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LAPAROSCOPIC CHOLECYSTECTOMY

Many patients have gallstones which do not cause symptoms and require no surgery. If, however, these stones attempt to pass out of the gallbladder and block the gallbladder outlet, severe upper abdominal pain can develop.

Common symptoms may include:

  • Upper abdominal pain, occurring after meals rich in fat.
  • Nausea and vomiting.
  • Pain between the shoulder blades, and beneath the right shoulder.
  • Chills and fever.
  • Symptoms usually last for short periods of time and often occurs after fatty meals which stimulate the gallbladder to contract.

Causes

The formation of gallstones seems to be related to many factors, some of which are:

  • Body weight – over-weight people have a higher incidence of gallstones.
  • Diet – a diet high in fat and cholesterol, and low in fibre.
  • Gallbladder motility – if the gall bladder is slow to drain.
  • Rapid weight loss – bariatric surgery patients experience higher incidences of gallstones.

Acute Cholecistitis

Occasionally, these stones may become lodged within the neck of the gallbladder and result in prolonged episodes of pain associated with infection. This is known as acute cholesystitis and generally requires admission to hospital and cholecystectomy.

Obstructive Jaundice

Another complication of gallstones may be obstructive jaundice. In this situation, the gallstones pass out of the gallbladder and into the bile duct where they block the bile duct exit; that is, the gallstones prevent the flow of bile secretions into the duodenum. Jaundice is first recognised in the eyes, but acute jaundice results in a yellow tinge onto the skin. This may result in cholangitis, a progressive form of jaundice and infections. This needs to be treated immediately. Once a person has had one attack of gallstones, they are likely to develop more. It is thus wise to remove the gallbladder between attacks, since surgery is simpler when there is no acute infection or obstruction.

Treatment

A small hole (port) is created, in the belly button, followed by the insertion of a thin scope with a camera at its end to allow visualisation within the abdominal cavity.  A second port is placed just under the breast bone, sternum, in the mid line of the abdomen, while third and fourth ports are placed in the right side of the abdomen.  (These allow for removal of the gallbladder later in the procedure.).

The gallbladder is then freed of any scar tissue which may be present from previous episodes of acute cholecystitis. The cystic duct (the duct that joins the gallbladder to the bile duct) is then identified. Also identified is the cystic artery, a small blood vessel leading to the gallbladder.

The cystic duct is divided after sealing it with metallic clips. The cystic artery is then clipped and divided and the gallbladder is separated from the bed of the liver with a cautery device or laser. The gallbladder is then removed through one of the small incision ports. Finally, the ports are closed.

Patients are able to eat immediately after waking from a lap chole procedure and are usually discharged home that same day or the next. Most patients return to normal activities within one to two weeks of their surgery.

Complications

Laparoscopic cholecystectomy has a complication rate of under two percent. It is a well-documented and frequently-performed procedure. Most patients recover and resume normal activities quickly. Rarely does the surgery impact adjacent organs in the body. When this occurs, a second procedure may be required.

GENERAL CONTACT INFORMATION:

Tel: +27(0)12 993 1160 Fax: +27 (0)12 993 3986
Address: Suite M27, Second Floor, Netcare Pretoria East Hospital, Cnr Garsfontein & Netcare Roads, Moreleta Park, Pretoria

Appointments & Information

Lynette van der Merwe

Tel: +27(0)12 993 1160
Fax: 012 993 3986

Appointments & Information

Amanda Jooste

Tel: +27(0)12 993 1160
Fax: 012 993 3986

Accounts & Practice Manager

Dalene van Zyl

Tel: +27(0)12 993 3121
Fax: 012 993 3986

Medical Nurse

Lena Meintjies

Tel: +27(0)12 993 1160
Fax: 012 993 3986