Prior to Surgery
Gallstones are often detected on routine abdominal x-rays, computerized axial tomography (CT) scan, or abdominal ultrasound that are done for other medical illnesses. Prior to surgery there are tests that will be necessary in order for the surgeon to determine several things about your health including your gallbladder, it's function, and the presence and location of any gallstones. Tests that may be necessary include:
- Abdominal Ultrasound
- HIDA Scan
- Chest x-ray
Abdominal Ultrasound is the most common test for a person with the symptoms of gallstones. Sound waves are sent through your body in the region of the gallbladder. If gallstones are present they can be detected by sound waves bouncing off them, revealing their location. Also, information about the ducts or tubes that carry the bile can be obtained by the ultrasound. There are many advantages to ultrasound. It is a non-invasive, pain-free procedure. There are no known side effects, and it does not involve any radiation. An ultrasound is done on an outpatient basis. It requires that you not eat or drink anything for 8 hours prior to the test.
HIDA Scan is a study designed to determine how well the gallbladder empties. It involves having a radioactive isotope injected into a vein. Then you will be scanned for approximately 1 hour. This test can tell the doctor not only how well the gallbladder empties but if there is a blockage in the channel (cystic duct) that flows to the small intestine. There is very little pain involved, except for the injection. You will need to have nothing to eat or drink for 4 hours prior to the test.
ERCP or endoscopic retrograde cholangiopancreatography can often detect gallstones that have become lodged in the bile duct that leads from the liver to the small intestine. This test involves being sedated with medicines and having a flexible fiberoptic scope called a duodenoscope placed into the mouth and down into the small intestine where dye can be injected into the bile duct. ERCP is done with the aid of fluoroscopy, a type of x-ray. The dye outlines the duct and can detect gallstones. If a gallstone is in the duct, oftentimes it can be removed, however surgery will still be necessary to remove the gallbladder. Patients are required to have nothing to eat or drink after midnight and must have a person with them who can drive them home after the test. If gallstones are removed then it is possible that you will be kept overnight in the hospital for observation.
Blood work, EKG, and Chest x-ray are part of a pre-operative "work-up." Some or all of these may need to be performed prior to your operation depending on your age and overall physical health. The pre-operative "work-up" also means that you will need to spend time being interviewed by the anesthesiologist and having a complete physical examination by a resident physician. This is done during a clinic visit. You will be called by a Pre-Care nurse the night before your surgery. The nurse will tell you what time you should arrive at Pre-Care, to begin preparation for your operation.
The afternoon before your surgery (or the Friday before if you are scheduled for surgery on Monday), a Pre-Care Nurse will call to tell you what time you should arrive for surgery. If you will not be at home or if it is difficult for the nurse to call you, then you may call (919) 966-2273 between 3pm and 6pm to find out the time to be at the hospital the day of your surgery. You may be told to stop taking medications the night before your surgery. You will receive instructions from the anesthesiologist at the "work-up." Do Not Eat or Drink After Midnight the night before your operation.
The Day of your Operation
You should arrive at Pre-Care at the time given you. Your family may be with you while you are being prepared for the operation as well as with you in the operating room holding area. They will be instructed to wait in the surgical family waiting room on the 4th floor of the Anderson Building while the operation is being performed.
In Pre-Care you will be prepared for surgery. This means changing into a hospital gown, obtaining your vital signs and being interviewed by a nurse. You then will be taken into the operating room holding area where you will meet the anesthesiologist and again more questions may be asked. Once you are placed in the operating room, you will have an intravenous line (IV) placed and you will be given anesthesia for the operation to begin.
Surgery at the Ambulatory Care Center
If you will be having your surgery performed at the Ambulatory Care Center (ACC), then you will be called by the nurse from the ACC Day Op the day before surgery. You will be given a time to arrive at the ACC Day Op area and any special instructions for that location. If you will not be at home or if it is difficult for the nurse to contact you, you may call (919) 966-7330 between 3pm and 5pm to receive your instructions. Your family will wait in the ACC while your surgery is being performed. You will be discharged home from the Post Anesthesia Care Unit, (PACU) when your recovery is complete.
The surgeon uses a laparoscope (a tiny "telescope" attached to a camera) to see a magnified view of your internal organs on a monitor. The operation requires that 3 tiny (1/4 to 1/2 inch) incisions are made under the right ribcage and a fourth incision about 1 inch at the bellybutton where the laparoscope and surgical instruments are inserted. The surgeon operates through these incisions to remove the gallbladder.
The outside incisions are usually closed with dissolvable stitches. Steri-strips or small pieces of tape are placed over the incision and a gauze bandage is applied. The bandages may be removed in 48 hours. The steri-strips will come off on their own or you may remove them in 5 days.
There is a small percentage of operations that can not be performed laparoscopically and they need to be converted to an "open" operation. Your surgeon will discuss this with you.
The operation lasts from 50 minutes to 2 hours (average 1 hour). Immediately after the operation, you will be taken into the Post Anesthesia Care Unit, (PACU), or recovery room, for approximately 1 to 2 hours. You will be watched closely until you are awake and then you will be transferred to a hospital room. The length of time you will be away from your family may be 2 to 4 hours. Your family will be notified of your condition be the surgeon once the operation is complete. During the post-operative period you will have:
- Intravenous line (IV) for fluids and pain medication. Some patients continue to have an IV for the length of time they remain in the hospital, others have the IV discontinued after they are able to drink fluids.
The hospital stay after this operation is usually 8 hours or overnight. In our experience approximately half of the patients are discharged later in the day after surgery, and the remaining patients return home the next day. A small number of patients are discharged home from the recovery room, however this is done rarely. While you are in the hospital you are monitored closely by the nursing staff. They are specially trained to take care of surgery patients and will assist you in your initial recovery.