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Gallbladder Removal Surgery

Dr Thng Yongxian

Gallstones Doctor
MBBS • MMed • MRCS (IRE) • FRCSED • FAMS

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Gallbladder removal surgery, or cholecystectomy, is a common procedure to remove the gallbladder. The gallbladder is a small organ located in the upper right part of the abdomen that stores bile, a fluid produced by the liver to aid in digesting fatty foods.

When is Gallbladder Surgery Required?

Gallbladder removal surgery is typically recommended when gallstones or other conditions cause significant symptoms or complications. This includes:

  • Recurrent Gallstone Attacks: Persistent episodes of severe pain caused by gallstones blocking bile ducts.

  • Acute or Chronic Cholecystitis: Inflammation of the gallbladder, either sudden and severe or prolonged.

  • Biliary Colic and Gallstone Pancreatitis: Severe abdominal pain from gallstones, or inflammation of the pancreas caused by gallstones.

  • Gallbladder Polyps Larger Than 1 Cm: These polyps may carry an increased risk of becoming cancerous.

  • Gallbladder Dysfunction (Biliary Dyskinesia): When the gallbladder does not empty bile properly, leading to symptoms without gallstones.

  • Suspicion of Gallbladder Cancer: Surgical removal is often necessary if there is concern for malignancy.

Preparations for Gallbladder Removal

Before undergoing gallbladder removal surgery in Singapore, patients should adhere to the following preparations:

Fasting

Patients should refrain from eating or drinking anything for at least 4 hours before the surgery, but may take small sips of water if needed to consume approved medications.

Not Consume Unprescribed Medication

They should discontinue any medications not prescribed by their doctor, particularly avoiding blood thinners to reduce the risk of bleeding and to facilitate quicker recovery.

Overnight Hospital Stays

Although a cholecystectomy is typically an outpatient procedure, there may be situations where an overnight hospital stay is necessary for monitoring of laparoscopic cases.

Types Of Gallbladder Removal Surgery

Laparoscopic Cholecystectomy

A laparoscopic cholecystectomy is a minimally invasive surgical procedure used to remove the gallbladder. It is preferred over open surgery due to its minimally invasive nature, which typically results in reduced pain, shorter hospital stays, and faster recovery times.

 

Step-by-Step Procedure

  1. Anaesthesia Administration
    The patient is administered general anaesthesia, ensuring they are unconscious and pain-free throughout the procedure.

  2. Incisions Are Made in the Abdomen
    The surgeon makes several small incisions (usually four) in the abdomen. One incision is used for inserting a port that fills the abdomen with carbon dioxide gas. This inflates the abdomen, giving the surgeon more room to work and a better view of the organs.

  3. Inserting the Laparoscope
    A laparoscope, which is a long, thin tube with high-intensity light and a high-resolution camera at the front, is inserted through one of the incisions. The surgeon operates while watching a video monitor that displays the internal view of the abdomen.

  4. Identifying and Dissecting the Gallbladder
    The surgeon identifies the gallbladder, the cystic duct and the artery. These structures must be clearly visualised to safely remove the gallbladder. The surgeon carefully separates the gallbladder from the surrounding liver tissue and clips the cystic duct and artery.

  5. Removing the Gallbladder
    The gallbladder is then removed through one of the abdominal incisions, usually the one at the umbilicus (navel).

  6. Checking for Complications
    Before ending the surgery, the surgeon inspects the abdominal area for any potential bleeding or bile leakage. A drain may be placed if deemed necessary.

  7. Closing the Incisions
    Finally, the incisions are closed with sutures or surgical glue. Sometimes, sterile adhesive strips are also applied.

Open Cholecystectomy

An open cholecystectomy is considered only in the circumstance where a laparoscopic cholecystectomy is unsafe. This procedure involves a single larger incision for direct access to the gallbladder and is performed under general anaesthesia, typically lasting about 1 hour.

Step-by-Step Procedure
  1.  Anaesthesia Administration
    The patient is administered general anaesthesia, ensuring they are unconscious and pain-free throughout the procedure.

  2. Incision Made in the Abdomen
    A single, large incision (about 10-15 cm) is made under the rib cage on the right side of the abdomen, known as a right subcostal incision or Kocher incision. This provides direct access to the gallbladder.

  3. Exposing the Gallbladder
    The abdominal muscles are carefully divided, and the peritoneum is opened. The liver and gallbladder are exposed, with particular attention paid to identifying the gallbladder clearly from surrounding tissues.

