Indications:
Gallstones: Gallstones are common and often cause no problems. However, in some people they can cause:
- Pain – This arises if gallstones block the outlet from the gallbladder. It can last minutes to hours and resolve spontaneously (biliary colic). It may however last longer, with inflammation of the gallbladder (cholecystitis), often requiring antibiotics.
- Pancreatitis – Inflammation of the pancreas gland can occur if a stone passes down the bile duct and irritates the opening to the pancreas.
- Jaundice – This is a condition whereby a patient turns a shade of yellow, often most noticeable in the white of the eyes. It is due to a stone moving from the gallbladder into the bile duct, and partially blocking the flow of bile into the bowel. If this occurs, your urine may become darker, your faeces lighter, and your skin may itch.
Procedure:
Both the gallbladder and stones are removed. This can be done as a laparoscopic (keyhole) procedure under general anaesthesia (you are completely asleep), through four small holes, each 1-2cm in length, made in the tummy wall. Occasionally it is not possible to complete the operation by the keyhole method and a bigger incision (cut) is needed under the right rib margin. The risk of the keyhole operation being converted to an open operation is about 2%.
The operation is usually straightforward, and you will usually be able to go home the following day. 95% of people have no long-term side-effects following the surgery, there are however risks with any operation and although they are rare, these are detailed below:
- Shoulder pain – This often happens after keyhole surgery but tends to last less than 24-hours. It is due to the gas used to inflate the inside of the abdomen during the operation.
- Infection – This can occur in the wound(s), in the lungs, at the site of the intravenous drip, or at the position where the gallbladder was located.
- Bleeding – This can occur during or after the operation, as with any surgery.
- Damage to surrounding structures – Rarely, nearby structures can be damaged inadvertently during this operation. These structures include the bile duct, bowel, and the blood supply to the liver. A bile duct injury is potentially very serious but fortunately rare, occurring in approximately 3 in every 1000 operations. An injury to the bile ducts can lead to a bile leak, which would likely necessitate a further procedure to drain the leak and in severe cases may require another operation to repair the bile ducts.
- Deep vein thrombosis (DVT)/Pulmonary embolus (PE) – Clots forming in the veins can occur with any surgery, but the risk is increased with laparoscopic surgery. We give you a blood thinning agent to decrease this risk and ask you to wear compression stockings for two weeks following the operation.
- Retained stone – Before or during the operation a stone can move into the main bile duct. This often causes no problem and passes into the bowel. However, if it does not pass, a second endoscopic procedure (a flexible scope that is passed through the mouth) may be necessary to remove it.
After your consultation:
- Obtain authorization from your medical aid and book your bed for your hospital admission.
- Carefully read through pre-operative information provided.
Day before surgery:
- Do not eat/drink after 22h00, the night before your surgery, unless otherwise specified by your surgeon or anaesthetist (you should be fasting for at least 6 hours before the procedure for solids but you are allowed to take clear liquids up to two hours before your procedure).
Day of surgery:
- Arrive for admission as indicated on ‘Code & Consent’ sheet.
- Change into theatre attire, remove all valuable belongings.
Duration of hospital stay:
- One – two days (dependent on pain management and general state of patient).
Activities:
- Refrain from strenuous activities (incl. exercise) for at least 4 weeks post-operatively.
Back to work:
- Sick leave required post-operatively is approximately 7-10 days.
Some pain and discomfort post operatively may be expected following any operation, but the following measures are used to lessen the pain experienced:
- Warming devises in theatre as well as warm intravenous fluids.
- Intra-operative pain medication through the drip.
- Post-operative medication through the drip, please inform the nurses if you are in pain so that medication will be administered to you.
- As close to one week after discharge as possible. Please contact the rooms to schedule an appointment.
More procedures performed by Dr Jeske
A SKIN INCISION IS MADE AND THE CONTENTS OF THE ABSCESS IS DRAINED.
THE FISTULA TRACT IS IDENTIFIED AND IS OPENED ALONG ITS LENGTH, AND THE EXPOSED INSIDE OF THE TRACT IS THEN CLEANED OUT.
AN OPERATION TO REMOVE AN APPENDIX THAT IS INFLAMED/SWOLLEN/HAS RUPTURED/HAS FORMED AN ABSCESS.
THE COMMON BILE DUCT (CBD – THE MAIN TUBE CARRYING BILE FROM THE LIVER TO THE INTESTINE) IS OPENED UP. ANY GALLSTONES WITHIN THE DUCT CAUSING A BLOCKAGE CAN BE REMOVED.
PTC is a procedure performed by a radiologist (specialist X-ray doctor) who takes X-ray pictures of the bile ducts which are tubes inside the liver.
