Laparoscopic Cholecystectomy (Laparoscopic Gallstone Surgery)

Procedure description 

1. Laparoscopic gallstone surgery is performed by using a laparoscope.
2. A laparoscope is a tube with a tiny camera at one end to visualise and capture images inside your abdomen. 
3. Once you are given the anaesthesia, the laparoscope is inserted into your abdomen through one of the incisions. 
4. Carbon dioxide is pumped into your abdomen through one incision. This helps inflate your abdomen to make it easier for the surgeon to see inside. 
5. The surgeon will insert surgical instruments into the abdomen via the incisions. 
6. The surgeon will cut the gallbladder and detach it from the liver and other nearby organs using these surgical tools.
7. The gallbladder is packed into a bag inside your body and then removed out through the incision.
8. The surgical area inside your body is cleaned, and the excess blood is drained.
9. The instruments are removed of the incisions.
10. The surgeon will then close the incisions with the help of stitches, a surgical stapler, or surgical glue.
11. If you have complications or if the surgeon feels the gallbladder is severely infected, then this laparoscopic surgery may turn into a traditional open cholecystectomy surgery.

What to expect before surgery? 

1. Your surgeon will write you a prescription with all the basic tests that need to be conducted before your surgery. 
2. The tests, along with a general examination, will help decide if you are physically fit for the surgery.
3. Your surgeon will refer you to a general physician for physical fitness for surgery.
4. Your physician will ask for your medical history, results of all the tests, and then provide you with a fitness certificate.
5. The surgeon will fix a date for your surgery based on this certificate. 
6. Inform your surgeon if you are under certain medicines like blood thinners, such as warfarin and clopidogrel, or painkillers, such as aspirin, ibuprofen, and naproxen. Your surgeon asks you to stop taking these medicines at least two weeks before surgery to avoid complications.
7. You will have to fast for at least four hours before surgery. This means that you cannot eat or drink anything from four hours before the laparoscopic gallstone surgery. 
8. You cannot drive or move about post-surgery. So you will need a family member to take care of you.
9. Get your queries, if any, solved by your surgeon.

What to expect on the day of surgery? 

1. On getting admitted, you or your family member need to sign a few consent forms in case of any complications. 
2. You will have to remove your clothes, jewellery, dentures, and other accessories, if any, before your surgery. 
3. The nursing staff will shave your abdominal hair, and the surgical site will be prepped for surgery.
4. You may be in surgery for about one to two hours.

What to expect during surgery? 

1. You will lie down on your back and will be given the IV line for receiving fluids and medicine during the procedure. 
2. Once you are in the set position, the anaesthesiologist will give you general anaesthesia and put you to sleep.
3. The surgical site is then cleaned with spirit and betadine and then draped with an aseptic cloth to be kept ready for the surgeon.
4. Your blood pressure, pulse, and respiratory rate are measured throughout the procedure. 
5. The surgeon will make four small incisions on your abdomen.
6. The laparoscope is inserted into your abdomen through one of the incisions.
7. The surgical instruments will be inserted into the other incisions. 
8. Once the surgery is done, the gallbladder is removed through one of the incisions in your abdomen.
9. The incisions are then sutured and dressed. 

What to expect after surgery? 

1. After the surgery, you will be shifted to the recovery room for observation.
2. The surgeon will monitor for post-surgical complications, wearing off anaesthesia effects, and your vitals. 
3. If all is well, you will be discharged on the same day or the next day. 
4. You will be on antibiotics for infection and pain relievers for the pain. 
5. You may feel bloated due to the wearing-off effects of the carbon dioxide. 
6. You may experience diarrhoea after the surgery, which is normal.
7. You will be allowed to walk once you are awake and are feeling better. 
8. You will be advised of the following:
9. Drink plenty of water.
10. Avoid eating high-fat foods to reduce your liver and bile production load. 
11. Resume the medication that you stopped prior to surgery only after checking with your doctor.
12. Resume routine activity within a week after surgery. However, consult your doctor before you start your usual work.
13. Avoid lifting heavy weights and strenuous activity for at least six weeks after surgery.

First follow-up appointment 

1. The first follow-up is usually within 1-2 weeks.
2. In case of the following complaints, then you will need to visit your surgeon sooner:
3. High-grade fever
4. Severe pain or swelling in your abdomen
5. Jaundice (yellowish discoloration of your skin)
6. Nausea or vomiting
7. Inability to eat or drink anything
8. Bleeding or discharge of pus from the incisions of the surgery
9. Intolerable pain
10. Breathing difficulty
11. Severe cough

When to consult a doctor? 

You may experience some side effects or complications after laparoscopic gallstone surgery. If you have any of the following, then you must consult your doctor immediately:

1. High-grade fever
2. Infections around the surgical site
3. Bleeding from the surgical site
4. Severe pain in your abdomen
5. Loss of appetite
6. Severe diarrhoea