Gallbladder Removal Surgery

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Dr Thng Yongxian

MBBS

MMed

MRCS (IRE)

FRCSED

FAMS

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What Is Gallbladder Removal Surgery?

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.

Indications for Gallbladder Removal Surgery

Gallbladder removal surgery is recommended for people experiencing gallstone-related complications, such as biliary colic, where stones block the flow of bile, causing severe pain. Symptoms that may indicate the need for gallbladder removal surgery include abdominal pain lasting several hours, nausea, vomiting, fever, chills, jaundice, and other signs of serious infection or inflammation of the gallbladder, liver, or pancreas.

Gallbladder Removal Surgery Preparations

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

Patients should fast – refrain from eating or drinking anything – for at least 4 hours before the surgery. They may take small sips of water if needed to take approved medications.
They should discontinue any medications not prescribed by their doctor, particularly avoiding blood thinners to reduce the risk of bleeding and facilitate quicker recovery.
Although cholecystectomy is typically an outpatient procedure, there may be situations where an overnight hospital stay is necessary for monitoring.

Two Types of Gallbladder Removal Surgery

Gallbladder surgery can be done in one of two ways.

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.

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.

Benefits of Gallbladder Removal Surgery

Gallbladder removal surgery alleviates the pain and discomfort associated with gallstones, improving the quality of life for patients. By removing the gallbladder, the surgery eliminates the risk of further gallstone formation and associated complications, such as biliary colic. Additionally, cholecystectomy can prevent recurrent infections or inflammations, ensuring better gastrointestinal health.

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Post-Surgical Care and Recovery

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

  • 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.
  • Vigilant Monitoring and Follow-Up: Keeping an eye out for signs of complications and attending follow-up appointments 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.

How to Prevent Gallstones?

To prevent gallstones and the need for gallbladder removal surgery, people 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.
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.
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Dr Thng Yongxian

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 6000 surgical procedures.

  • 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

He pursued his subspecialty training in Hepatopancreatobiliary surgery first in the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital. Following this, he completed a clinical fellowship in Minimally Invasive Hepatopancreatobiliary Surgery at Seoul National University Hospital in Bundang, South Korea.

Dr Thng set up and pioneered the Minimally invasive surgery program for his hospital in complex liver and pancreas cases. His surgeries were featured on live national television. His surgical videos have also been presented at international surgical conferences. He also pioneered the use of capsule colonoscopy for colorectal screening.

Dr Thng has served on various committees at hospital, cluster and ministry level. Dr Thng served as a member of the Ministry of Health (MOH) Laparoscopic cholecystectomy Clinician workgroup for value-driven care (VDC).

Patient Reviews

I cannot possibly express how grateful I am for the compassionate care received by Dr Thng during my hospitalization. I was 20 hours away from flying back to the USA after a long work trip, and homesick already when diagnosed with acute appendicitis and a UTI. To say that I was nervous to undergo surgery so far away from home, friends and family is an understatement. He was expedient, attentive and thorough. He even took the time to text and call my husband back home multiple times to update him on my status. His infectious laugh, sense of humor and kindness helped to sooth my own frazzled nerves. I am so appreciative to have had Dr Thng as my surgeon.

Ms Tina Hunter

I was diagnosed for ampullory cancer in 2021. I am very thankful to Dr. Thng Yongxian who kept me calm when revealing the report to me. I really felt like God sent his angel to speak to me.He helped me overcome the operation. Dr. Thng said 3 things that I needed to do before the operation....Stay positive, exercise n eat well, have faith in God. He even gave me his handphone number incase I need to consult him when home. Indeed the 8 hrs operation was a success n I am able to write this testimonial, living a normal life. Finally, its still God who works all things good for those who love Him... Romans 8:28.

Mdm Tang K H

I recently underwent gallbladder stone removal surgery performed by Dr. Thng, and I am impressed with the quality of care I received during this process. Dr. Thng demonstrated exceptional professionalism and expertise throughout my entire experience. From the initial consultation to the post-operative care, Dr. Thng explained the procedure in great details, answered all my questions, and alleviated my concerns and ensuring that I fully understood each step of the process. His compassionate and caring demeanor put me at ease, making me feel confident in his abilities. The outcome of the procedure was beyond my expectations. Dr. Thng successfully removed all my 3 gallstones, and I experienced a smooth recovery process. I am grateful for his expertise and the care I received under his supervision. Overall, my experience with Dr. Thng was exceptional. I highly recommend him for his professionalism, compassion, and outstanding surgical skills. Thank you, Dr. Thng for your excellent care.

Mr Low LT

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    Nexus Surgical @ Mt. Alvernia

    820 Thomson Road, #06-05 ,Singapore 574623

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    Frequently Asked Questions (FAQ)

    What are the risks of gallbladder removal surgery?

    Gallbladder surgery is considered relatively safe with a minimal rate of complications. Risks include those associated with general anaesthesia, the potential for infection, bleeding, and the possibility of damaging adjacent organs, which might require further surgical intervention to repair any injuries.

    What happens after I remove the gallbladder?

    The liver continues to produce bile for digestion, but instead of being stored in the gallbladder, it’s held in the bile ducts before being released into the small intestine when you eat.

    Typically, patients are advised to avoid very greasy foods for the first 2 weeks post-surgery, as the bile in the ducts might not be sufficient to digest a fatty meal. After 2 weeks, the bile ducts adapt, increasing their storage capacity and allowing them to return to a normal diet.

    What happens before surgery?

    Before surgery, you will undergo a preoperative assessment to ensure you are fit for the procedure. This may involve blood tests, discussions about the type of surgery, and advice on lifestyle changes like quitting smoking or losing weight.

    How soon can I return to work after the gallbladder removal surgery?

    The recovery time varies depending on the type of surgery and healing. Most people generally return to work within 1-2 weeks after laparoscopic surgery and 4-6 weeks after open surgery.

    Can gallstones return after the surgery?

    Since the gallbladder is removed during surgery, gallstones cannot form there again. In rare cases, stones can develop in the bile ducts or liver post-surgery, requiring further treatment.

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