Laparoscopic gallbladder removal in Niš

The gallbladder is a small, pear-shaped organ under the liver, on the right side of the abdomen. It stores bile, a fluid that is made by the liver and helps to digest fats. Laparoscopic gallbladder removal, known medically as laparoscopic cholecystectomy, involves removing the whole gallbladder through several small cuts in the abdomen, usually three to four. The cuts are usually between half a centimetre and one and a half centimetres long, and the cut through which the gallbladder is taken out may be slightly longer when the gallstones are large. A camera (laparoscope) is passed through one cut and sends an enlarged image to a screen, and thin instruments are passed through the others. During the procedure, the abdomen is filled with gas (carbon dioxide) to give the surgeon space and a good view. After the operation, the liver continues to make bile, which then flows through the bile ducts directly into the small intestine. The procedure is part of general and abdominal surgery at Maja Hospital.

The most common reason for the operation is gallstones (cholelithiasis) that cause symptoms, for example attacks of severe pain in the upper right part of the abdomen or below the breastbone. These attacks, known as biliary colic, last from half an hour to several hours and often come on after a large meal or at night. Surgery is also considered for inflammation of the gallbladder (cholecystitis), for gallbladder polyps of a certain size, and when a gallstone has caused inflammation of the pancreas or a blockage of the bile ducts. Gallstones that do not cause symptoms are usually just monitored, except in particular cases assessed by the doctor. Whether surgery is needed and when to have it is assessed by the surgeon on the basis of an examination, an abdominal ultrasound scan and blood tests, and, if needed, an MRI scan of the bile ducts (MRCP). The final decision is made by the patient together with the surgeon. Severe pain in the upper abdomen that does not go away even after several hours, especially with a high temperature, shivering, vomiting or yellowing of the skin and the whites of the eyes, needs an urgent examination, not a booked appointment. In that case, call the emergency medical service on 194 or go to the nearest emergency department.

Laparoscopic surgery is the usual way of removing the gallbladder in most patients. When the operation is technically more demanding, for example when the gallbladder is severely inflamed or there are adhesions (bands of scar tissue) from previous abdominal operations, it usually takes longer. Conventional (open) surgery is done through a longer cut, usually below the ribs on the right side, when the laparoscopic approach is not possible or not safe. In a small number of cases, the surgeon decides during a laparoscopic operation that it is safer to complete the procedure as open surgery, a possibility that is discussed before the operation. When needed, the bile ducts are X-rayed with contrast during the procedure (intraoperative cholangiography). When a gallstone has moved from the gallbladder into the main bile duct, it is usually removed endoscopically, using a thin instrument with a camera that is passed through the mouth (ERCP), before or after the operation, and less often surgically, during the operation itself. The Maja Hospital price list includes laparoscopic, complex laparoscopic and open (conventional) gallbladder surgery, as well as gallbladder surgery with a procedure on the bile ducts, when a stone is removed from the main bile duct during the operation or a new connection is made between the bile duct and the intestine. X-ray imaging of the bile ducts during the operation and the consultation with the surgeon are listed as separate items in the general surgery price list. After the consultation, the surgeon explains which price list item applies to the planned operation.

Arrive at the hospital at the agreed time, having had nothing to eat or drink as instructed, and bring all your test results and medical records. On admission, your results are checked and you talk to the anaesthetist about the anaesthetic, any previous illnesses and the medicines you take. After the procedure and its possible risks have been explained to you, you sign a consent form for the operation. A thin plastic tube (cannula) is then placed in a vein in your arm, and fluids and medicines are given through it. The operation is done under general anaesthetic, so you are asleep throughout the procedure. After you wake up, your blood pressure, pulse, breathing and pain are monitored. Usually on the same day, when the doctor allows, you get up for the first time with help from the staff and have something to drink. You go home when the surgeon judges that you are recovering well, usually on the first or second day after the operation, with a discharge summary, written instructions and a follow-up appointment. You need someone to accompany you home, as driving yourself is not recommended for the first few days after the operation.

Laparoscopic gallbladder removal is a common and well-known procedure, but like any operation it carries certain risks. Bleeding, wound infection, bile leakage, a hernia where a cut was made or a reaction to the anaesthetic may occur. Less often, injury to the bile ducts or the intestine, or blood clots, may occur. Sometimes a stone is left behind in the main bile duct after the operation, and it is then usually removed endoscopically. In some patients, symptoms similar to those before the operation, such as pain or bloating, may continue afterwards. This is why the surgeon assesses before the operation whether the symptoms really are caused by the gallbladder. At the consultation, the surgeon explains the risks in relation to your health and what is done to reduce them.