Keyhole surgery to remove the gall bladder

In this procedure the gall bladder is taken out using the laparoscope as the tool, whereas conventional surgery requires a laparotomy (cutting the abdominal wall to get inside). The laparoscope has become a sophisticated surgical instrument and it relies on gaining access inside the abdomen via thin 5mm and 10mm tubes (trocars). Vision is provided by a high definition high resolution camera system that magnifies the image 30 times and relays it on to a monitor.

The surgeon uses slender instruments and carries out the operation while watching the monitor. 
The gall bladder is removed through one of the 10mm incisions.

Laparoscopic choly can be done through multiple incisions and three to four incisions for three to four instruments or through a single incision at the navel where three instruments are inserted from this limited incision. This is more cosmetic and relatively less painful.

The commonest reason for taking out the gall bladder is taking out the gall stones. These stones may form when there is a nidus (nest or breeding place) for deposition of crystals within the gall bladder, for example after typhoid in which the gall bladder becomes inflamed. Stones are basically formed from crystalline constituents of bile which is formed in the liver and is stored in the gall bladder to be squeezed out into the gut for digestion of fat. 
When the proportion of crystals in the bile increases, they precipitate. Such bile is known as lithogenic bile (stone-forming bile). Stone formation is increased during pregnancy in which hormones make the gall bladder sluggish and the bile stagnates, giving rise to stones.

The usual and mild symptoms of gall stones are indigestion, heaviness in the upper abdomen, especially after a meal, bloatedness. When a stone get stuck in the duct of the gall bladder on its way out, pain is experienced and it can be severe. The pain is experienced in the upper abdomen and it tends to move along the rib cage to the back, most times on the right side.

If the stone gets dislodged and falls back into the gall bladder, the pain abates. If it stays stuck, the gall bladder cannot empty itself of bile then it swells up and the retained bile can turn into pus. This is more pronounced in people with diabetes.

If the stones escapes the gall bladder, it goes into the bile duct where its blockage can cause jaundice and pancreatitis (swelling of the pancreas). Pancreatitis by itself can be mild or severe and life-threatening. 
A laparoscopic cholecystectomy procedure is carried out under general anesthesia. The interesting thing about this procedure is that the wounding remains the same whether a patient is thin or obese as opposed to open surgery in which the size of the wound varies with the girth of the abdomen

In addition, the pain is tolerable enough that the patient goes home in less than 24 hours after the procedure./p>

Mumtaz Maher 2
Dr Mumtaz Maher
Chief of Surgery,
Bariatric (Obesity) Surgeon

Monday, Wednesday, Friday

4pm to 6pm


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