Gall Bladder Stones: One-Day Hospitalization Surgery

What is cholecystectomy?

Treatment for gall bladder stones (or gall stones) involves either medication to dissolve gallstones or surgery to remove the gall bladder. Medication may take months or years for the stones to dissolve completely and is generally reserved for those who are unable to undergo surgery. The surgical procedure for treating gallstones is called Cholecystectomy. It involves removal of the gall bladder, a pear-shaped organ below the liver on the upper right side of the abdomen. Cholecystectomy is a common procedure that allows bile to flow directly from the liver into the small intestine rather than being stored in the gall bladder. Though the body can no longer store bile, gall bladder removal does not affect one's ability to digest food and the organ is not essential for survival. Cholecystectomy can be performed in two ways: Open surgery, in which the surgeon makes a six-inch incision in the abdomen, and requires two to three days hospitalization, or Laparoscopic surgery, in which the surgeon makes four small incisions and uses a laparoscope and other special instruments. Patients are released on the same day or might require an overnight stay at the hospital.

Why cholecystectomy?

Gall bladder collects and stores bile, a digestive fluid produced by the liver. Gallstones block the flow of bile into the digestive tract. Cholecystectomy may be necessary if the patient experiences pain from gallstones in the gall bladder (cholelithiasis) or bile duct (choledocholithiasis), or have gall bladder inflammation (cholecystitis) or pancreas inflammation (pancreatitis). Surgery is also recommended in cases where gallstones occur frequently.

What is the procedure for laparoscopy gallbladder surgery for gallstones?

The surgeon begins the laparoscopic cholecystectomy procedure by making four small incisions in the abdomen. A telescopic instrument with a camera fitted at the end (laparoscope) is inserted in one of the incisions, and other surgical tools are inserted in the other incisions. The laparoscope allows the surgeon to view the affected area on a monitor and remove the gall bladder. Along with the gall bladder, the bile duct is also screened beforehand for any abnormalities. Once the gall bladder is removed, incisions are sutured and patient is taken to the recovery area. The surgery is performed under general anaesthesia and takes about one to two hours. Patients are released from the hospital on the same day or may require an overnight stay. Generally, most patients are able to walk unaided and eat and drink without pain from the first day itself. Complete recovery, however, takes about seven days.

What are the known complications of the surgery?

The known risks of cholecystectomy are:

1. Leakage of bile
2. Bleeding and blood clots
3. Infection and injury to nearby organs like the bile duct, liver and small intestine
4. Heart problems
5. Pancreatitis
6. Pneumonia

What are the dietary and physical activity requirements before and after surgery?

Mild diarrhoea is experienced by many patients post the surgery, but it goes away with time. Patients are able to eat normally soon after the operation and on the same day itself. Here are some guidelines that ensure a smooth recovery post cholecystectomy:

1. Eat small, frequent meals initially. This will allow available bile to mix well with the food.
2. Include lean protein, vegetables, fruit and whole grains in diet.
3. Cut down on fat-rich foods and opt for low-fat food items.
4. Gradually increase the fibre content in diet to help normalize bowel movements and reduce incidences of diarrhoea or constipation.

What precautions or steps are necessary to stay healthy and happy during the treatment?

The patient may be asked to do the following prior to the surgery:

1. Drink a prescription solution for few days ahead of the procedure to flush out stool from the intestines.
2. Skip meals and drinks at least four hours before the surgery.
3. Eat a low-fat diet for several weeks before the surgery.
4. Stop taking certain medications and supplements (as advised by the doctor).

Recovery after the procedure depends on the patient's individual condition, but laparoscopic cholecystectomy allows patients to return to their normal activities within a week.

How can the disorder be prevented from happening or recurring?

Dietary modifications cannot prevent gallstones from recurring. Cholecystectomy is the only method to prevent future cases of gallstones.

How can a caregiver support and help the patient cope with the surgery?

The patient may require assistance from a friend or family member to be driven home after the surgery and immediate care for first couple of days. Sources:"Laparoscopic Gallbladder Surgery for Gallstones," WebMD, Healthwise Staff, 15 July, 2011, https://www.webmd.com/digestive-disorders/laparoscopic-gallbladder-surgery-for-gallstones"Cholecystectomy (gallbladder removal)," Mayo Clinic, Mayo Clinic Staff, https://www.mayoclinic.com/health/cholecystectomy/MY00372"Nutrition and healthy eating," MayoClinic.com, Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D., 13 July, 2011, https://www.mayoclinic.com/health/gallbladder-removal-diet/MY01815"Do I need to change my diet after gallbladder surgery?" NHS.uk, https://www.nhs.uk/chq/Pages/2443.aspx?CategoryID=51