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| Abdominal - Cholecystectomy (open) |
| << --- Open | Laparoscopic --- >> |
These notes give an overall guide to your stay in hospital. You may see some differences in the details of your treatment, since it is tailored to suit your own condition.
WHAT IS A GALLBLADDER? The gallbladder lies behind your right ribs at the front, below the liver and above the duodenum (gut). It is a pouch which is connected with the tubing (bile ducts) that carries bile from the liver to the gut. Stones forming in the gallbladder often cause pain. If stones escape from the gallbladder they can block the bile ducts and cause pain, fever and jaundice (a yellow skin) or block the duct of the pancreas and cause inflammation of that organ.  WHAT DOES THE OPERATION CONSIST OF? A cut is made in the skin below the right ribs at the front. It is usually made in a skin crease across your tummy so that it hardly shows afterwards. The gallbladder and its stones are removed. X-rays may be taken to show whether there are any stones in the bile ducts. If there are, they are removed. The exact procedure depends very much on the detailed findings at the time of the operation. The cut in the skin is then closed up. WHAT HAPPENS BEFORE THE OPERATION? Reception When registering at reception your medical aid details will be required. Your medical aid may require that you obtain an authority number from them for the hospital. Please check this. If you are not on a member of a medical aid you will be required to pay a deposit or to sign an indemnity form. As far as possible we will try to advise you about hospital costs before your admission. Welcome to the ward You will be welcomed to the ward by the nurses or the receptionist and will have your details checked. Some basic tests will be done such as pulse, temperature, blood pressure and urine examination. You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings. The surgeon will have explained the operation and you will be asked to sign your consent for the operation. If you are not clear about any part of the operation, then read this again and then ask for more details from the surgeon or from the nurses. Visit by the anaesthetist If you are having a general anaesthetic, the anaesthetist who will be giving your anaesthetic will interview and examine you. He will be especially interested in chest troubles, dental treatment and any previous anaesthetics you have had. Diet You will have your usual diet until 6 hours before the operation when you will be asked to take nothing by mouth. This will let your stomach empty to prevent vomiting during the operation. Shaving The operation area will be shaved to remove excess hair. Timing of the operation. The timing of your operation is usually arranged the day before so that the nurses will tell you when to expect to go to the operating theatre. Do not be surprised, however, if there are changes to the exact timing. Transfer to theatre You will be taken on a trolley to the operating suite by the staff. You will be wearing a cotton gown, wedding rings will be fastened with tape and removable dentures will be left on the ward. There will be several checks on your details on the way to the operating theatre where your anaesthetic will begin. The operation is then performed. WHAT HAPPENS AFTER THE OPERATION? Coming round after the anaesthetic Although you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back in your bed on the ward. Some patients feel a bit sick for up to 24 hours after operation, but this passes. You will be given some treatment for sickness if necessary. You may be given oxygen from a face mask for a few hours if you have had chest problems in the past. You will be given salt solutions or blood down a plastic tube into an arm vein until you are drinking normally. You may have a fine plastic tube down the back of your nose to drain your stomach for a day. Will it hurt? The wound is painful and there is discomfort on moving rather than severe pain. You will be given injections, suppositories or tablets to control this as required. Ask for more if the pain is still unpleasant. You will be expected to get out of bed the day after operation despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The third day after operation you should be able to spend most of your time out of bed and in reasonable comfort. You should be able to walk slowly along the corridor. By the end of one week the wound should be virtually painfree. Drinking and eating The operation causes the bowel to stop working for a day or two. Until the bowel starts up again, you will be given water, salts and sugar solutions into your arm vein. There may be a tube in your nose will be used to draw off any build-up of stomach juices which is usually removed the day after the operation. On the day after the operation you will be able to drink fluids and then gradually take sloppy foods. When you are able to drink freely, the arm drip tubing is removed. The first signs of returning bowel activity are noises in your tummy and passing wind out of your back passage. You should be eating normally after 4 or 5 days. You should be on a full diet within a week. Opening bowels It is quite normal for the bowels not to open for a day or so after operation. Passing urine It is important that you pass urine and empty your bladder within 6-12 hours of the operation. If you find using a bed pan or a bottle difficult, the nurses will assist you to commode or the toilet. If you still cannot pass urine let the nurses know and steps will be taken to correct the problem. Sleeping You will be offered painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know. Physiotherapy If you have chest problems the physiotherapist will check that you are clearing your lungs of phlegm by coughing and that you are helping your circulation by movement of your arms and legs. Coughing, although uncomfortable, will not harm your wound. The wound The wound has a dressing which may show some staining with blood in the first 24 hours. The wound is held together by stitches which are removed after 8-10 days or may be dissolving stitches. The dressing is usually removed after 1 - 3 days and replaced. This dressing is usually waterproof allowing you to shower. Sometimes a plastic drain is used to drain excessive secretions from the wound or abdominal cavity. It may be slightly uncomfortable, but is removed after a few days. If it was necessary to remove stones from the bile duct during the operation then a tube drain is left in the bile duct for 7-10 days. An xray is taken before the tube is removed to check that no stones have inadvertently been left behind. There may be some purple bruising around the wound which spreads downward by gravity and fades to a yellow colour after 2 to 3 days. It is not important. There may be some swelling of the surrounding skin which also improves in 2 to 3 days. After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor matchhead sized blebs form on the wound line, but these settle down after discharging a blob of yellow fluid for a day or so. Washing You can wash the wound area as soon as the dressing has been removed or earlier with a waterproof dressing. Soap and tap water are entirely adequate. Salted water is not necessary. How long in hospital? Ususally you will feel fit enought to leave hospital after 2 to 5 days. You will be given an appointment for a check up about 1 to 2 weeks after your operation. Sick notes Please ask your surgeon for any sick notes or certificates that you may require. After you leave hospital You are likely to feel a bit tired and need rests 2 or 3 times a day for two weeks or more. After about a month you will be back to your normal activities. Lifting At first discomfort in the wound will prevent you from harming yourself by too heavy lifting. After two months you can lift whatever you like. There is no value in attempting to speed the recovery of the wound by special exercises before the month is out. Driving You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 3 weeks. What about sex? You can restart sexual activities within 3 to 4 weeks, when the wound is comfortable enough. Work You should be able to return to light work within 4 weeks and a heavy job within 6 weeks. Complications Complications are seldom serious and are well known. If you think that all is not well, please ask the nurses or doctors. Bruising and swelling may be troublesome. The swelling may take 4 to 6 weeks to settle down. Infection is a rare problem and will be treated appropriately by the surgeon. Sometimes there is some discharge from the drain by the wound. This stops given time. Aches and twinges may be felt in the wound for up to 6 months. Occasionally there are numb patches in the skin around the wound which get better after 2 to 3 months. Chest infections may arise, particularly in smokers. Co-operation with the physiotherapists to clear the air passages is important in preventing the condition. Do not smoke. GENERAL ADVICE The operation should not be underestimated. Some patients are surprised how slowly they regain their normal stamina. However, virtually all patients are back doing their normal duties within 6 weeks. If you have any problems or queries, please ask the nurses or doctors. |
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