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Gallbladder stone surgery: Know what happens before, during and after surgery

Gallbladder stone surgery is a very commonly done surgery. Except in rare circumstances, it is done by the laparoscopic method, means by a minimally invasive method. As a doctor, I understand that however common or routine a surgery is, anybody who is about to undergo the surgery always have their apprehensions. And I have learned from my patients, that knowing exactly what and how things are going to progress, surely deceases this anxiety. Hence this exercise is to let the patients awaiting surgery, walk through the whole process form the surgeon's view.

Preparations prior to admission

Once a decision is made regarding your Gallbladder stone surgery, its date and time, the surgical team contacts the Operation Theatre in charge to fix the timing of surgery. The OT in charge also updates the anaesthetist doctor regarding the date and time of surgery. The surgeon will also give a call to the anaesthetist to discuss what surgery is planned, what is expected during the surgery. The anaesthetist would like to know at this stage whether the patient is having any medication condition, which would need further investigation or optimisation with medicatiosn prior to surgery. In a situation where such is the case, your surgeon will advise you to do so and that may need to delay the surgery if needed.

The OT in charge will make sure that the instruments are properly sterilized prior to your surgery, all the devices are working properly and all the materials needed for surgery are available in the OT during the surgery.

What happens when you get admitted

Once you get admitted, the doctor on duty will check all your investigations and your surgeon’s instructions. The doctor will also ensure that you have not had food and water since 6 hours prior to the scheduled time of surgery. Then he/she will call your surgeon and update him regarding your admission and all your prior investigations. You surgeon will also be updated regarding your current temperature, pulse, blood pressure, sugars. With advice from your surgeon, the on-duty doctors will get the remaining investigations like ECG, blood test and X-ray.

The anaesthetist doctor will also be updated regarding your admission, your prior and recent investigation reports. Preparation of your surgery site is done by shaving the necessary part. Your consent for surgery will be taken at this time. While doing all this, the doctor on duty will try to calm down the nerves of the patient and their dear ones. Everyone in the hospital is aware of your anxiety prior to surgery.

What happens in the operation theater before you are given anesthesia

In the recovery room

You shall be shifted to the OT recovery room about 10-15 minutes prior to the time fo surgery. Again the nursing staff will recheck all your investigations. They will reconfirm that all the preparations are done properly. You surgeon or anaesthetist or both will come and meet you, mainly with the intent to calm you down. You will be asked to go to the washroom to pass urine prior to finally shifting you to the operation theatre. 

Inside the operation theatre

When you enter the theatre, you will be able to see a couple of OT staff getting all the instruments and the gadgets ready. You will be made to lie down on the OT table. An intravenous line or an IV line will be taken in your hands to administer medications. Also, ECG leads, blood pressure cuff and a pulse-oxygen sensor will be applied. They will monitor your pulse, BP, oxygen levels, and heart activity throughout your surgery. Again the anaesthetist doctor, OT staff, and the surgeon will be talking to you during this whole process so that all this doesn’t seem scary.

Once these preparations are done, the anaesthetist will place a mask on your face and ask you to breathe through it. Anaesthetic gases are coming from this mask and will make you a bit sleepy. Further medications are given through your IV line to put completely to sleep. When you go to deep sleep the anaesthetist will place a tube into your windpipe through your mouth. This tube and a ventilator machine will make you breathe during the entire surgery. The anaesthetist controls the depth of your sleep, your breathing, and keeps a vigil eye on the monitor. The monitor shows your pulse, BP, oxygen levels, and heart activity. So now is your time to relax and sleep. He will gradually bring you back to the conscious state once the surgery is over.

 

Know the team that performs your surgery

Your surgery is not performed just by your surgeon. There is a whole team at work during the surgery. Any surgery, even when they are routinely done is a complex set of multiple tasks done by many people in the team. Minimal post-surgery pain and fast recovery may make this process simple, but actually, it is not so.     

