Tom Reeve Academic Surgical Clinic  ·  St Leonards

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Thomas J. HughSpecialist Hepato-Biliary & General Surgeon
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Patient resources · Gallbladder surgery

What happens during keyhole gallbladder removal?

Keyhole gallbladder removal is called laparoscopic cholecystectomy. It removes the gallbladder and the stones inside it through several small abdominal cuts. The recommendation depends on your symptoms, imaging, health and the expected benefits and risks.

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/ 01Overview

What is the name of the gallstones operation?

Laparoscopic cholecystectomy is the usual name for keyhole gallbladder removal. The operation removes the gallbladder with the stones inside because stones commonly reform when the gallbladder remains. Treatment is considered after assessment rather than from a scan result alone.

The gallbladder stores bile made by the liver. People can generally live without it because bile continues to flow from the liver into the bowel.

/ 02Patient information

What happens on the day of surgery?

You meet the surgeon and anaesthetist before a general anaesthetic. Several ports allow a camera and instruments into the abdomen, the gallbladder is separated from the liver and removed, and the cuts are closed. Operating time and hospital stay vary with inflammation, anatomy and general health.
  • Admission instructions cover fasting, medicines and arrival time.
  • Many planned operations take around an hour, while difficult inflammation or anatomy can extend the procedure.
  • Many patients leave on the day of surgery or after one night when clinically appropriate.
  • A change to open surgery may be required when keyhole completion would carry greater risk.
/ 03Patient information

What is an operative cholangiogram?

An operative cholangiogram is an X-ray of the bile ducts taken during surgery after dye is introduced through a small tube. It can clarify bile-duct anatomy and identify some unsuspected duct stones. Whether it is used, and what follows from the result, depends on the clinical situation.

The 2020 O'Neill study was an observational series from a practice using routine cholangiography. It found unsuspected duct stones in some patients, although an observational study cannot establish that one policy is preferable for every patient.

/ 04Patient information

What alternatives should be considered?

Observation may suit gallstones that have caused no symptoms. Acute illness can require pain relief, fluids, antibiotics in selected cases, drainage or later surgery. Public-hospital care is also available. The appropriate pathway depends on symptoms, complications, operative risk and patient preference.
/ 05Patient information

What risks should be discussed before surgery?

Material risks include bleeding, wound or internal infection, bile leak, bile-duct injury, retained duct stones, injury to nearby structures, blood clots, anaesthetic complications and conversion to open surgery. Personal risk varies, and consultation should cover the risks that matter in your circumstances.
/ 06Common questions

The usual operation removes the gallbladder with the stones inside because stones can form again in a gallbladder that remains.

Laparoscopic cholecystectomy commonly uses several small ports. Their number and size can change if the anatomy or inflammation requires another approach.

Many planned operations take around an hour. Acute inflammation, scarring, anatomy and bile-duct findings can make the operation longer.

Many people go home on the day of surgery or after one night when clinically appropriate. Your recovery and home support help determine discharge.

Yes. Conversion to an open incision is sometimes the appropriate way to complete the operation when inflammation, bleeding or anatomy makes keyhole surgery unsuitable.

/ 07Evidence and review

What evidence supports this information?

Current independent guidelines provide the main basis for treatment information. Professor Hugh’s publications are listed separately as research and practice context, with the limits of each study stated.

Independent guidelines and reviews

  1. NICE guideline CG188: Gallstone disease, diagnosis and management. Evidence-based recommendations for assessment and management. Guidance applies to populations and requires individual clinical interpretation.
  2. 2020 World Society of Emergency Surgery guidelines for acute calculous cholecystitis. International guideline addressing diagnosis, operative timing and alternatives in acute cholecystitis.

Research involving Professor Hugh

These publications provide research and practice context. Their design, population and age limit how broadly each finding can be applied.

  1. Hugh et al. Prospective study of 100 laparoscopic cholecystectomy patients (1992). An early single-series study describing outcomes in 100 patients. Its size, era and non-comparative design limit present-day generalisation.
  2. Connor et al. Operation-specific checklist (2014). A methods paper developing a standardised operative checklist rather than a trial of patient outcomes.
  3. Bender et al. Total 5 mm port approach (2018). A feasibility report about port technique. It does not establish a patient benefit over other port configurations.
  4. O'Neill et al. Routine intra-operative cholangiography (2020). An observational study of unsuspected bile-duct stones, which cannot determine the preferable policy for every patient.
  5. Wennmacker et al. Predicting operative difficulty (2019). A predictive study in acute biliary presentations. Prediction does not determine an individual operative course.

Reviewed by Professor Thomas J. Hugh, MBBS, FRACS, MD

Published 25 August 2026. Last reviewed 25 August 2026.

/ 08Related reading

Last updated 25 August 2026