Specialist Upper Gastrointestinal & Bariatric Surgeon

Secretary: Nicola Symons

Telephone: 01872 226150

Specialist Upper Gastrointestinal & Bariatric Surgeon


As a specialist in gallbladder surgery, Mr Clarke follows latest national and international guidelines (see resources) in the investigation and management of patients with gallstones, utilizing the most up-to-date surgical techniques, including laparoscopic common bile duct exploration and intra-operative ultrasound.


What is the gallbladder?

The gallbladder is a small sac attached to the underside of the liver. Its function is to store and then release bile (a fluid consisting of water, bile salts, bilirubin and fats) into the intestine after eating a meal in order to aid digestion of fat.

What are gallstones?

Gallstones develop when there is an imbalance in the constituents of the bile within the gallbladder causing sedimentation

What problems do gallstones cause?

There are 5 main conditions related to gallstones:-

Biliary colic: A gallstone becomes stuck in the exit channel from the gallbladder (commonly after eating a fatty meal) resulting in the gallbladder squeezing repeatedly to clear the blockage. The stone eventually drops back inside the gallbladder clearing the exit.

Cholecystitis: As above but the blockage fails to clear and inflammation +/-infection then develops inside the gallbladder.

Common bile duct blockage: A stone passes out of the gallbladder into the main bile drainage system (common bile duct) and becomes stuck causing a blockage to bile drainage.

Pancreatitis: The pancreas gland, responsible for controlling blood sugar (through insulin & glucagon production) and producing chemicals (enzymes) to help break down food, can develop inflammation when a gallstone passes through the main bile duct and alters drainage from the pancreas gland.

Gallstone Ileus: This is a rare condition in which a gallstone erodes through the wall of the gallbladder into the small intestine (duodenum) and can subsequently cause a blockage of the bowel.

What are the treatment options?
Watch and wait:

– Patient has no symptoms
– Patient is not fit enough for a surgical procedure
– Patient choice


Generally ineffective and only useful in those not fit for surgery with very small stones. There is a high incidence of stones reforming.

Surgery (see below)

Patients who have symptoms affecting their quality of life
Patients who have had a complication related to their gallstones (e.g. cholecystitis, common bile duct blockage, pancreatitis)

ERCP (telescope test performed under a sedative in the endoscopy department)

Patients with a stone in the common bile duct where either surgical removal of the stone at the time of gallbladder surgery is deemed unsuitable, the patients is not fit for surgery or the patient has had their gallbladder removed previously
Patients with gallstone related pancreatitis who are not fit for gallbladder surgery

What does surgery involve?
Before surgery

Once a decision is made to go ahead with surgery, you will need to attend the pre-assessment clinic at which a number of routine checks and blood tests will be performed. You may be asked to complete a special liver reducing diet in the one or two weeks prior to surgery.

The operation (Laparoscopic Cholecystectomy)

The gallbladder is removed using laparoscopic (keyhole) surgery. It requires 4 small stab incisions in the skin (measuring 5mm-10mm), all of which are closed using dissolvable stitches. In a small number of cases (3%) a larger incision may be required. You will routinely be issued anti-embolism stockings to wear during the surgery. The procedure normally takes around 45 minutes.

Where the patient has previously had abnormal liver function blood tests or has widening of the main bile duct on ultrasound scan, an x-ray (cholangiogram) or ultrasound is performed during the surgery to ensure no gallstones are in the main bile duct. If stones are seen within a widened common bile duct (over 8mm wide) they can be removed at the same time using a small telescope and basket.

After surgery

Most patients are discharged on the same day as the operation (daycase). Patients are normally ready to be discharged around 4-6 hours following surgery. You will be discharged with painkillers and written post-operative instructions. All stitches are dissolvable. The waterproof dressings are suitable for the shower and can be removed after 7 days.

Full recovery takes two weeks after keyhole surgery, but may take 4 weeks after open surgery.

What are the potential risks?
  • a) Shoulder tip pain – This is common after keyhole surgery and normally resolves within 24 hours. It is due to gas used to inflate the abdomen during surgery.
  • b) Bleeding – This can occur with any operation and on occasions may require a blood transfusion (unless the patient expresses a wish not to). It is more common in patients taking blood thinning medications (e.g. warfarin, clopidogrel, dipyridamole).
  • c) Infection – This may affect the wounds, lungs or site of intravenous lines.
  • d) Blood clots in the legs or lungs (deep vein thrombosis or pulmonary embolism) – Patients wear antiembolism stockings to reduce this risk.
  • e) Bile duct injury – this can occur in 1 in 300 operations and may require further intervention including further major surgery
  • f) Retained stone – Sometimes a stone may have moved into the main bile duct prior to or during the operation. If it fails to pass through into the bowel it may require a further procedure to remove it.

