Sudden pain? Keeping an eye on gallstones

2 What exactly happens during a laparoscopic cholecystectomy and how does the procedure differ from open surgery?

Laparoscopic cholecystectomy is a minimally invasive procedure. The gallbladder is removed via small incisions (usually 3-4, approx. 0.5-1 cm in size).

During the operation, the abdominal cavity is filled with CO₂ gas to ensure there is sufficient space and the gallbladder can be visualised well. This lifts the abdominal wall, creating more space and a better view for the surgeon.

The gallbladder is exposed using a small camera (laparoscope) and special surgical instruments. It is separated from the bile duct, and blood vessels and bile ducts are securely closed. The gallbladder is usually removed through the navel or another small incision.

Compared to open surgery, the procedure results in significantly less pain, faster recovery, smaller scars and a shorter hospital stay.

Nevertheless, certain circumstances (e.g. scars, previous operations or complications) may make open surgery necessary. This is rare and is performed when the laparoscopic method is not possible. Sometimes it is also necessary to switch to the open procedure during laparoscopic surgery. In open surgery, an incision about 8 cm long is made below the right costal arch. The gallbladder can also be exposed and removed through this incision.

3 How safe is the minimally invasive method - and what risks or complications can occur?

The minimally invasive method is now regarded as the standard procedure for removing the gallbladder and is very safe and well-established. Over 95% of operations are performed without any major complications. This procedure is made possible by modern technology and is performed safely by experienced surgeons.

In addition to general surgical risks (post-operative haemorrhage, infections at the puncture sites or in the abdominal cavity, thrombosis or embolisms), specific complications can occur during cholecystectomy. The most serious complication is injury to the central bile duct (in 0.3-0.6 % of cases). Depending on the severity of the bile duct injury, further therapeutic measures (antibiotic therapy, insertion of a percutaneous drain, ERCP) may be necessary. Very rarely, a follow-up operation may also have to be performed.

In addition, injuries to blood vessels (1-2 % of cases) or neighbouring organs (<0.5 % of cases) may occur. Conversion from minimally invasive to open surgery is required in around 2% of cases.

4 How long does the procedure take and when can patients usually return home and resume their daily routine?

The operation usually takes 30 to 60 minutes. In cases of severe inflammation of the gallbladder, the operation may take longer. Patients usually stay in hospital for 1 to 3 days. You will be able to eat normally again shortly after the operation. It is typically possible to return to work and light activities after about a week. After two weeks, full physical activity is usually permitted again.

5. are there any restrictions in life without a gallbladder?

Bile is produced in the liver and released into the intestine via the common bile duct. It emulsifies the fats ingested with food so that they can be processed in the small intestine. The function of the gallbladder is to store bile.

After removal of the gallbladder, the bile flows continuously, but less concentrated, directly from the liver into the intestine. In principle, sufficient bile is available at the time of eating to enable normal digestion. In principle, you can therefore eat anything you like. Nevertheless, a balanced diet is recommended.

Food that is difficult to digest, very fatty or strongly flavoured can cause discomfort in some people. In rare cases, excessive fat consumption can lead to fatty stools (steatorrhoea).

For most people, life without a gallbladder is quite possible and largely symptom-free - provided that they pay attention to their diet and monitor their individual tolerance.

6 What developments and advances have been made?

Minimally invasive removal of the gallbladder is now the gold standard worldwide. Intraoperative cholangiography improves safety through precise visualisation of the bile ducts. Intraoperative ultrasound is also increasingly being used.

Initial experience with robotic cholecystectomy shows no clear superiority over classic laparoscopy. New procedures such as single-port cholecystectomy or the NOTES procedure (removal via natural orifices) improve aesthetics and reduce post-operative discomfort.

7. what do you recommend to patients who have gallstones but no symptoms?

For asymptomatic gallstones, the general recommendation is to wait and see. Around 70-80% of those affected do not develop any symptoms. Preventive surgery is not routinely recommended as the risks usually outweigh the benefits.

In special cases - e.g. very large gallstones (>2-3 cm), porcelain gallbladder or certain blood disorders - preventive removal may be advisable. It is also sometimes recommended before bariatric surgery.

Regular medical check-ups and information about possible symptoms are usually sufficient.