Cholecystectomy

What it is

Removal of the gallbladder, the small sac under the liver that stores bile. The commonest planned abdominal operation, almost always done by keyhole surgery. The liver keeps making bile, which then flows straight into the duodenum.

Why it is done

• Gallstones causing repeated pain (biliary colic)
• Acute cholecystitis (an inflamed, infected gallbladder)
• Gallstone pancreatitis, once recovered, to prevent recurrence
• Gallbladder polyps above 10 mm or a porcelain gallbladder (cancer risk)

Before the procedure

• Ultrasound confirming stones; liver function tests; MRCP or ERCP if stones are suspected in the bile duct
• Fasting; general anaesthetic
• Antibiotics at induction if inflamed

Step by step

1. Four ports: one at the navel for the camera, three under the right ribs
2. The gallbladder is retracted upward to expose Calot's triangle
3. The cystic duct and cystic artery are identified with a 'critical view of safety', clipped and divided
4. The gallbladder is peeled off the liver bed with diathermy and removed in a bag through the navel port
5. An X-ray of the bile duct (cholangiogram) may be done during the operation

Afterwards

• Home the same day or next morning
• Shoulder-tip pain from residual gas for a day or two
• Normal diet resumed; some people notice looser stools after fatty meals

Recovery

Most people return to normal activities within two weeks; heavy lifting avoided for a few weeks.