Cholecystectomy (Laparoscopic/Open)

Introduction
The gallbladder is a sac connected to the bile ducts, responsible for concentrating and storing bile used for fat digestion.
Gallstones and acute cholecystitis are common conditions. If a patient exhibits symptoms of gallbladder disease, such as biliary colic, cholecystitis, or acute gallstone pancreatitis, doctors will recommend the removal of the gallbladder and any gallstones within it (cholecystectomy). The removal of the gallbladder does not severely impact normal digestive function.
Symptoms of gallbladder disease include indigestion, nausea, and upper abdominal pain. In cases of infection such as acute cholecystitis, you may also experience severe pain and fever.

Surgical procedure

1. The surgery requires a general anaesthetic.
2. The procedure can be performed by laparoscopic cholecystectomy or open cholecystectomy.

Laparoscopic cholecystectomy

Three to four small incisions of 0.5 to 1 cm are made through the abdominal wall, and carbon dioxide is inflated to create a surgical space, using a camera to observe the internal organs within the abdominal cavity.
The success rate ranges from 60 to 90%. The failure rate is higher in patients with acute cholecystitis and gallbladder contractions.
If the situation is difficult, the procedure may be converted to an open cholecystectomy as required (10% – 40%)

Open cholecystectomy

1. A transverse or vertical incision in the upper abdomen
2. Once the cystic duct and artery are properly ligated, the gallbladder is removed.
3. If common bile duct stones are found during surgery, the necessary procedures must be carried out accordingly.
4. If necessary, drain the accumulated fluid with abdominal drainage.
5. Suturing a wound

Surgical risk

1. Complications involving anaesthesia:
2. Cardiovascular complications: myocardial infarction or ischaemic heart disease, stroke, deep vein thrombosis, pulmonary embolism, etc.
3. Respiratory tract complications: atelectasis, pneumonia, asthma attack, chronic bronchitis
4. Allergic reactions and shock
5. Complications involved in the surgical procedure (not an exhaustive list of all possible complications):

General complications involved in surgical procedures:

1. Wound infection (5%)
2. Cholecystectomy Syndrome (30%)

Rare but serious complications:

1. Bile duct injury (0.1–11 TP3T), including bile leakage
2. The incidence of bile duct injury during laparoscopic cholecystectomy is relatively high (0.5–11 TP3T)
3. Complications associated with laparoscopic surgery
   For example, intestinal perforation and vascular injury (< 0.1%)
4. Postoperative intraperitoneal haemorrhage
   For example, slipping of a cystic duct ligation
5. Residual bile duct stones
6. Incisional hernia
7. Adhesive intestinal obstruction
8. Death (0.1 – 1%)

Pre-operative preparation

1. Depending on the circumstances, the surgery may be classified as elective or emergency surgery. For example, acute cholecystitis requires emergency surgery.
2. If a cholecystectomy is performed on a voluntary basis, admission can be arranged for the day before or the day of the surgery.
3. Pre-operative anaesthetic assessment
4. Fasting 6 to 8 hours before surgery
5. Change into hospital scrubs before entering the operating room.
6. A urinary catheter may be required, otherwise the bladder must be emptied before surgery.
7. Pre-medication and intravenous infusion may be required.
8. Antibiotics may need to be taken or administered beforehand.
9. Inform your doctor about any drug sensitivities, regular medications, or other medical conditions you have.

Post-operative instructions
Generally speaking, after surgery

1. Slight discomfort or pain in the throat may occur due to intubation.
2. You may feel slight discomfort or pain in your abdomen, shoulders or neck due to the insufflation. If the pain is severe, please inform the nurse or doctor.
3. Nausea or vomiting may occur; please inform the nurse if the condition is severe.
4. Please inform the nurse if you require further painkillers.
5. You may get out of bed and move around 6 hours after surgery if there is no intravenous drip or abdominal drain.
6. If a cholecystectomy is performed electively, you can usually be discharged on the same day or 1 to 2 days after the operation.

Wound cuisine

1. A percutaneous abdominal drainage tube may be required to drain infected fluid.
   Usually removed after 2-5 days, depending on the amount of drainage.
2. On the first day after surgery, patients can shower but must be careful (keeping the wound dressing dry).
3. Approximately 7 to 10 days for suture removal or wallet removal (if applicable)

Food and drink

1. Initially, you may need to refrain from eating and drinking.
2. The next day, you can gradually resume eating as per the doctor's instructions.
3. It is recommended to eat liquid and fibre-rich foods.

Things to note after discharge
If any of the following situations occur, you should contact your doctor or go to the emergency department.

1. Increased pain or redness and swelling at the wound site
2. Wound exudate
3. Worsening abdominal pain
4. Fever, chills
5. Jaundice
6. If necessary, take the painkillers prescribed by your doctor.
7. Difficulty digesting fat and mild diarrhoea may occur within 6 months of surgery.
8. Gradual return to normal activities (depending on individual circumstances)
9. Avoid lifting heavy objects for the first 4 weeks.
10. Avoid excessive bending and stretching of the body for the first 4 weeks.
11. Please remember to return to the clinic to have your stitches/staples removed on the scheduled date. Please attend your follow-up appointment at the specialist clinic on time.

Notes
This leaflet provides only basic information about the surgery, and not all possible risks or complications can be listed. The risk level also varies for different types of patients. Please contact your doctor if you have any questions.

Source: https://www.ekg.org.hk/pilic/public/surgery_pilic/surgery_laparoscopicopencholecystectomy_0152_chi.pdf