General Surgery  |  Gallbladder Pathway - Protocol for Direct Access Gallbladder Surgery

General Surgery

Gallbladder Pathway - Protocol for Direct Access Gallbladder Surgery

Scope: This pathway outlines the care for direct access laparoscopic gallbladder surgery

Length of stay: Expected day-stay.

Associated resources:

Before Surgery:

The GP is to identify a suitable patient. In general these are young fit patients with typical symptoms, who are likely to have uncomplicated surgery. Therefore, the inclusion criteria include:

  • Younger than 60 years of age
  • Typical biliary symptoms
  • BMI <35
  • Has not had cholecystitis (admission to hospital for cholecystitis or thick wall gallbladder on ultrasound)¬†
  • Ultrasound confirming a thin walled gallbladder and stones or sludge
  • No medical illness requiring anaesthetic review (excludes well controlled hypertension)
  • Has a support person to look after them for the first 24 hours after surgery
  • Medications excluded Warfarin, Clopidigral, Dabigatran

Patients are referred on the pro forma and if suitable, the patient and GP are advised of the expected date for surgery. If unsuitable, the patient will be placed on the traditional pathway and graded accordingly.

One to two weeks prior to surgery, the GP checks the anaesthetic questionnaire and patient consent form has been completed and there are no medical concerns, ensures up to date FBC, creatinine and LFT results are available and surgery has been discussed with the patient. GP has provided the guide to laparoscopic cholecystectomy patient information booklet and consent info, ensuring patient is happy to be involved in the process.

Day of Surgery:

1. Patient admitted to Surgical Admissions Unit (SAU) at 07:00
2. Patient is seen in SAU at 07:30-08:30 by surgeon and anaesthetist.
3. If appropriate for direct access surgery, Consent to perform the operation is completed.
4. If inappropriate for direct access surgery, the patient is rebooked for OPD clinic
5. Surgery performed.
6. Post operatively, the patient transferred to SAU
7. Patient seen post operatively by surgical team before discharge

Discharge medications:

Paracetamol 1g PO QID X 2/52, Brufen 400mg PO TDS X 2/52,
Oxynorm 5mg X 3 doses, maxalon 10 mg TDS X 3 doses

Post operation

Patient discharged on day of surgery. GP follow up within 2 weeks post operatively to check patient is doing well and review histology.

Last updated : Friday, May 04, 2018
Next review date : Saturday, May 04,2019

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