a general anaesthetic is associated with risks to your health. Serious complications in healthy patients are extremely rare. Potential problems can include:
- Heart problems (heart attack, stroke, death)
- Lung problems (pneumonia)
- Blood clots (clots in the legs or lungs)
- Drug reactions
It is important that you tell Dr O’Neill and your anaesthetist if you have any other medical conditions or take any regular medications prior to your surgery.
For more detailed information on gall stones see:
Australian and New Zealand Gastric and Oesophageal Association