If gallstones do cause symptoms, the best treatment is surgery to remove the gallbladder(cholecystectomy).
Nowadays, laparoscopic cholecystectomy (see the video) is considered to be the ‘gold standard’ for the treatment of gallstones and is the best method to remove the gallbladder as it causes less pain and requires less days in hospital than open surgery.
If gallstones do not cause symptoms, you and your doctor may need to decide whether to go for surgery or watchfully wait until you have an attack of gallstone pain. Watchful waiting is usually safe and recommended in the elderly, patients with mild pain, patients with no complications (e.g. jaundice) and patients who are at high risk due to other serious comorbidities (e.g. heart failure).
Laparoscopic cholecystectomy is currently one of the most frequently performed procedures in general surgery. The procedure is performed under general anesthesia and usually takes 1-2 hours.
The surgeon inserts a small telescope(laparoscope) through a 1cm incision under the umbilicus. Three(3) more incisions are made in the abdomen. A port(nozzle) is introduced into one of the slits and carbon dioxide is used to insufflate the abdomen in order to visualize the gallbladder easily and create enough working space for the surgeon. Surgical instruments are then placed into the other slits and are used to remove the gallbladder.
In rare cases, the surgeon may need to convert to an open technique if laparoscopy is technically not possible or it jeopardizes the safety of the procedure.
IS LAPAROSCOPIC CHOLECYSTECTOMY A SAFE PROCEDURE?
All surgical procedures carry a risk for complications. General complications regarding general anesthesia, although uncommon, include Deep Venous Thrombosis, pneumonia, post-operative fatigue etc. These are prevented by the use of peri-operative blood thinners, early mobilization of the patient and breathing exercises.
Complications exclusively associated with laparoscopic cholecystectomy are bile leakage, bleeding from the liver bed, fluid collections in the abdomen and bile duct injury. Conversion of a laparoscopic to an open procedure is NOT considered a complication, it just reflects the fact that some gallbladders are very difficult to remove.
Bile duct injury is the most feared and devastating complication of laparoscopic cholecystectomy and has been reported in up to 1-2% of cases from published series throughout the world.
This complication can occur even in the most experienced hands and should be discussed with your surgeon prior to the procedure. In case it happens, referral to a specialist liver (hepatobiliary) surgeon is advised for immediate or delayed reconstruction.