Gallbladder Surgery
The Gallbladder is a small pouch like bag, which lies just under the liver on the right-hand side of the abdomen. It is used as a storage facility for bile which is produced by the liver from the breakdown of old red blood cells and is then reused by the body to break down and digest the fat in your food, it also helps the body utilise vitamins A, D and E. The component parts of bile can sometimes clump together forming different sizes of gallstones ranging from small, tiny pebbles to small bird eggs or larger in size. Quite often gallstones cause the individual no problems, but sometimes they can cause irritation and inflammation of the gallbladder causing significant pain. Mr Whitelaw specialises in the removal of the gallbladder for the treatment of gallstones and biliary disease. This includes cholecystitis, biliary colic, jaundice, and pancreatitis. Every case of gallstones is different, and Mr Whitelaw has a comprehensive approach with expertise in all the different techniques including Laparoscopic Cholecystectomy (keyhole gallbladder removal), Laparoscopic bile duct exploration for gallstone removal from the bile duct either pre or post removal of the gallbladder. Laparoscopic bile duct bypass for strictures caused by gallstones and Endoscopic Retrograde Cholangiopancreatography (ERCP), for endoscopic bile duct exploration. He also performs Laparoscopic and endoscopic Cholangioscopy (Spyglass), this is where a 3mm specialised mini endoscope is passed into the bile duct during keyhole surgery or passed up the bile duct during ERCP, this allows gallstones to be removed, or broken up insitu. This is particularly useful if there is an extra-large gallstone. Mr Whitelaw is also experienced at gallbladder removal from patients who have a higher Body mass index. Appointments to see Mr Whitelaw can be made via this Clinic Link. He holds weekly clinics at The Cobham Clinic, Luton, Spire Harpenden Hospital and Spire Bushey Hospital, Watford, Hertfordshire. He is recognised by all the major healthcare companies and is registered with the Private Practice Register (PPR).
Cholecystitis
An inflamed gallbladder or cholecystitis is usually caused by gallstones, it is the most common condition needing a Laparoscopic Cholecystectomy and can cause extreme pain on the right side of the abdomen, a raised temperature, nausea, vomiting and anxiety for the individual. Gallstones are common and found in people of all ages and are the most common cause of cholecystitis and biliary colic. Gallstones are basically crystals of cholesterol, fats and salts which form in the gallbladder overtime. They can occur in both men and women at any age, causes of gallstones can include rapid weight loss, a higher-than-normal body mass index and increasing age. Often, they do not cause any symptoms. However, if symptoms occur such as pain, inflammation, pancreatitis, or a blockage in the bile duct causing jaundice, they need to be removed, usually by removal of the gallbladder through keyhole surgery. Sometimes gallstones can also get stuck in the bile duct, the small tube which drains bile from your liver into your intestine. As the stone pass down the bile duct, they can cause intense right sided abdominal pain, sometimes radiating through to the back and the right shoulder, this is known as biliary colic. To prevent further episodes removal of the gallbladder is recommended. A bile duct exploration can be performed at the same time as the keyhole gallbladder surgery to remove any large gallstones Alternatively bile duct stones can be removed endoscopically without surgery as a day-care endoscopic procedure detailed later (ERCP). Jaundice is caused by a build-up of bilirubin in the blood. It is a natural by-product of the body breaking down old red blood cells, it is made in the liver and then secreted into the bile duct and passed into the small intestine where it is eventually passed out of the body in your stool. If your bile duct is blocked by stones this prevents the bilirubin being excreted causing jaundice. A yellowing of the skin, yellowing of the white of the eye and itchy skin are all symptoms of jaundice. There are also a few other illnesses that can cause jaundice, including a tumour of the gallbladder, treatment of Jaundice will depend on what the cause is. Acute Pancreatitis is an inflammation of the pancreas and can cause severe pain in the centre of your abdomen with it radiating through to your back, a high temperature, nausea, and vomiting. Treatment of pancreatitis involves a hospital admission, intravenous fluids, testing of bloods including your amylase or lipase levels to make the diagnosis. You will initially be nil by mouth or water only until symptoms begin to improve. Pancreatitis can resolve quickly within a few days; in more severe cases it can take several weeks and occasionally months. Pancreatitis usually involves one or two scans of your Pancreas and gallbladder, these can include ultrasound, or CT. Diagnosis of Gallstones Your General Practitioner should be able to organise an ultrasound of your abdomen where a small probe will be passed externally across your tummy and should be able to pick up any signs of stones in your gallbladder. If you have suspected biliary colic some blood tests may be done to check your liver function tests. If these are abnormal it may indicate, you have gallstones in your bile duct and you may need an MRI scan to confirm that there are stones present. If stones are present in the bile duct and causing biliary colic, they will need to be removed by ERCP.
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy is normally performed as a day case under general anaesthetic and takes about an hour to complete. You will have four ports inserted into your abdomen with small incisions up to about 1cm, which will then be gently inflated with carbon dioxide gas to provide the best view of the gallbladder and allow better access for Mr Whitelaw to complete the gallbladder removal. The four port incisions will later be closed with a dissolvable, invisible suture and medical glue will then cover the wound. Post operatively you will spend a short time in the post operative recovery room where you will be woken up whilst theatre recovery staff check your blood pressure and pulse. You will then be returned to the ward where a few post operative checks will continue for a while. All being well you will be allowed home later in the day after Surgery. It is advisable to mobilise gently post operatively in between resting for the first few days taking analgesic as and when you require it. Moving around after surgery is important to prevent deep vein thrombosis and chest infections and other post operative complications. Resume all your daily activities as soon as you feel able to. You can resume driving as soon as you are feel able to do an emergency stop. You can return to work after one to two weeks. Recovery following a Laparoscopic Gallbladder removal should be quick, all though this will vary from person to person. You don't need to stick to any particular diet following surgery. As with all procedures that require a general anaesthetic there are risks to gallbladder surgery that include very rare respiratory or cardiac complications, wound, chest and urinary tract infections, very rare deep vein thrombosis or DVT and Pulmonary Embolism or PE, both the later are a type of clot. Generally, post operatively it is always good as soon as you feel able to gently mobilise regularly, do deep breathing exercise and hydrate yourself properly. Post operatively if you have any symptoms that you are concerned about you should call the ward or Mr Whitelaw’s emergency contact.
ERCP
An ERCP in an endoscopic minimally invasive procedure which is performed to access the bile duct without the need for surgery. It is usually a procedure that takes place to remove gallstones from the bile duct either before or after gallbladder removal or to unblock the duct where a gallstone or tumour is blocking it. An ERCP does not need a full general anaesthetic and is normally carried out under intravenous sedation as a day case. In some situations a small either plastic or titanium tube called a stent is left in the bile duct to allow bile to drain past an obstruction. The stent does not cause any discomfort and can be removed at a later date. If you are having an ERCP you will be admitted as a day patient and will be asked not to eat after midnight the night before. Once admtted you will be seen by Mr Whitelaw who will have explained in detail what will be happening. You will be given some light sedation and then an endoscope (long flexible tube with a camera) will be passed down your oesphagus through your stomach and carefully navigated into your bile duct where any gallstones will be removed or a stent if necessary will be placed to relieve any obstruction that is there. You'll wake up quite quickly in the recovery area and be offered a cup of tea while your blood pressure and pulse are checked. After an hour or two if you are wide awake and feeling fine you will be able to go home.