GALLBLADDER REMOVAL (Cholecystectomy)

Cholecystectomy is the operation for removal of the gall bladder. Traditionally the surgery was carried out through an incision in the right side of the upper abdomen. More recently the surgery is done through a laparoscope employing 3 or 4 small incisions.

The gallbladder is a small pear shaped organ located beneath the liver in the right side of the upper abdomen. 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 concentrate and store bile. It releases bile by ejecting it through the common bile duct into the small intestine when fatty foods are eaten. The bile aids in the digestion of fatty foods. However, one can live without the gallbladder without suffering symptoms. Stones may form in the gall bladder, which block the flow of bile resulting in pain in the right upper abdomen. 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 gall bladder disease is unknown. Some studies suggest that gallstones may be related to how the body handles cholesterol and bile acids that are synthesized in the liver and stored in the gall bladder. While some people may have no symptoms even in the presence of gallstones, others may have gallbladder problems even in the absence of stones.

Diagnosis

Those individuals most likely to have gallbladder attacks are:

• Women, especially in their 40s.
• Women who have been pregnant . The risk of gallstones may increases with each pregnancy.
• Overweight men and women.
• People who eat large quantities of dairy products, animal fats and fried foods.
• Family history of gallbladder disease.

Gallbladder disease with stones may be associated with bloating, nausea or vomiting and in severe cases fever and other signs of infection. There may be intolerance to fatty foods. The symptoms of gallstones may occur after eating fried or oily foods, or a heavy meal. The symptoms may recur frequently and may be disabiling.

Indications:

Commonly patients with gallbladder problems have nausea, vomiting, or various types of pain due to their gallbladder not functioning properly. In the majority of patients the problem is the presence of stones within the gallbladder (cholelithiasis) although in some patients the problem is that the gallbladder doesn’t contract, (or squeeze) normally. This is termed biliary dyskinesia, and is another indication for gallbladder removal.

Pre-operative Evaluation:

• 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 echoes from the sound waves are recorded and imaged on a screen. 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 scan. This scan employs a radioactive isotope to evaluate the function of the gallbladder

Procedure:

In the vast majority of patients, the gallbladder can be removed laparoscopically using small incisions, a television camera, and long thin instruments. In some patients a longer, traditional incision is required.

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.

Patients 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, patients are discharged home on the same day as their laparoscopic cholecystectomy was performed with a prescription for pain medication. Occasionally a patient may remain overnight. If a traditional open gallbladder removal is done, the patient may stay three to five days after open surgery.

Recovery:

Patients eat a normal light diet on the day of surgery and may be able to return to light work in 3-4 days. It is preferable to avoid exertion and heavy work for a several weeks though one can take regular walks. No driving on prescription pain medication. After open surgery no driving for two weeks and no lifting over five pounds for six weeks.