  4. Identifying and Dissecting the Gallbladder
    The surgeon locates the cystic duct and the cystic artery, ensuring these are clearly visualised before any dissection proceeds. The gallbladder is carefully dissected from its bed in the liver. Surgical clips are applied to the cystic duct and artery to prevent leakage and bleeding as they are cut.

  5. Removing the Gallbladder
    Once completely detached, the gallbladder is removed through the open incision. The surgical site is checked for any remaining debris to ensure complete removal.

  6. Checking for Complications
    The area is inspected for any potential bleeding from the liver bed or cut vessels. Active bleeding is controlled with sutures or cautery. A drain may be placed in the surgical field to prevent fluid accumulation and facilitate healing.

  7. Closing the Incision
    The incision is closed in layers. The peritoneum and the abdominal muscles are sutured first, followed by the subcutaneous tissue and the skin, which may be closed with sutures or surgical staples. A sterile dressing is applied to the site to prevent infection.

Single-Incision Laparoscopic Surgery (SILS)

A Single-Incision Laparoscopic Surgery (SILS) is an advanced minimally invasive technique for gallbladder removal. This method involves making only one small incision, typically hidden within the navel, to access and remove the gallbladder. It aims to achieve an even more aesthetically pleasing outcome by concealing the surgical scar. Like traditional laparoscopic surgery, SILS is performed under general anaesthesia and typically lasts about 1 hour.

Step-by-Step Procedure
  1. Anaesthesia Administration: The patient is administered general anaesthesia, ensuring they are unconscious and pain-free throughout the procedure.
  2. Single Incision Through The Navel: A single small incision is made, usually within the umbilicus (navel). This entry point allows the surgeon to introduce all necessary instruments and the laparoscope.
  3. Abdominal Inflation and Laparoscope Insertion: Carbon dioxide gas is used to inflate the abdomen, creating space for visualisation. A specialised port, designed for single-incision access, is inserted through the navel, allowing the passage of the laparoscope and surgical tools.
  4. Identifying and Dissecting the Gallbladder: Guided by the laparoscope’s view on a monitor, the surgeon carefully identifies the gallbladder, cystic duct and cystic artery. The gallbladder is then precisely dissected from the liver bed. The cystic duct and artery are secured with clips before division.
  5. Removing the Gallbladder: The detached gallbladder is then retrieved through the single incision in the navel.
  6. Checking for Complications: The surgical area is meticulously inspected for any signs of bleeding or bile leakage before the procedure concludes.
  7. Closing the Incision: The single incision is closed with sutures, and often adhesive strips, designed to make the scar virtually invisible once healed within the navel’s natural fold.

Risks and Complications Of Gallbladder Surgery

While gallbladder surgery in Singapore is generally safe, as with any surgical procedure, there are potential risks and complications. This includes:

  • Bleeding or Infection at Incision Site: Minor bleeding or infection can occur at the surgical wound, which is usually manageable with appropriate care.

  • Bile Duct Injury (Rare But Serious): Though uncommon, damage to the bile ducts during surgery can lead to serious complications requiring further intervention.

  • Injury to Nearby Organs: In rare instances, surrounding organs such as the liver, bowel or blood vessels may be inadvertently injured during the procedure.

  • Post-Cholecystectomy Syndrome (Persistent Symptoms): Some patients may experience continued abdominal pain, indigestion or diarrhoea even after the gallbladder has been removed.

Post Surgical Care and Recovery

Post-surgical care and recovery after gallbladder removal surgery are important for a smooth healing process. Some tips include:

  • Effective Pain Management:


    Managing pain is vital for comfort and recovery. A combination of medications and strategies ensures that post-surgery discomfort is kept at bay, enabling patients to focus on their healing.

  • Nutritional Adjustments:


    The digestive system needs gentle care post-surgery. A diet low in fat and rich in nutrients supports the body’s healing process, with small, frequent meals recommended to ease the digestive tract back into normal function.

  • Gradual Resumption of Activities:


    While rest is important, light physical activity, such as walking, is encouraged to promote circulation and hasten recovery. It’s a balance between not overexerting oneself and staying mobile to avoid complications. Patients can typically return to normal activities in 1 to 2 weeks, with full recovery usually achieved in 3 to 4 weeks.

