Frequently Asked Questions about Gallstones and their Treatments

What does my gallbladder do?
The gallbladder is found lying near to the liver. The liver produces a green fluid known as bile, which breaks down the fat we take in our diet. The bile produced is stored in the gallbladder. When we eat a meal that contains a lot of fat the gallbladder releases some of the bile to digest the fats.

What are gallstones? Why did I get them?
Gallstones are solid 'stones' that form in the gallbladder. In some patients, the bile becomes rather thick and some of its constituents form gravel-like deposits that later clump together to form stone (gallstones). Women are nine times more likely to have gallstones than men, and that reflects the hormonal changes that women get with periods, pills and pregnancies. These hormonal changes alter the composition of the bile and disturbs the balance between its various chemicals, some of which then form sand which later turns into stones. Also losing weight quickly or putting it back on quickly can lead to gallstones forming. In some patients there may be an obscure genetic factor, as gallstones run in some families.

Should I have my gallstones treated?
In the majority of patients (usually women), gallstones cause no symptoms or problems whatsoever, and are only accidentally found on an ultrasound scan of the abdomen or an X-ray that was carried out for another reason. If so, these gallstones do not need any treatment and can be ignored, except perhaps in young patients who are likely to run into trouble from their gallstones over a course of 20-40 years. If the gallstones however cause symptoms such as pain, or complications such as inflammation of the gallbladder (cholecystitis) or pancreas (pancreatitis), or obstruction of the bile duct with yellow discolouration of the skin (jaundice) then removal of the gallbladder by an operation (usually a keyhole operation, called laparoscopic cholecystectomy) becomes necessary otherwise the gallstones almost always cause more problems, some of which are potentially serious.

What is a Laparoscopic Cholecystectomy?
This is removal of the gallbladder by an operative technique that is called laparoscopic surgery, better known as keyhole surgery. The term cholecystectomy simply means removal of the gallbladder. Although we have traditionally removed the gallbladder by an 'open' operation through a fairly big cut in the tummy in the past, we can now remove the gallbladder by a keyhole technique (laparoscopic). This involves making a few (usually 4-5) small incisions (between -1 cm) in your abdomen to remove the gallbladder.

Do I have to have my gallbladder removed?
We know that once the gallstones have caused symptoms, they go on to cause more symptoms or complications in the future. Whilst adhering to a low-fat diet might reduce the frequency of your pain, it does not prevent further attacks of pain and does not guarantee freedom from complications. If you are fit for surgery, there is no doubt that this is the best course of action.

Can the gallstones be removed without the gallbladder?
Although this is technically feasible, leaving the gallbladder (the factory of gallstones) behind can only risk the development of more stones. There is little value in such approach and it is not normally practiced.

Can I live without my gallbladder?
We can live without the gallbladder with no ill effects. The body adapts to the removed gallbladder quite well, and the bile duct gradually dilates to store more bile and take on the function of the removed gallbladder.

Can the gallstones be dissolved?
Whilst there are medications available to dissolve gallstones, their use is quite unpopular for several reasons:
The gallbladder has to be functioning
Stones ought to be of a certain type (cholesterol stones)
Stones ought to be small in size (less than 15 mm)
Medications need to be taken for 2 years

As a result, only a small proportion of patients are suitable for this therapy and many patients drop out of treatment due to side effects. This treatment is therefore only successful in less than a third of patients, and in most the stones recur after discontinuation of treatment. We would only recommend this therapy in patients unfit for surgery.

Laparoscopic Cholecystectomy: Before and After Surgery

What is laparoscopic cholecystectomy?
My operation is planned as a 'day-case', what does that involve?
What can I expect to happen before I come to hospital?
What will happen when I come into hospital?
What will happen when I am discharged home?
What can I eat? Can I drink alcohol?
When can I drive?
When can I return to work?
Who and how do I contact anyone if I need to?

What is a Laparoscopic Cholecystectomy?
You will be having your gallbladder removed by a technique that is called laparoscopic surgery, better known as keyhole surgery.

The term cholecystectomy simply means removal of the gallbladder. Although we have traditionally removed the gallbladder by an 'open' operation through a fairly big cut in the tummy in the past, we can now remove the gallbladder by a keyhole technique (laparoscopic). This involves making a few (usually 4-5) small incisions (between -1 cm) in your abdomen to remove the gallbladder.

Whenever we do keyhole surgery, however, there is a small possibility of having to convert to an open operation if the surgery is difficult for some reason; the likelihood of this however is very small (less than 1 in 100 patients that we operate on for gallstones).