There are 6-7 people in the OT during the surgery actively working to make it a success. This includes an anaesthetist and a support staff with him for the anaesthesia part.

About four people including the surgeon perform the surgery. The surgeon is accompanied by a camera person, an assistant, and a trolly staff. The camera person is in charge of the camera and guides the vision of the surgeon during the entire surgery. The assistant helps the surgeon during the surgery as and when needed, mainly to help make the working space. The trolly person helps in the exchange of instruments and getting the necessary material on the trolly as needed during the surgery. 

Apart from this, there is a runner staff as a stand-by, in case something is needed unexpectedly during the surgery. Good and coordinated teamwork is needed to give you the desired results. 

How will your gallbladder stone surgery progress

Anesthesia and preparation for surgery

Once you are completely put to sleep and the anesthetist doctor says all in control, the surgical team starts their action.

At first, they start preparing the part where the surgery is to be done, that is your tummy. It is made germ free by applying betadine solution methodically. This is called “painting”, that is painting the part with betadine. Then whole your body except your tummy is covered with sterile drapes. This is called “draping”, that is separating the germ-free part of surgery from the rest of the body with sterile drapes (germ-free cotton sheets).

Then, the team prepares all the gadgets. This includes the laparoscopic system and the energy source. The laparoscopic system includes the camera, a laparoscope, a light source cable, and an insufflating tube to fill Co2 gas in your tummy. All this is pre-sterilized by a special method called ETO sterilization. The energy source is the device that will help in doing the surgery in a bloodless manner. 

Gas insufflation of tummy, local anaesthetic injection, and port placement

Once all the setup is ready, the surgeon will inject a small amount of local anaesthetic solution at the place where the first cut is to be made. This will help the surgeon in keeping you pain-free once you are awake after surgery. Then a small cut is made around your navel and a special needle is inserted in your tummy through this cut. After confirming that it is in the proper place the insufflating tube is attached to this needle and CO2 gas insufflation is started. Once adequate gas in filled in your tummy to create space, the needle is removed and the first port is inserted into your tummy through the same cut. This port is a hollow metal tube, through which the laparoscope and instrument can go inside your tummy. Gas is also continuously filled to maintain the space throughout the surgery. 

Now is the time to insert the laparoscope inside your tummy, and the live images are seen on the monitor in front of the surgical team. The surgeon now inspects the inside of your tummy before proceeding with the surgery. Once that is done, three more ports are placed after injecting the anaesthetic solution before giving cuts. These three new ports are placed under the laparoscopic vision. Means, when they are placed the surgeon can exactly see them coming inside the tummy through a laparoscope. Hence the surgeon can place them exactly at the site where needed in your case.

Actual surgery 

Now the actual surgery starts. The camera person shows the exact area of surgery with a clear focus. The assistant inserts one instrument through one of the ports and holds the fundus (top part) of the gallbladder and pushes it towards your right shoulder. Now your surgeon has clear access and vision to the area of surgery. He then focuses the attention on the duct connecting the gallbladder to the main bile duct. He cuts the thing tissue over this duct with the help of an energy device. By doing this he clearly identifies this connecting duct called the cystic duct, which is the short and thin tube connecting the gallbladder and main bile duct. He also identifies a small blood vessel supplying blood to the gallbladder.

The surgeon then applies multiple clips on both and cuts them. Thus the Gallbladder is separated from the main duct. Now the gallbladder is separated from the liver using the energy device in a bloodless manner. Once this is completed, the gallbladder with its stones is ready to be removed from your tummy. You can watch a short clip of surgery by clicking here.

Removal of Gallbladder and completion

The gallbladder is then removed from the tummy through one of the ports. Many times a small plastic bag called an endo bag is used to remove it. The bag is used if they are changes in the spillage of stones while removing the gallbladder. 

