HCF We're different from other funds

.
print

1. Preparation

WHAT IS A CHOLECYSTECTOMY?

Cholecystectomy is the surgical removal of the gallbladder. It is one of the most common operations performed. The two techniques used to remove the gallbladder are by laparoscopic cholecystectomy (“keyhole surgery”) or open cholecystectomy (laparotomy).



gall-bladder-removal.gif

WHY IS IT DONE?

The gallbladder is a small pear-shaped sac found under the liver on the right hand side of the abdomen. It stores bile produced by the liver, which is then released into the bowel to aid digestion by breaking down fats.


The most common disorder of the gallbladder is the formation of gallstones, affecting about 15 percent of people aged 50 and over. Gallstones form when excess cholesterol in the bile crystallises, causing the gallbladder not to empty properly. They can vary in size from a minute grain of sand to a large golf ball. The gallbladder can then become inflamed and/or infected; this is known as cholecystitis.


If gallstones are present you may experience pain, often at night and especially after eating a meal of rich, high fat foods. The pain starts in the abdomen and may spread to the chest, back or between the shoulders. You also experience nausea and vomiting, and in some cases jaundice (a build up of bile in the blood stream causing a yellow tinge to the skin and eyes).


Although an infection can be treated with antibiotics, repeated bouts of cholecystitis often require surgical intervention. In the past gallstones were sometimes treated with Lithotripsy, a procedure that uses high-frequency sound waves to break down the stones, but results can be poor and this is now rarely performed.


Causes of Gallstone Formation :

Gallstones can be hereditary and higher than normal levels of estrogen, insulin or cholesterol may also increase the risk of gallstone formation. When pregnant or taking contraceptives, activity in the gallbladder slows down, contributing to the risk of gallstones developing. This is also the case with diabetes, pancreatitis and celiac disease (wheat intolerance).

Other reasons why gallstones may form in the gallbladder:

  • A high-fat, low-fibre diet
  • Heavy drinking
  • Smoking
  • Obesity
  • Rapid weight loss
  • Coronary artery disease or other recent illness
  • Intestinal disorders
  • Multiple pregnancies

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a General Surgeon who can perform the procedure.


You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the RoyalAustralasianCollege of Surgeons via their website www.surgeons.org. This is a very informative website.


The list of questions below may help you better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).


To access a list of General Surgeons who participate in HCF’s Medicover no gap arrangement:


Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.


WHAT SHOULD I ASK MY SPECIALIST?


  • Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.

  • In addition to what the procedure involves, you should also ask about:
  • Preparation
  • Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Aftercare
  • Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:

  • Aspirin (or any related products)
  • Blood thinners (Warfarin, heparin.)
  • Arthritis medication
  • Pain medication
  • Anti-inflammatory medication
  • Insulin

Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.

WHERE IS IT DONE?

A Cholecystectomy is done in an overnight hospital. Your expected length of stay after laparoscopic surgery is 2-3 days, and 4-6 days after open surgery.


HOW LONG IS THE PROCEDURE?

Both the laparoscopic and open procedures may take approximately 1 – 2 hours, dependent on individual circumstance.


WHO IS INVOLVED?

The people involved in the procedure are:


  • The General Surgeon, your Specialist doctor
  • There may be an assistant surgeon
  • Anaesthetist : they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
  • Nurses for the procedure and recovery
  • Pathologist for blood tests and/or specimen samples
  • Radiologist for x-rays
  • You may see a physiotherapist after the operation

HOW DO I PREPARE FOR A CHOLECYSTECTOMY?

If you are a smoker and you cannot give up completely, try to reduce smoking in the weeks leading up to your surgery; this may help to lower the risk of post-operative complications such as chest infection.


You will be notified of your fasting times prior to theatre. If surgery is scheduled for the morning, you will usually have to fast from midnight, otherwise if your operation is scheduled for the afternoon you will be required to fast for at least 6 hours prior to surgery.


Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.


WHAT DO I TAKE WITH ME TO THE HOSPITAL?


  • Do not bring any valuables with you
  • Leave all jewellery at home, a wedding ring is acceptable
  • Wear comfortable clothing
  • Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
  • Bring any relevant x-rays or scans

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims pain for Laparoscopic Cholecystectomy admissions for the financial year 13/14 are provided below.

