The gallbladder stores bile and releases bile into the intestine, where it helps to digest fat at meal times. The gallbladder does not produce bile. Bile is produced by the liver. If the gallbladder is surgically removed, the liver continues to produce bile which similarly flows into the intestines.
Gallstones generally refer to stones that are found in the gallbladder. Gallstones are more common in females than males, in persons that are overweight or those with hemolytic diseases. Gallstones form when the amount of bile and other fluid in the gallbladder become unbalanced. When this happens, some of the chemicals become solid and form stones.
Often there are no symptoms that arise due to the gallstones (asymptomatic), and many patients only come to know that they have gallstones when they get a scan done for other reasons, for example during a health screening. When symptoms arise, they can range from discomfort after eating, especially with fatty food, to severe cramping pains over the middle and right of the upper abdominal area. Occasionally, complications can occur due to the gallstones such as infection of the gallbladder or blockage of the bile duct. In such cases, fever and jaundice (yellowing of the eyes) may be experienced in addition to the pain. Migration of the gallstones through the bile duct may also cause blockage of the pancreatic duct which leads to inflammation of the pancreas known as pancreatitis.
A scan is necessary to confirm gallstones. Most commonly, an ultrasound is performed. Stones may also be detected on CT scan or MRI of the abdomen. In addition, your doctor will also do a blood test to rule out any obstruction of the bile ducts.
Surgery is not necessary in most cases without symptoms as the risk of the surgery is more than the risk of developing symptoms and complications from the gallstones. Once gallstones become symptomatic, they tend to recur and can become worse. Thus surgery is advocated when symptoms develop, or when the patient develops complications from the gallstones such as infection of the gallbladder, obstruction of the bile duct or inflammation of the pancreas due to a stone that had blocked the pancreatic duct.
Surgery to remove the gallbladder is the standard treatment for gallstones. Surgery to remove just the gallstones and leave the gallbladder intact is not recommended as it does not treat the underlying diseased gallbladder.
A laparoscopic cholecystectomy is the procedure of choice for removal of the gallbladder. This is a procedure in which the gallbladder is removed using keyhole (laparoscopic) surgical techniques. In 5-10% of patients undergoing the laparoscopic procedure, there may be a need to convert to the open procedure due to circumstances encountered during the surgery. Such a decision will be made during surgery in order that the surgery proceeds safely and this is not considered a complication.
The operation is performed under general anaesthesia through small incisions in the abdomen. The gallbladder is detached from the liver and clips are applied to the artery that supplies the gallbladder and the duct that drains from it. The gallbladder is then extracted out of the body through one of the incisions.
Occasionally an X-ray, called a cholangiogram, may be performed during the operation to check for any stones in the bile duct or to visualize the anatomy of the bile duct. If there are one or more stones in the bile duct, the surgeon may remove them during the surgery itself or he may choose to have them removed later through an endoscopic procedure called ERCP, or he may convert to an open operation in order to remove all the stones during the operation.
This is a procedure where the gallbladder is removed through a longer incision on the abdominal wall. This incision is usually oblique and lies below the rib cage.
Risks of the surgery
This is a safe operation with very low complication rates. The risks of surgery include wound infection, bleeding and rarely blood clots in the legs or lungs. The risks specific to cholecystectomy are as follows:
• Small risk (less than 1%) of an injury to the bile duct, bowel and/or blood vessels, which may require further operative repair of the injury.
• Hernia may form at the incision sites, especially in obese patients. This may require operative repair.
• Small risk (less than 5%) of an undiagnosed stone or stones in the bile duct which may require subsequent procedures to address.
In the event of conversion of the laparoscopic approach to an open procedure, the risks will remain the same as above. However patients may experience more pain and may have a slightly longer stay in hospital.
Gallbladder removal is a major abdominal surgery and a certain amount of of post surgical pain may occur. Nausea and vomiting is not uncommon. Most patients go home on the same day or the day after the surgery. If the surgery was performed with a open procedure, the patient may have to stay a few days longer.
Activity is dependent on how the patient feels. Most of the patients can return to work within seven days following the laparoscopic procedure. Some patients may continue to experience abdominal bloating, and some may have increased frequency of stools after the surgery. Both symptoms will usually resolve within a couple of months.