Post operation advice from Consultant Surgeon Mr James Kirkby-Bott
Cholecystectomy Gallbladder Surgery :
Post Operation Advice
The following advice leaflet has been written by your gallbladder surgeon - Mr James Kirkby-Bott, with advice on helping with your recovery. Please read it and use the advice to help minimise discomfort and maximise your outcome.
What to expect after gallbladder surgery:
The first 2-3 days are the worst in terms of feeling discomfort, nausea, tiredness, a sore throat and generally not feeling yourself. Gallbladder surgery and general anaesthetic are perceived by your body as a trauma and this takes some time and patience to recover from.
If I can offer any general advice it is this: Try not to get pre-occupied with how you feel or how you feel compares to what you have been expecting. Instead try and go with the flow. Give yourself a period of rest time from work and activities. As each day passes try and increase your activity levels doing gentle exercise and keeping moving around the house. Going for a walk might be pleasant, but don’t do strenuous sports until you feel up to it. Remember any unusual sensations are temporary and will improve as time goes by. Don’t be distracted by feeling unwell. Stay positive and doing things you enjoy for your rest time will help you achieve that. It is OK to enjoy your recovery time. After all you’ve just had a big gallblaldder operation and deserve the rest!
Wound and Dressings:
The following advice is designed to make your scar feel as invisible and normal as before gallbladder surgery as your body will allow. If you don’t want to follow this advice it will all heal well but following this advice will maximise the final outcome you have.
The 4 small wounds are covered in a plaster and under this are small adhesive strips (called steristrips) that are positioned to take tension off your wound edges. This helps neat healing and a neat scar. Leave these on for 10 days. Underneath the skin is closed with an absorbable stitch that doesn’t need removing.
It is OK to shower from the first morning after gallbladder surgery. No need to feel grungy or stinky!
Keep the dressing in place for 10 days and pat it dry when wet.
Make yourself comfortable.
If the dressing starts to come off please replace it with a fresh one. The fewer dressing changes the better for avoiding wound infection.
You will have a bruise and maybe some mild swelling.
This happens to everyone. It will look reddy brown and be sore. This is not a sign of a wound infection. It is normal healing. Leave it alone and don’t worry about it. It will disappear as a bruise usually does and the swelling will go down with the bruise disappearing. From day 1 perform regular stretches to the point of slight discomfort and continue at least daily noting how the range of movement changes each day. After 10 days remove any dressings. It will have healed by now. To help the scar heal as neatly as possible continue the stretches and start to apply a moisturizer (any that you would happily put on your face is fine) twice a day to the whole of the front of your wounds and rub firmly (to the point it is slightly uncomfortable after a few more days) and stretch gently with exercises. This will help keep tissue layers free and ensure the area feels comfortable to move in the long term. It takes a good 12 months for scars to fully heal and the tissues to remodel. During this time don’t be surprised if the scar becomes raised, or coloured. Just perform the exercises above and wait. It will subside and become less apparent as the remodelling continues.
Changes to bowel function
Your gallbladder has no real function beyond storing bile that is released to help digest the fats in food and drink. Without a gallbladder your liver will still make bile and release it with meals. Over a few months some adaptations occur to mean more bile is held in the bile duct to secrete after meals to aid digestion. In the meantime a heavy or large meal especially if containing a lot of fats may cause bloating and some discomfort. This might increase your bowel frequency too. It can last for a few months (uptown about 6) and will improve over this time. To minimise this effect try avoiding having significant amounts of fat in your diet. Remember most foods and many drinks have some fat content. Both 'good' and 'bad' fats need bile to absorb them so even a healthy diet can cause these effects at first. Some websites call this post cholecystectomy syndrome. Everyone is different, so different people, each with a different diet will experience this normal physiological process differently.
Activities Post Gallbladder Surgery:
• You can shower from day 1.
• Be up, dressed and mobile from day 1.
• You can get the wound wet in a bath from day 10.
• You can get in a swimming pool once all the dressings are off and the wound is dry. - Day 10
• Exercise as you feel able from day 1. Start with a gentle walk. Running, cycling and exercise classes should be ok from day 10. The more strenuous the activity the longer the rest time needed before resuming the activity. Weight classes may need 4-6 weeks before they feel OK to join. Start with higher repetition of small weights rather than low reputations of higher weights.
• As a general rule if it feels comfortable to do it is OK to do it. If not, stop and try again in a couple of days
• To be able to drive the law states that you must be able to safely perform an emergency stop. It is also worth making sure you can turn to look back over your shoulder. This might take 10-14 days.
• Expect to need some time ( typically 2-3 weeks) off work depending upon what you do.
Everyone is sent home post gallblader surgery with pain relief. Some people don’t feel they need it and some do. Take it as you need to, but follow this advice for the best results:
Take paracetamol regularly four times a day until you aren’t taking anything else and then start to take it as you need to till you no longer need it. In the prescribed dose it has no side effects and is the most effective painkiller on the market.
If more pain relief is needed take some Ibuprofen in addition to the paracetamol. Take it up to 3 times a day and each time you take it have it with some food or a nutritious drink. This drug has some interactions with other health problems, but taken in the prescribed amount for a just a few days is generally very safe with few side effects. You can ask for advice about whether to take this if you feel uncertain.
Lastly, you will go home with Dihydrocodeine. This painkiller is really strong and if taken when not really needed will cause sleepiness and can cause headaches. It also causes constipation so make sure your bowel habit is regular (aim for once day) and use a laxative if you need to use this drug and it is causing constipation. Only take this only as required. Add it to the paracetamol and Ibuprofen that you should already be taking.
I always follow up my gallbladder cases. At this meeting we can:
Discuss the histology or diagnosis from the resected specimen.
Review any blood results taken and to ensure you have recovered as expected and to review surgery success.
We can then discharge your care back to your referring doctor.