Gall stones are very common in the population and up to 30% of the population can actually
have them.
However, you only need to have your gallbladder removed if develop symptoms and complications
from these gall stones.
These symptoms include pain in the abdomen particularly after eating a fatty diet and
this pain can spread to the back and to the shoulder blades.
Complications from these gall stones also include infections of the gall by the wall
itself in which the wall of the gallbladder becomes inflamed and in severe situations
can perforate, leading to fluid accumulating around the gallbladder.
These gall stones can also travel and get stuck in the ducts from the gallbladder causing
obstructive jaundice, in which the skin becomes yellow and your stool becomes pale and urine
becomes dark.
Also more seriously, these stones can then become stuck in a duct of the pancreas leading
the pancreatitis; which is inflammation of the pancreas in the abdomen which is a serious
condition and has a certain amount of mortality associated with it.
All in all, about 3% of people with these gall stones develop these side effects and
complications.
Nowadays the vast majority of gallbladder operations are performed laparoscopically
or via keyhole techniques.
This is when we use small instruments and cameras which enter the abdomen by small incisions.
This means that the patient experiences less pain and the surgeon gets a better view of
the surgical field.
This is important to avoid cutting of the incorrect structures.
When perform laparoscopic surgery, there is a risk that we can cause damage to internal
organs such as the bowel or blood vessels which we can generally fix via the keyhole
technique, but in certain circumstances we may have to make a big incision.
In particular, when we take out the gallbladder, we must cut the duct that is attached to and
there are many ducts in that area which if we cut becomes a serious complication.
The risk of that occurring is approximately 1 in 300.
If we cannot fix that duct damage there and then, we would have to send the patient to
a specialist unit to have that repaired which would be major surgery.
If there's been some doubt as to whether not these gall stones are symptomatic or if there
are coexisting bowel problems, then the most common side effect would be continuation of
the same symptoms as before surgery.
However, up to 30% of people can develop diarrhoea following gallbladder surgery.
This is because the gall bladder acts as a store for bile which has been secreted by
the liver and it's important in fat digestion.
Once a gallbladder is removed, instead of the bowel being secreted in response to fatty
foods, the bile is being continuously created in a drip like function into the bowel itself.
Well, most people will recover from this, but I would suggest that everyone needs to
reduce the amount of fat in their diet to about 40 grams per day.
For example, one egg contains about four grams of fat.
They can then aim to go back to normal diet within a month after surgery or as their diarrhea
resolves.
In very small numbers of patients, they may require continual medication for their diarrhea.
If there have been no side effects from the surgery, then there's no need to make a permanent
change to your diet and I've been asked many times, but no, they can drink alcohol.
There is no reason why you can't drink alcohol, but of course if you're on pain medication
following surgery, you need to avoid this.
Most patients after gallbladder operation can return to work after one week.
Because we perform this via laparoscopic techniques, we want to reduce the risk of hernias forming
in the incisions of the abdomen and therefore, I always tell all my patients to avoid heavy
physical labour for at least two weeks.
In terms of driving, they can practise doing emergency stop in the car while it's stationary,
and if they can do this, then they can start driving.