The operation is performed under general anaesthesia, which involves being put fully to sleep by a specialist doctor (anaesthetist).

My operation is planned as a 'day-case', what does that involve?
This means that you will come to hospital in the morning of the operation day, have the operation, and then be allowed home on the evening of the same day. You would have been selected for the day-case surgery based on your medical fitness, distance of your home from the hospital, and social circumstances. The assessment of your suitability to have the operation as a day-case is made at first in the clinic by the doctor who have seen you and advised you on the surgery, and subsequently at a pre-admission clinic (see below) and after you have agreed to it.

What can I expect to happen before I come to hospital?
You will have already seen the consultant and have agreed to the keyhole surgery. You will receive a letter from the hospital asking you to come to the hospital for a few hours where a nurse and a doctor will see you at a pre-admission clinic. At the clinic you will be asked questions about your general health and you will also have some tests and investigations, which may include blood tests, chest X-ray and a heart trace (ECG). These are routine investigations that are required for most patients before a general anaesthetic.

You will also be given details about your admission to hospital. This visit to the hospital will also give you the opportunity to ask any questions about your condition, the operation and the intended future admission into hospital for surgery. You will also be asked to sign a consent form (if not already done so) to give permission to the doctors to carry out the operation on your next hospital admission.

What will happen when I come into hospital?
You will be asked to ring the ward on the morning of your planned admission to hospital to make sure that there is a bed available for you. However, if your admission is scheduled to the Day Surgery Unit, you will be asked to attend the unit at 7:30 am. You ought to have fasted for the operation and have had nothing to eat or drink from the midnight before surgery. You will be admitted by the nursing staff, and the surgeon and anaesthetist will see you before your operation.

After the operation, you will be allowed to drink and have something light to eat. Your consultant will come to see you about four hours after you have returned to the ward.

If the consultant is satisfied with your recovery and if your operation was scheduled as a day-case you will be allowed home that evening provided that you have someone (an adult) to look after you for the first night. As there is always a small possibility that you may need to stay in hospital overnight, say if you are being sick or feeling too sleepy, it is advisable that you bring some nightwear and toiletries with you.

What will happen when I am discharged home?
Because you will have had a general anaesthetic it is vital that you make arrangements prior to coming into hospital for somebody to collect you, preferably by car. If you had a day-case operation, it is also requested that you have somebody to stay with you for at least twenty-four hours.

You will be sent home with some painkiller tablets, which the ward staff will provide you with. You will also be given instructions of when you may take them.

You will have small waterproof dressings on you wounds, which we advise you to try and leave on for five days. You can have a shower or a bath with the dressings on, and simply peal the dressings off after five days. The stitches are on the inside of your wounds and will dissolve on their own, and so do not need to be removed. You may have your wounds closed with special glue, in which case there may be no dressings at all, and you would be able to shower or bath at any time.

What can I eat? Can I drink alcohol?
You may find that you feel a bit sickly for the first day or two after your operation. Again this is normal and is usually due to the effects of the anaesthetic. During this time just take light meals and plenty of fluid, as you are able to tolerate. After that, you may eat and drink as you wish, as there are no dietary restrictions.

There is also no reason why you cannot drink alcohol but this is not advised in the first 48 hours after your surgery.

When can I drive?
We recommend that you do not drive a car for at least one week. It is also advisable that you contact your insurance company to ensure you are covered in the event of an accident.

When can I return to work?
The following time absent from work is recommended according to your job:

Office or Sedentary work: 1-2 weeks, Skilled Work: 2-3 weeks, Manual Work: 3-4 weeks

You will know when you feel ready to return to work. You will be given a sick note to cover the time you have been in hospital but you will then need to get sick notes from your GP to cover any further time you need off work.

Will I need to come back to the hospital for follow up?
After you have left hospital we will send you an appointment to come to the out patients clinic to see one of the members of the surgical team. This is to ensure that you have made a good recovery and will also allow you to ask any questions about concerns or queries you may have. Should everything be satisfactory from your and our point of view you will then be discharged.

Your GP will be fully informed of your progress regarding your hospital admission, surgery and follow up appointment.

Who and how do I contact anyone if I need to?
You will be given a list of the people you should contact anytime if you are concerned about anything following your operation. You may also contact the ward of admission, or your GP for advice. Alternatively, you may call back to the casualty department (A&E) of the hospital.