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $5,594 $0 $5,382
1 Medical Services Component
Anaesthetic Services $763 $271 $263 $541 42.3% $0 57.7%
Assistant in Operations Services $267 $129 $95 $222 19.3% $0 80.7%
General Surgical Services $1,502 $659 $503 $1,210 28.0% $0 72.0%
Pathology Services $211 $106 $94 $135 8.0% $0 92.0%
Specialist Consulations $236 $130 $85 $114 18.2% $0 81.8%
Radiology Services $203 $105 $58 $119 34.1% $0 65.9%
2 Total Average Medical Services $2,725 $1,179 $941 $1,047 57.5% $0 42.5%
Hospital and Medical Services Average for Laparoscopic Cholecystectomy Admissions $8,319 $1,179 $6,323 $1,047 57.5% $0 5 42.5%

Cholecystectomy FY14.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 2,066 overnight admissions with an average length of stay of 1.9 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 30445.

  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.


2 The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. diagnostic procedures. Therefore, the total average

medical service charge ($2,725) differs from the sum of the individual average charges as

shown.


3 Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.


4 Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.


HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of

the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers,

registered under the HCF Medicover No Gap arrangement will receive as full payment

for services provided. This also applies to unregistered providers should they charge

within the schedule of benefit listed. This arrangement ensures that our members incur no

out of pocket expense.


5 This percentage indicates the total coverage of hospital and medical services for all

Laparoscopic Cholecystectomy admissions. The percentages shown for each type of

medical service are much higher as they are calculated for those services only and not the

entire admission, which includes all medical services and the hospital services. In an

admission you may have one medical service with an out of pocket expense, which then

excludes the whole admission from being fully covered. Hence the significant difference in

percentage for individual types of medical services as compared to the total admission

fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL?

When you arrive at the hospital, the admissions clerk will attend to the paperwork associated with your stay.


On admission to the hospital a nurse will orientate you to your surroundings and request your medical history, current medication and any known allergies. The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation to discuss your anaesthetic. A general anaesthetic is given which means that you are asleep throughout the procedure. You will also discuss the type of pain relief you will receive after the operation.


An intravenous line will be put into the back of your hand so that you can be given sedation, antibiotics and fluid replacement.


You may be given a pre-medication before leaving the ward, in which case you may already be sleepy once you enter the operating theatre.


WHAT CAN I EXPECT DURING A CHOLECYSTECTOMY?

You will be taken into the anaesthetic bay where, if you haven’t already had one inserted, a small plastic tube called a cannula will be placed into a vein in your arm or hand. A sedative – the first part of your anaesthetic – will be put through the cannula. You will be fully asleep before being moved into the operating theatre itself. Your next memory will be waking up in the recovery room adjacent to the theatre.


Laparoscopic Cholecystectomy (“Keyhole surgery”)


Over the last decade or so this technique has become the more common way of performing a cholecystectomy. In a small minority of patients, the operation might begin as laparoscopic, but progress to an open procedure due to complicating factors such as significant infection or scarring in the area.


Your surgeon is usually required to make around four small incisions in the abdomen; commonly one is just under the belly button and 3 are below the right lower ribcage (although the number and position may vary for each individual). The incisions range from about 0.5 to 2.5cms long.


Carbon dioxide is blown into the abdomen to lift the abdomen wall away from the gallbladder and other organs, and enable the surgeon to view the gallbladder and surrounding area clearly. Images are projected from a small camera on the tip of the laparoscope onto a TV screen. The other incisions are required to insert instruments necessary for the removal of the gall bladder, which is brought out via one of the incisions.


Metal clips, made of surgical grade stainless steel, are used to seal the blood vessels leading from the gallbladder to the other tubes (ducts) and the arteries leading to the gallbladder. These clips remain in the body on a permanent basis and do not cause any problems. They are also not detected when you pass through a metal detector.


As soon as the gallbladder is taken out, all the instruments are removed from the abdomen. The carbon dioxide is then allowed to escape and the small incisions are closed with staples or stitches.


Open Cholecystectomy (Laparotomy)


The gallbladder is removed through one large abdominal incision of about 10cm just under the right rib cage. Although it is more invasive than a laparoscopic procedure, the surgeon is afforded a better view and easier access which may be required for more complex procedures. Essentially, the technique for removing the gall bladder from the surrounding structure is the same as for the laparoscopic procedure. A small tube, or drain, is usually inserted to ensure safe removal of any residual blood or fluid from your abdomen. Some surgeons will routinely xray the bile ducts at the time of operation to ensure there are no residual stones that need to be removed.

3. Aftercare

WHAT HAPPENS AFTER A CHOLECYSTECTOMY?

