GALLBLADDER SURGERY (CHOLECYSTECTOMY)

Cholecystectomy is the operation for removal of the gallbladder. In the vast majority of patients, the gallbladder can be removed laparoscopically using small incisions, a television camera, and long thin instruments. This laparoscopic approach allows for a shorter recovery period than traditional “open” surgery. In less than 2% of patients a longer, traditional abdominal open incision is required.

WHAT IS THE GALLBLADDER?

The gallbladder is a small pear shaped organ about the size of a golf ball that lies beneath the right side of the liver. The cystic duct carries bile from the gallbladder and joins the common hepatic duct to form the common bile duct. The common bile duct then empties into the beginning of the small intestine.

The main purpose of the gallbladder is to store bile. After we have eaten food that contains fats (fried foods, dairy products), the gallbladder releases bile which travels through ducts (known as the cystic and the common bile ducts) to the small intestines where digestion of fatty foods takes place. The bile aids in the digestion of fatty foods. However, one can live without the gallbladder without suffering symptoms because your liver will ultimately compensate.

Stones may form in the gallbladder that block the flow of bile resulting in pain in the right upper abdomen. Pain may radiate to the back or to the shoulder tip. These symptoms may be accompanied by nausea, vomiting, fever or jaundice. Gallstones can lodge in the terminal part of the common bile duct that opens into the small intestine. Here the stones can also block the flow of pancreatic juice from the pancreatic duct that joins the common bile duct. This may result in a severe inflammation of the pancreas called pancreatitis.

The exact cause of gallbladder disease is unknown. While some people may have no symptoms even in the PRESENCE of gallstones (cholelithiasis), others may have problems even in the ABSENCE of stones. In some patients the problem is that the gallbladder doesn’t contract, (or squeeze), normally. At times the gallbladder can undergo spasms or biliary dyskinesia and this, too, is reason for surgery.

WHO DEVELOPS GALLBLADDER PROBLEMS?

There are many possible factors which lead to people developing gallbladder problems. It is believed to be either related to how our bodies process fats in food or due to a gallbladder infection. Studies show that the following groups have a higher likelihood to develop gallbladder problems:

• Women in their 40’s
• Women after pregnancy. The risk of gallstones may increase with each pregnancy
• Men and women who are overweight
• People who eat large amounts of dairy products, animal fats and fried foods.
• Men and women with a family history of gallbladder disease.

HOW DOES YOUR DOCTOR DIAGNOSE GALLSTONES?

Your doctor will ask you for your medical history. Commonly patients with gallbladder problems have nausea, vomiting, right sided or central abdominal pain that may radiate to the back.

Tests that may be ordered to diagnose gallbladder disease include:

• Blood tests may be taken to detect jaundice or elevation of enzymes that occur as a result of blockage to the flow of bile.
• Ultrasound of the abdomen. This test employs sound waves to scan the abdomen for gallstones. The presence, size and position of the gallstones can be determined as well as gallbladder wall thickness and the size of the common bile duct.
• HIDA (OR CCK) scan. This scan employs a radioactive isotope to evaluate the function of the gallbladder or how well it contracts.

RISKS:

As with all surgery, laparoscopic and open gallbladder surgeries carry risks of complication. In addition to the risks associated with anesthesia there are recognized surgical risks which include bleeding, infection, and injury to organs, blood vessels, nerves or other structures, including bile ducts.

In the event of a complication, additional surgery and/or a longer stay in the hospital may be necessary and recommended by your physician.

While death is a risk and can result from gallbladder surgery it is an extremely rare event.

Patient should further consult their surgeon if they have questions or would like additional information.

LENGTH OF STAY:

The patient usually has minimal pain that is well controlled with medication. Frequently the patients are discharged home on the same day as their laparoscopic cholecystectomy was performed. Occasionally a patient may remain overnight. If a traditional open gallbladder removal is done, the patient may stay three to five days after surgery.

RECOVERY:

Patients eat a normal light diet on the day of surgery and may be able to return to light work in three to four days. It is preferable to avoid exertion and heavy work for several weeks though one can take regular walks. No driving while on prescription pain medication. You will be seen post-operatively in the office approximately seven to ten days after your surgery. After open surgery, no driving for two weeks and no lifting over five pounds for six weeks.