  • Vigilant Monitoring and Follow-Up:


    Keeping an eye out for signs of complications and attending follow-up appointments with your gallbladder specialist are required. These steps ensure that the recovery is on track and any issues are promptly addressed, paving the way for a smooth return to daily life.
Dr Thng Yongxian

Dr Thng Yongxian

Senior Consultant

HEPATOPANCREATOBILIARY & GENERAL SURGEON

MBBS (SG) • MMed (Surg) • MRCS (Ire) • FRCSEd (Gen) • FAMS (Surg)
Dr Thng Yongxian is a dual fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6,000 surgical procedures. His accreditations include:
  • Bachelor of Medicine & Bachelor of Surgery
  • National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

Dr Thng Yongxian is a dual fellowship-trained hepatopancreatobiliary (HPB) with extensive experience in advanced laparoscopic liver and pancreas surgery. Over his career, he has performed a wide range of procedures, from complex liver resections to minimally invasive pancreatic and gallbladder operations.

 

He first honed his subspecialty expertise in HPB surgery at the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital, before completing a clinical fellowship in minimally invasive HPB laparoscopic surgery at Seoul National University Hospital in South Korea. His surgical experience spans both public institutions such as the National University Health System as well as private hospitals including Mount Elizabeth, Gleneagles, and Mount Alvernia Hospital.

 

Dr Thng has been instrumental in advancing HPB surgery in Singapore, pioneering his hospital’s laparoscopic HPB programme and performing complex liver and pancreas surgeries, including ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy). His surgical techniques have been featured on live national television and presented at international surgical conferences.

Areas of Expertise
  • Advanced Laparoscopic HPB Surgery: Expert in minimally invasive approaches for liver, gallbladder, bile duct, and pancreas conditions, including laparoscopic cholecystectomy, minimally invasive gallbladder surgery, and single-incision gallbladder removal.
  • Gallbladder and Biliary Conditions: Provides comprehensive care for gallstone disease treatment, acute cholecystitis management, chronic cholecystitis care, biliary colic relief, gallbladder polyps treatment, and gallbladder cancer surgery.
  • Complex Surgical Procedures: Experienced in bile duct exploration and advanced surgical techniques in gallbladder removal, focusing on patient safety, precision, and improved postoperative recovery for gallbladder surgery.
  • Surgical Oncology & Trauma Care: Management of HPB cancers and emergency surgical cases requiring coordinated, multidisciplinary expertise.
  • International Training & Collaboration: Completed advanced training at Seoul National University Hospital Bundang, working alongside leading HPB surgeons in minimally invasive techniques.
Professional Appointments
  • Former Clinical Lead, HPB Division, National University Health System (NUHS)
  • Member, Ministry of Health (MOH) Laparoscopic Cholecystectomy Clinician Workgroup for Value-Driven Care (VDC)
CONSULT DR THNG YONGXIAN

How to Prevent Gallstones?

To prevent gallstones and the need for gallbladder removal surgery, you can consider the following preventive measures:

Maintaining a Healthy Diet

  • Avoid foods high in saturated fats like meat pies, sausages, butter, cream, and cakes.
  • Consume plenty of fresh fruits, vegetables, whole grains, and nuts.

Weight Management

  • Control weight through a healthy diet and regular exercise to reduce cholesterol in bile.

  • Avoid rapid weight loss as it can increase the risk of gallstone formation, which will require consultation with an experienced gallstones doctor to rectify.

Avoid Crash Diets

  • Aim for a safe weight loss of 1-2 lbs per week through a balanced diet and exercise regimen.
  • Consider a low-fat diet if you suffer from symptoms related to gallstones.

Frequently Asked Questions About Gallbladder Surgery in Singapore

Will I need a special diet after surgery?
Most patients do not require a strictly special diet after gallbladder removal surgery. Initially, a low-fat diet may be recommended as your body adjusts. Gradual re-introduction of foods is advised, and any dietary concerns can be discussed with your gallbladder doctor or a dietitian.
Yes, it is generally safe to live without a gallbladder. Its function of storing bile is compensated by the liver directly releasing bile into the small intestine. Patients typically experience no long-term adverse effects after successful gallbladder surgery in Singapore.

Related Liver Treatments

Beyond gallstones, several other gallbladder-related conditions may necessitate medical evaluation or treatment, such as:

Corporate and Personal Insurance Plans

Clinic Locations

Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

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