Following the surgery, you will wake up in the recovery room where you will be closely monitored by nursing staff who will constantly assess your breathing and vital signs. You will be receiving supplemental oxygen either via a face mask or small plastic tubes, nasal prongs, in your nose. You can expect to have some pain in the abdomen and the nurses will give you medication, usually in the form of an injection at this stage, to manage the pain. You may also have some nausea and vomiting which can also be treated with an injection, commonly into your vein so it’s painless.


Once you are fully awake and comfortable you will be returned to the ward. The cannula in your arm will remain in place and you will be given an intra-venous drip until you are eating and drinking normally. After a laparoscopic procedure you will usually be able to start drinking the same day, and gradually build up to a normal diet the day after surgery. If you have had an open procedure the process will take longer because of the increased handling of the bowel.


Your pain relief after the operation will depend on the type of operation you have had and your personal requirements. In most case you will be given strong tablets and an injection if required. Occasionally after open surgery you may be given a PCA – patient controlled analgesia. This allows you to press a button and deliver small doses of a drug such as morphine into your vein. The machine is carefully programmed so that you cannot receive too much.


Your wound could have stitches or clips and be covered with stick-on or spray-on dressings. The drain tube from your side will be removed the day after surgery and you may also have a shower the day after surgery.


You will be encouraged to start walking and moving as soon as you can to avoid Deep Vein Thrombosis (DVT) - blood clots that form in your legs and can potentially travel to your lungs. Avoid smoking after your operation to prevent coughing and chest infection. You may also be advised to perform breathing exercises (sometimes with the aid of a small machine) each hour, which will help to clear your lungs and prevent infection.


You should be given comprehensive advice on discharge about what to expect over the next few weeks at home. Ensure you are fully informed on the following issues:


  • Any changes to your diet
  • Level of activity, including heavy lifting and returning to work
  • Driving (don’t forget to also check with your insurance company)
  • Wound care and removal of sutures
  • Follow up appointments
  • Any changes to your medication

Complications are rare, but you should contact your doctor if you experience any of the following:


  • Bleeding or offensive discharge from your wound(s)
  • Fever and cold chills
  • Pain that cannot be relieved by painkillers
  • Swelling in the abdomen
  • A yellow tinge to your eyes and skin

1. Preparation

WHAT IS A CHOLECYSTECTOMY?

Cholecystectomy is the surgical removal of the gallbladder. It is one of the most common operations performed. The two techniques used to remove the gallbladder are by laparoscopic cholecystectomy (“keyhole surgery”) or open cholecystectomy (laparotomy).




gall-bladder-removal.gif

WHY IS IT DONE?

The gallbladder is a small pear-shaped sac found under the liver on the right hand side of the abdomen. It stores bile produced by the liver, which is then released into the bowel to aid digestion by breaking down fats.


The most common disorder of the gallbladder is the formation of gallstones, affecting about 15 percent of people aged 50 and over. Gallstones form when excess cholesterol in the bile crystallises, causing the gallbladder not to empty properly. They can vary in size from a minute grain of sand to a large golf ball. The gallbladder can then become inflamed and/or infected; this is known as cholecystitis.


If gallstones are present you may experience pain, often at night and especially after eating a meal of rich, high fat foods. The pain starts in the abdomen and may spread to the chest, back or between the shoulders. You also experience nausea and vomiting, and in some cases jaundice (a build up of bile in the blood stream causing a yellow tinge to the skin and eyes).


Although an infection can be treated with antibiotics, repeated bouts of cholecystitis often require surgical intervention. In the past gallstones were sometimes treated with Lithotripsy, a procedure that uses high-frequency sound waves to break down the stones, but results can be poor and this is now rarely performed.


Causes of Gallstone Formation :


Gallstones can be hereditary and higher than normal levels of estrogen, insulin or cholesterol may also increase the risk of gallstone formation. When pregnant or taking contraceptives, activity in the gallbladder slows down, contributing to the risk of gallstones developing. This is also the case with diabetes, pancreatitis and celiac disease (wheat intolerance).


Other reasons why gallstones may form in the gallbladder:


  • A high-fat, low-fibre diet
  • Heavy drinking
  • Smoking
  • Obesity
  • Rapid weight loss
  • Coronary artery disease or other recent illness
  • Intestinal disorders
  • Multiple pregnancies

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a General Surgeon who can perform the procedure.


You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the RoyalAustralasianCollege of Surgeons via their website www.surgeons.org. This is a very informative website.


The list of questions below may help you better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).


To access a list of General Surgeons who participate in HCF’s Medicover no gap arrangement:


Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.


WHAT SHOULD I ASK MY SPECIALIST?


  • Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
  • In addition to what the procedure involves, you should also ask about:
  • Preparation
  • Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Aftercare
  • Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:

  • Aspirin (or any related products)
  • Blood thinners (Warfarin, heparin.)
  • Arthritis medication
  • Pain medication
  • Anti-inflammatory medication
  • Insulin

Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.

WHERE IS IT DONE?

A Cholecystectomy is done in an overnight hospital. Your expected length of stay after laparoscopic surgery is 2-3 days, and 4-6 days after open surgery.


HOW LONG IS THE PROCEDURE?

Both the laparoscopic and open procedures may take approximately 1 – 2 hours, dependent on individual circumstance.


WHO IS INVOLVED?

The people involved in the procedure are:


  • The General Surgeon, your Specialist doctor
  • There may be an assistant surgeon
  • Anaesthetist : they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
  • Nurses for the procedure and recovery
  • Pathologist for blood tests and/or specimen samples
  • Radiologist for x-rays
  • You may see a physiotherapist after the operation

HOW DO I PREPARE FOR A CHOLECYSTECTOMY?

If you are a smoker and you cannot give up completely, try to reduce smoking in the weeks leading up to your surgery; this may help to lower the risk of post-operative complications such as chest infection.


You will be notified of your fasting times prior to theatre. If surgery is scheduled for the morning, you will usually have to fast from midnight, otherwise if your operation is scheduled for the afternoon you will be required to fast for at least 6 hours prior to surgery.


Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.


WHAT DO I TAKE WITH ME TO THE HOSPITAL?


  • Do not bring any valuables with you
  • Leave all jewellery at home, a wedding ring is acceptable
  • Wear comfortable clothing
  • Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
  • Bring any relevant x-rays or scans

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims pain for Laparoscopic Cholecystectomy admissions for the financial year 13/14 are provided below.

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $5,594 $0 $5,382
1 Medical Services Component
Anaesthetic Services $763 $271 $263 $541 42.3% $0 57.7%
Assistant in Operations Services $267 $129 $95 $222 19.3% $0 80.7%
General Surgical Services $1,502 $659 $503 $1,210 28.0% $0 72.0%
Pathology Services $211 $106 $94 $135 8.0% $0 92.0%
Specialist Consulations $236 $130 $85 $114 18.2% $0 81.8%
Radiology Services $203 $105 $58 $119 34.1% $0 65.9%
2 Total Average Medical Services $2,725 $1,179 $941 $1,047 57.5% $0 42.5%
Hospital and Medical Services Average for Laparoscopic Cholecystectomy Admissions $8,319 $1,179 $6,323 $1,047 57.5% $0 5 42.5%

Cholecystectomy FY14.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 2,066 overnight admissions with an average length of stay of 1.9 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 30445.

  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.


2 The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. diagnostic procedures. Therefore, the total average

medical service charge ($2,725) differs from the sum of the individual average charges as

shown.


3 Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.


4 Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.


HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for services

provided. This also applies to unregistered providers should they charge within the

schedule of benefit listed. This arrangement ensures that our members incur no out of

pocket expense.


5 This percentage indicates the total coverage of hospital and medical services for all

Laparoscopic Cholecystectomy admissions. The percentages shown for each type of

medical service are much higher as they are calculated for those services only and not the

entire admission, which includes all medical services and the hospital services. In an

admission you may have one medical service with an out of pocket expense, which then

excludes the whole admission from being fully covered. Hence the significant difference in

percentage for individual types of medical services as compared to the total admission

fully covered.


2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL?

When you arrive at the hospital, the admissions clerk will attend to the paperwork associated with your stay.


On admission to the hospital a nurse will orientate you to your surroundings and request your medical history, current medication and any known allergies. The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation to discuss your anaesthetic. A general anaesthetic is given which means that you are asleep throughout the procedure. You will also discuss the type of pain relief you will receive after the operation.


An intravenous line will be put into the back of your hand so that you can be given sedation, antibiotics and fluid replacement.


You may be given a pre-medication before leaving the ward, in which case you may already be sleepy once you enter the operating theatre.


WHAT CAN I EXPECT DURING A CHOLECYSTECTOMY?

You will be taken into the anaesthetic bay where, if you haven’t already had one inserted, a small plastic tube called a cannula will be placed into a vein in your arm or hand. A sedative – the first part of your anaesthetic – will be put through the cannula. You will be fully asleep before being moved into the operating theatre itself. Your next memory will be waking up in the recovery room adjacent to the theatre.