The surgeon will finally inspect the whole area of surgery. This is to recheck that the lips are in place and there is nor bleeding which needs to be controlled before concluding the surgery. Now all the instruments and ports are removed under laparoscopic vision. The gas is emptied out of the tummy. The muscles of the tummy wall at the site of 10 mm ports (the larger ports) are closed with one stitch. This stitch is self-dissolving and will dissolve after a few months. the 5 mm ports do not need such stitch around the muscles. The skin cuts are then closed with glue and covered with bandages. Now you are ready to be awakened.

Watch this short video of the surgery to understand it better.

 

What happens once the surgery is over

Once the surgery is done, the anaesthetic doctor will change the medications such that you will start to awake. Once he is sure you are awake enough to breathe yourself and gulp the saliva, he will remove the tube from your windpipe. He will make sure you are comfortable, pain-free, and breathing well. Once he is convinced about your wellbeing, we will shift you to a shifting bed. You are then taken to the recovery room on this bed itself. 

In the recovery room, your pulse, BP, and oxygen will be monitored for about 10 minutes. This is the time when you would be still very sleepy. Hence, one staff will be there to comfort you and monitor your condition. The surgeon and anaesthetist will also visit you to make sure you are doing well. They will also talk to the relatives and update them about your condition and will allow them to meet you. All this is done to relieve you and your relatives from the anxiety of surgery.

What happens once you are back to the room

Recovery: Initial few hours

Once you are reasonably awake you would be shifter back to your room. You would be allowed to rest for a couple of hours. On duty, the doctor will be there in case you need any help. After 2 hours, the staff will check your pulse, BP, and oxygen levels. And once they make sure you are well awake, you would be advised to sit. Gradually, as you feel comfortable water and then other liquids will be started orally. You would be advised to get out of bed, walk a few steps in the room under the observation of staff. At his point in time, all the IV drip and medications are stopped. 

Once all this goes well, you would be advised to go to the washroom and pass urine. Initially, there may be a little bit of pain, but that reduces once you start moving around. In case the pain is more, further medications will be given by the doctor after a telephonic talk with your surgeon. All the medications are given orally once liquids are started and you do not have vomiting. Even if all is well, your progress will be updated to your surgeon by the on-duty doctor.

Further recovery and discharge

After about 4-5 hours of surgery, once you have tolerated liquids, a soft diet will be started. The surgeon also will make a visit to ensure all is processing well. Any of your apprehensions about going home will be addressed by him during this visit. You can have a shower the next morning, as the bandages are wash-proof.

Ready for discharge

Once you are relatively pain-free, tolerating liquids and food, have passed urine, you are ready for discharge. The discharge can be done on the same day for young patients with no other medical problems and coming from the same city. For all the rest, discharge is generally done the next day of surgery.

Follow up visit at the clinic after Gallbladder stone surgery

You will be called for a follow-up visit in a couple of days after discharge. The main aim is to ensure that you are doing well and check your wounds. The surgeon will check your wounds, clean it, and reapply the bandages. He will discuss regarding your diet and resuming of activities after surgery. Any other questions of yours would be answered at this time. 

 Generally, you can resume a normal diet after a couple of days. A normal healthy diet is what you need. Unless your diet needs to be changed due to any other medical condition. The bandages are now to be removed by yourself, at home while bathing after 5 days. If for any specific reason, your wounds need to be rechecked, then your surgeon would specify.

You also need to collect your biopsy report from the hospital. Generally, it will be available in 5-7 days post-surgery. The next visit would be a month later, just to make sure you are doing well. In between if you any issues you can schedule an appointment as per need.

ADROIT Centre for Digestive and Obesity surgery is performing all kinds of the gallbladder and other advanced laparoscopic surgery routinely. Our outcomes are par with international standards and our patient satisfaction level is great. This the reason why Dr Chirag Thakkar is rated amongst the best doctors for gallbladder stone treatment by our patients. Click the below links to listen to our patient’s feedback.

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