Dr. Lee Ser Yee, Senior Consultant Hepatopancreatobiliary Surgeon at Surgical Associates based in Mount Elizabeth Hospital explains what gallstones are, who is at risk of gallbladder disease and how to prevent it.
When Is It Needed?
Surgery is not necessary for individuals who do not have symptoms. In these cases, risks
that come with surgery, albeit low, pose a greater concern than the risk of developing
symptoms and complications from the gallstones. However, gallstones that cause abdominal
pain and other symptoms and/or complications in the past need to be surgically addressed.
It is important to highlight that occasionally, the first realisation of having gallstones is a gallstone-related complication occurring such as acute cholecystitis, jaundice or pancreatitis.
Gallbladder removal surgery is the ideal treatment for symptomatic gallstones. Surgery to remove just the gallstones and leave the gallbladder intact is not usually recommended as it does not effectively treat the diseased gallbladder and makes it more likely for gallstones to come back. Moreover, removal of the gallstones alone without the gallbladder is a riskier procedure.
Two Types of Surgery to Remove the Gallbladder
Gallbladder surgery in Singapore can be done in one of two ways:
- A “keyhole” removal of the gallbladder is the procedure of choice. It is performed under general anaesthesia through 3-4 small cuts (0.5 -1cm incisions) in the abdomen. The gallbladder is detached from the liver and clips are applied to the artery that supplies the gallbladder and the duct that drains from it. The gallbladder is then removed in a bag through one of the incisions. Some of the benefits of this minimally invasive surgery are lesser pain, faster recovery as well as a shorter hospital stay with minimal downtime.
- This is a procedure where the gallbladder is removed through a longer incision (10-15cm) on the abdomen. This incision is usually oblique and placed below the ribs on the right side. This may be considered if the minimally invasive approaches are deemed unsuitable.
Who Needs to Have Gallbladder Removal?
People who frequently experience recurrent or substantial abdominal pain or discomfort or previous complications due to gallstones are usually the ones who will benefit from gallbladder removal.
How Should I Prepare for Gallbladder Removal?
Some preparations that patients need to do prior to a gallbladder removal surgery include:
At least 4 hours before the surgery, patients must not consume any food or water. They can only have sips of water if they are taking approved medications.
Stop medications that are not prescribed by doctors as advised. Avoid blood-thinning medications such as, Aspirin, Plavix, as this can increase risk of bleeding and impede fast recovery.
While a cholecystectomy is commonly a day surgery, there are instances when the patient may be asked to stay overnight for observation.
What to Expect
Patients who opt for gallstone removal in Singapore can expect the following:
Before the Procedure
Before surgery, anaesthesia will be given intravenously so that patients will not be conscious throughout the procedure. A tube is also inserted into the throat to facilitate breathing.
During the Procedure
Depending on the patient’s health and preference, as well as the doctor’s recommendation, cholecystectomy may be done laparoscopically (keyhole) or open surgery.
After the Gallstone Surgery
Most patients go home on the same day or the day after the surgery. If the gallstones surgery was performed with an open procedure (larger cut), the patient may have to stay a little longer. Some pain, nausea and vomiting may occur but most are well-controlled by medications.
Once discharged, most patients can perform light duties and most activities of daily living. Most of the patients can return to work within a week or less after the surgery, after a follow-up review with the surgeon. A minority of patients may still feel some bloating and some may have loose stools after the surgery as the body gets used to the absence of the gallbladder. Most symptoms will usually resolve within a couple of weeks.
What Are the Risks of Gallstones Surgery?
This is generally a safe operation with very low complication rates. The risks of gallstones
surgery include risks related to general anaesthesia, infection, bleeding and injury to nearby
organs, some of which may require repair of the injury. Hernia may form at the incision sites,
especially in obese patients that may require repair in the future (<1%). Occasionally (< 3%),
stones may drop into the bile duct during the surgery or it may be undiagnosed before the
surgery, these may require subsequent procedures (e.g., ERCP) to treat if necessary.
In the event of conversion of the laparoscopic approach to an open procedure, the risks will remain the same as above with similar good outcomes. However, post-operative recovery and hospital stay may be slightly longer.
Results and Recovery
Patients are able to go back to their normal lives and diet after having a gallbladder
surgery, rarely, but they may experience some differences in how they process fatty/oily
foods. This includes experiencing symptoms such as loose stools, bloating, and cramping.
This usually resolves in a couple of weeks with some simple diet modifications. The vast
majority of patients have a better or normal digestive habits after surgery.
Patients who have undergone laparoscopic cholecystectomy can go back to their regular routines a week or less after surgery, while those who had an open procedure may take a few more weeks to make a full recovery.