Dr. Manoj Choudhury

Prof (Dr.) Manoj Kr. Choudhury MS, FICS, FMAS

Registration Number : 7645 ( AMC )

Chief consultant, GI Surgery & Endo-laparoscopy centre, Guwahati

Visiting Consultant Laparoscopic Surgeon, Namcare Superspeciality Hospital

Specialist in Advanced Laparoscopic Surgery with 38+Years Experience

(+91) 7086090649(Appointment ) | 9864064895
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What is a Gallbladder
It’s a pear or globular thin walled hollow organ attached to liver bed and connected to the common bile duct. It acts as a reservoir of bile. Bile is concentrated in the gall bladder and prepared for digestion of fatty food.
What is bile- is a golden yellow fluid secreted from liver and carried by bile duct to gallbladder.  Bile in the gallbladder is concentrated and prepared for digestion of fatty food in the intestine.
What is a Common bile duct- It’s a tube like structure connecting liver with the intestine. Bile is carried from gallbladder and liver to the intestine when fatty food reaches intestine. 
What is the function of gallbladder- Inner wall of the gallbladder absorbs water from bile and pour a semisolid fluid and prepare for digestion of fatty food.  Gallbladder pumps the bile to the intestine via common bile duct when the fatty food reaches intestine. The process of pumping the bile is controlled by hormone.
How gall stone is formed –Usually the ingredients of bile maintain a balance. Salts and pigments precipitate when this balance is disturbed resulting in stone formation.
What are the symptoms of gall stones? - Upper abdominal colicky pain radiating to back ( not in all patients), vomiting, flatulence after spicy food, intolerance to fatty food, indigestions following  spicy food.  Fatty, fertile female of forty are the candidates for gall stone disease. 
What are the symptoms of stones in common bile duct? -  Acute colicky pain upper abdomen radiating to back with/ without jaundice and with/ without fever with chill. Sometimes may be associated with Pancreatitis  
What is obstructive jaundice-- Acute colicky pain upper abdomen with/ without fever followed by jaundice 
What is billiary pancreatitis –Acute pancreatitis (swelling of pancreas with accumulation of fluid around the pancreas) caused due to spasm in the lower opening ( ampulla) of the bile duct probably due to plugging by bile/ stone.
Diagnosis of Gall stones
Commonest and effective investigation is Ultrasound Examination
Acute Gall bladder infection (Acute Cholecystitis)- is diagnosed by routine blood examinations and liver function tests along with Ultrasound examination.  Contrast CT scan is required in specific situations.
Common bile duct stone or disease is effectively diagnosed by MRCP (Magnetic resonance cholangio-pancreatography). Endoscopic Sonography is also an effective investigation but not commonly available.
Contrast CT is done in some situations
Pre operative preparation- Thorough examination and investigation to exclude other problems like diseases of lung, heart, kidney, liver, blood etc and to inform the attendants and treat them prior to surgery.
Dietary advice for Gall stone patient - Avoid fatty ( Egg yolk, Oily fish, meat, Fried food, oily food, milk and its products) and spicy food when gall stone disease is detected. Advised to take boiled vegetables, fresh fruits, vegetable salads etc. Egg white is allowed.
Pre operation advice
 Smoking, alcohol must be stopped before surgery. Medications are taken as advised by doctor. Patient is given light food on previous night and advised laxatives.  Advised good bath with naval cleaning before surgery. Pre operative medications are taken on the day of surgery. Patient is not allowed anything by mouth six hours before surgery
Treatment of gallstone disease- Pre 1987 era, Gall stone diseases were treated with open surgery by making large incision. Hospital stay and recovery was prolonged.
1.Laparoscopic Cholecystectomy (Removal of Gall bladder by using laparoscope through small holes) is the method of choice for gall bladder removal due to minimal post operative pain, speedy recovery and negligible post operative scar. Hence cosmetically much superior than open surgery.  Patients are discharged within 24 hrs if there are no associated diseases.  With experience of more than 20000 gall bladder surgeries, laparoscopy has been safely carried out even in the badly infected gall bladder with excellent recovery. 
Single Incision Laparoscopic Surgery- Laparoscopic removal is also done through single opening at the umbilicus to avoid scar over the abdomen. This method is cosmetically better but with higher incidence of hernia. This procedure is done in selected patients using special equipments. It requires skill to do it and is costlier. We do in selected affordable patients.
Treatment of bile duct stones- bile duct stone can be treated by 
1) Open surgery – it was the procedure in earlier days to extract stone of bile duct as there were no alternatives.  
2 Laparoscopic Bile duct Surgery - I have been doing this procedure since 1998 and have pioneered the procedure in North East India. Stones more than 10-15 mm and larger stones with failed ERCP extraction are the ideal situations for this procedure. 
3) ERCP (Endoscopic Extraction)- Endoscope is pushed through mouth  and stomach to remove the stone from the lower end of the bile duct under radiological vision. Stones around 10 mm size or less are ideal for this procedure. But even up to 15 mm stone can be removed by experienced endoscopist.  Attendants should be explained about possible complications of ERCP and Laparoscopic bile duct exploration.
Gall stone with Billiary Pancreatitis- Gall bladder is removed one month after the patient recovers from acute pancreatitis 
Conversion to open surgery-. Patient and the attendants are counseled about probable complications and the possibilities of conversion to open surgery if situation demands and written consent should be taken.
Post operative advice- Patient is put on oxygen support till fully oriented and may be kept in the recovery ward if necessary. During this period patient is not allowed mouth feeding.  Light liquid is started four hours after surgery when the patient is well oriented.  Semisolid after 12hours, non spicy solids after 24hours if patient recovers well. Then gradually start normal diet. Patient is advised normal movements like going to toilet.  Symptomatic medications are prescribed for post operative period. Prophylactic antibiotics three doses are injected. Antibiotic is continued for minimum period of 5 days when there is infection. Wound dressing is removed after 7 days and allowed to take bath. Patient is advised to resume non strenuous work after seven to ten days.

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About Dr. Manoj Choudhury

Dr. Manoj Choudhury was awarded Master of Surgery in 1982 by Gauhati University. Then he joined as resident Surgeon of Surgery at Gauhati Medical College. Since 1984 he has been
performing various conventional Gastro-Intestinal, Hepatobiliary and Pancreatic Procedures with excellent result. Prof. Choudhury had undergone training in Advanced Laparoscopic Surgery in 1997 with Sir Cuschieri at Dundee, Scotland. Since then he has been closely associated with the development of Laparoscopic Surgery in the eastern part of India.He has been regularly conducting and organizing workshops and CMEs to update.. [Read More]
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