Other conditions affecting the gallbladder

Biliary dyskinesia

This is a poorly understood condition in which the gallbladder is thought to not empty properly after a meal, resulting in similar pains to those experienced with gallstones. Diagnosis is commonly made using a HIDA scan (a nuclear medicine scan assessing activity within the gallbladder after eating cream or a fatty meal). Surgery can lead to an improvement of symptoms in over 90% of patients.

Gallbladder polyp

In some patients a small swelling (polyp) may arise from the wall of the gallbladder with or without gallstones. Where a polyp less than 1cm is detected this is normally followed up by surveillance ultrasound, however once this reaches over 1cm in size, current recommendations are for the gallbladder to be removed due to the potential for cancer cells to be found within the polyp.

Porcelain gallbladder

This describes a hardening of the wall of the gallbladder (calcification) giving it a ‘porcelain’ appearance. Due to its possible relationship with future gallbladder cancer, surgery to remove the gallbladder may be recommended.

Gallbladder cancer

This is a rare cancer and more commonly affects those aged over 70 years. It often causes no symptoms in the early stages but later may cause upper abdominal pain, jaundice and weight loss. If this diagnosis is suspected you may require a more detailed x-ray scan (CT scan) to decide if it can be treated with surgery.


Very down to earth, made me feel very comfortable and reassured

May 2024

Extremely proficient, professional and considerate surgeon

April 2024

I felt confident and safe from the first appointment. I would recommend Michael Clarke especially to anyone worried about forthcoming op

March 2024

Very professional and easy going manner. Excellent understanding of my understanding and ability to suggest courses of action

February 2024

Very professional, personable and I felt listened to

February 2024

Mr Clarke was most reassuring, provided clear guidance and options. Altogether inspired confidence throughout

December 2023

Mr Clarke gave me confidence in his knowledge from our first meeting. he also listened to my questions

September 2023

Explained things well in a way people understand, good bedside manner

September 2023

Mr Clarke not only put me at ease at the first consultation but such is his manner and explanation that I felt confident throughout. If surgery can be a good experience, this was.

4th October 2022

I felt completely at ease, a friendly approach and a sense of humour. Would definitely recommend.

1st July 2022

Excellent Consultant who made me feel totally at ease and confident that he would return me to full health - which he did.

29th April 2022

Very pleasant surgeon to talk to and very reassuring. Explained everything in clear language.

20th October 2021

Mr Clarke was courteous and respectful to me and explained my condition and treatment required. I was very happy with my post op recovery and had very little pain. I would not hesitate to contact Mr Clarke if I ever needed his help again.

29th May 2021

Mr Clarke made me feel completely at ease and confident in his ability through his mannerisms and professionalism. Mr Clarke was exceptional on the day. I'd be happy for him perform surgery on me again.

15th April 2021

I felt that Mr Clarke listened to me really well and thoroughly investigated my symptoms before deciding surgery was the best option

22nd March 2021

The whole experience from start to finish was done in a very empathetic and professional way. I was given ample time for questions and all tension and worry was removed form the procedure.

9th March 2021

I highly commend his approachable friendly manner. He made me feel at ease and informed through all aspects of my treatment and surgery.

15th January 2020

Surgery, care and follow-up were carried out to a very high standard. I wouldn't hesitate to recommend Mr Clarke to others.

18th December 2019

I found Mr Clarke extremely confident in this line of surgery, knowledgeable and very nice. Had a great ability to keep me at ease throughout.

8th June 2019

Perfect from referral to discharge. Everything explained fully. Every discussion with Mr Clarke was perfectly judged.

1st December 2018

Mr Clarke was outstanding from the start of my treatment to the end. He was empathetic, knowledgeable, respectful and made you feel at ease.

23rd August 2018

Mr Clarke was extremely efficient both in consultation and surgery. He was very caring and took time to explain procedures. I would highly recommend him.

24th January 2018

Very pleased with outcome of op from Mr Clarke. Just like 2016 he was very helpful and so professional. Would definitely recommend.

27th January 2018

Excellent manner both in consultation, pre- and post-op. Would definitely be happy to see him and recommend to others requiring surgery.

13th October 2017

Mr Clarke made the whole experience a breeze. So calm, polite and understanding of patients' needs.

13th September 2017

My introduction to Mr Clarke was met with a warm smile and a firm handshake. He was professional and friendly and put me at ease. I have no hesitation in recommending Mr Clarke.

9th August 2017

Mr Clarke did everything he said he would. Appointments came through quickly and I was made to feel comfortable and I had confidence in Mr Clarke from the outset.

1st June 2017

Mr Clarke has been most helpful to my specific situation. He made allowances for me and adapted to my particular health issues.

24th February 2017

Mr Clarke could not have done more for me. He looked after me and made me feel important and safe.

23rd February 2017

Whole experience was very professional, so felt safe in his hands. Communication so important and Mr Clarke was brilliant.

1st December 2016

Due to unforeseen circumstances, the contact details for my secretary have changed. Please use the new contact details for Nicola Symons listed in the top right hand corner of my main webpage.

If you have been in touch using the old contact details in the last 14 days and not yet received a reply, please contact me using the new contact details.