Laparoscopic Cholecystectomy (“Keyhole surgery”)


Over the last decade or so this technique has become the more common way of performing a cholecystectomy. In a small minority of patients, the operation might begin as laparoscopic, but progress to an open procedure due to complicating factors such as significant infection or scarring in the area.


Your surgeon is usually required to make around four small incisions in the abdomen; commonly one is just under the belly button and 3 are below the right lower ribcage (although the number and position may vary for each individual). The incisions range from about 0.5 to 2.5cms long.


Carbon dioxide is blown into the abdomen to lift the abdomen wall away from the gallbladder and other organs, and enable the surgeon to view the gallbladder and surrounding area clearly. Images are projected from a small camera on the tip of the laparoscope onto a TV screen. The other incisions are required to insert instruments necessary for the removal of the gall bladder, which is brought out via one of the incisions.


Metal clips, made of surgical grade stainless steel, are used to seal the blood vessels leading from the gallbladder to the other tubes (ducts) and the arteries leading to the gallbladder. These clips remain in the body on a permanent basis and do not cause any problems. They are also not detected when you pass through a metal detector.


As soon as the gallbladder is taken out, all the instruments are removed from the abdomen. The carbon dioxide is then allowed to escape and the small incisions are closed with staples or stitches.


Open Cholecystectomy (Laparotomy)


The gallbladder is removed through one large abdominal incision of about 10cm just under the right rib cage. Although it is more invasive than a laparoscopic procedure, the surgeon is afforded a better view and easier access which may be required for more complex procedures. Essentially, the technique for removing the gall bladder from the surrounding structure is the same as for the laparoscopic procedure. A small tube, or drain, is usually inserted to ensure safe removal of any residual blood or fluid from your abdomen. Some surgeons will routinely xray the bile ducts at the time of operation to ensure there are no residual stones that need to be removed.


3. Aftercare

WHAT HAPPENS AFTER A CHOLECYSTECTOMY?

Following the surgery, you will wake up in the recovery room where you will be closely monitored by nursing staff who will constantly assess your breathing and vital signs. You will be receiving supplemental oxygen either via a face mask or small plastic tubes, nasal prongs, in your nose. You can expect to have some pain in the abdomen and the nurses will give you medication, usually in the form of an injection at this stage, to manage the pain. You may also have some nausea and vomiting which can also be treated with an injection, commonly into your vein so it’s painless.


Once you are fully awake and comfortable you will be returned to the ward. The cannula in your arm will remain in place and you will be given an intra-venous drip until you are eating and drinking normally. After a laparoscopic procedure you will usually be able to start drinking the same day, and gradually build up to a normal diet the day after surgery. If you have had an open procedure the process will take longer because of the increased handling of the bowel.


Your pain relief after the operation will depend on the type of operation you have had and your personal requirements. In most case you will be given strong tablets and an injection if required. Occasionally after open surgery you may be given a PCA – patient controlled analgesia. This allows you to press a button and deliver small doses of a drug such as morphine into your vein. The machine is carefully programmed so that you cannot receive too much.


Your wound could have stitches or clips and be covered with stick-on or spray-on dressings. The drain tube from your side will be removed the day after surgery and you may also have a shower the day after surgery.


You will be encouraged to start walking and moving as soon as you can to avoid Deep Vein Thrombosis (DVT) - blood clots that form in your legs and can potentially travel to your lungs. Avoid smoking after your operation to prevent coughing and chest infection. You may also be advised to perform breathing exercises (sometimes with the aid of a small machine) each hour, which will help to clear your lungs and prevent infection.


You should be given comprehensive advice on discharge about what to expect over the next few weeks at home. Ensure you are fully informed on the following issues:


  • Any changes to your diet
  • Level of activity, including heavy lifting and returning to work
  • Driving (don’t forget to also check with your insurance company)
  • Wound care and removal of sutures
  • Follow up appointments
  • Any changes to your medication

Complications are rare, but you should contact your doctor if you experience any of the following:


  • Bleeding or offensive discharge from your wound(s)
  • Fever and cold chills
  • Pain that cannot be relieved by painkillers
  • Swelling in the abdomen
  • A yellow tinge to your eyes and skin
Back to top

Disclaimer: Information is provided by HCF in good faith for the convenience of members. It is not an endorsement or recommendation of any form of treatment, nor is it a substitute for medical advice, and you should rely on the advice of your treating doctors in relation to all matters concerning your health. Every effort has been taken to ensure the accuracy of this information, however, HCF takes no responsibility for any injury, loss, damage or other consequence of the use of this information.