Pre-operative Preparation for a Laparoscopic Cholecystectomy procedure
No special pre-operative preparation is required for this procedure other than the usual restrictions that are required for general anaesthesia. From midnight through to 2 hours prior to the procedure you can drink water only and from then on, until after the procedure you must be nil by mouth. You should take your normal medications as usual with a sip of water unless specifically directed otherwise. All anti-coagulant therapy should have been ceased in accordance with instructions issued by Dr Renaut’s office.
Procedure
The operation to remove the gallbladder using keyhole surgery, otherwise known as a laparoscopic cholecystectomy, is performed with the patient fully anaesthetised. A camera is passed through a 10mm incision just below the umbilicus or tummy button. Three further 5mm incisions allow the passage of ports, through which are passed long instruments that are used to carry out the operation. The abdominal cavity is a potential space for when this is inflated to a pressure of approximately 15mm of mercury, this allows excellent visualization of the abdominal organs. The gallbladder is located beneath the under surface of the liver which is pushed up towards the diaphragm. This allows identification of the gallbladder itself and also the cystic duct and importantly the junction of the cystic duct with the common bile duct. The latter is carefully dissected to confirm the anatomy in particular to ensure that the common bile duct is not inadvertently injured.
Sometimes it is necessary to perform a special x-ray called an intra operative cholangiogram. This involves passing contrast or dye down the common bile duct via a fine tube and then taking an x-ray whilst the patient is anaesthetised. This once again allows confirmation of the anatomy and will often demonstrate stones within the common bile duct on the rare occasions that these exist. If indeed there are some stones within the common bile duct then these will need to be removed and this can be done either at the time of surgery or once the patient has recovered from the surgery via an ERCP.
Once the cystic duct has been fully dissected, together with the associated artery, both structures are clipped and divided. The gallbladder is then dissected from its bed in the liver using heat, otherwise known as diathermy.
Once the gallbladder has been completely detached from the liver it is then extracted via the 10mm port at the umbilicus.
Finally any remaining gas within the abdominal cavity is removed and the wounds are closed with sutures that run beneath the skin and therefore do not need to be removed.
The patient is then transferred to recovery where they will spend an hour or tow before being transferred back to the day surgery unit if the patient is going home the same day or to the ward if they are staying overnight. The decision as to whether the patient goes home the same day is generally made before hand is very much dictated by the patient's independence.
Laparoscopic Cholecystectomy
Post-operative Care following a Laparoscopic Cholecystectomy procedure
Pain
Because your operation has been done laparoscopically the level of discomfort you experience should be less than with an open operation. However it is inevitable that you will experience some discomfort. In particular this will be in the region of the ribs on the right hand side. You will also experience some discomfort associated with the four small incisions - one just below the umbilicus or navel and the three smaller incisions. Long acting local anaesthetic will have been injected into the wounds but after a few hours this effect will wear off. Before it does so it is important to have some pain killers on board and to continue these on a regular basis. You will be sent home with some pain killers - my preference is either Panadeine Forte or Nurofen. I recommend that you take these initially on a regular basis as directed on the packet. After about 48hrs it should be necessary to take these only as required.
Wound Care
The four wounds will each have a dressing. Leave these in place until they fall off. If they haven't fallen off within a week they can be safely removed at this point. It is perfectly safe to allow the dressing to get wet whilst in the shower - simply dab dry with a towel - this also applies to the exposed wound once the dressing have been removed. There will be some dissolving stitches beneath the wounds that do not require removal.
Wound Infection
This is an unusual occurrence but if it does happen it's usually on day 4 or 5. If the wounds become red, painful and swollen please contact Dr Renaut's office or if he is not available your local GP. A short course of antibiotics may be necessary.
Physical activity (including sexual activity)
It is very important to maintain a degree of physical activity following your operation. Please feel free to move around the house and go for short walks starting in the immediate post operative period. The degree of physical activity that is permissible is largely common sense. Too much will simply increase your discomfort level. As a general rule you should slow down if the wounds or the operation site becomes uncomfortable and build up gradually each day. Certainly within a week to 10 days you should e able to pursue normal day to day activities, with the exception of lifting heavy objects - this should be avoided for a period of 4 weeks following the surgery. Resuming sexual activity is once again a matter of common sense - it should be introduced on a gradual basis. Driving can be resumed after 1 week.
Medication
You should resume your normal regime of medication as soon as you are able to eat and drink after the surgery, unless specifically directed otherwise by Dr Renaut or your anaesthetist. As previously mentioned you will be discharged with some pain killers which should initially be taken regularly and then as required. Antibiotics are not normally prescribed by Dr Renaut as the chances of infection associated with this procedure are minimal.
Follow-up
Dr Renaut does not routinely see his patients for a follow-up appointment. In most cases it is not necessary. If however you have concerns about your recovery then he is very happy to discuss these on the phone and he will arrange to see you if he thinks this is necessary. He routinely notifies your GP of all procedures and your progress.