Gallbladder Surgery

Overview

The gallbladder is a tiny organ located in the upper abdomen. If various therapies do not reduce the inflammation and discomfort caused by gallstones and associated complications, a person may need gallbladder removal surgery.

What does the Gallbladder do?

The gallbladder is a tiny sac that contains bile, which is a digestive liquid generated by the liver and used in the breakdown of dietary lipids. The gallbladder draws water from its bile storage until the liquid is extremely concentrated. When fatty meals are present, the gallbladder releases its bile concentration into the small intestine.

Gallstones (biliary calculi) are tiny stones formed in the gallbladder from cholesterol, bile pigment, and calcium salts. They are a prevalent digestive problem that affects around 15% of adults aged 50 and over.

Gallstones can develop as a result of the crystallisation of excess cholesterol in bile and the inability of the gallbladder to drain entirely. Gallstones do not usually create any complications. However, if stones block ducts and create problems like as infections or pancreatic inflammation (pancreatitis), you may require immediate treatment

If gallstones (or other forms of gallbladder disease) are creating complications, surgeons may remove your gallbladder (called a cholecystectomy). Laparoscopic ('keyhole') cholecystectomy and open surgery are also options. Because the gallbladder is not a critical organ, your body may function normally without it.

To remove the gallbladder, surgeons used to make a huge cut (incision) in the belly. This is known as open surgery. Today, surgeons can do this operation with microscopic equipment and a few small incisions. Laparoscopic surgery is so named because the main instrument is a laparoscope. Surgery with these little equipment is referred to as minimally invasive surgery.

Symptoms of gallstones

In approximately 70 per cent of cases, gallstones cause no symptoms. The symptoms of gallstones may include:

Pain in the abdomen and back. Pain is generally infrequent, but severe
Increase in abdominal pain after eating a fatty meal
Jaundice
Fever and pain, if the gallbladder or bile duct becomes infected.

Types of gallstones

There are three main types of gallstones being:

Mixed stones – the most common type. They are made up of cholesterol and salts. Mixed stones tend to develop in batches
Cholesterol stones – made up mainly of cholesterol, a fat-like substance that is crucial to many metabolic processes. Cholesterol stones can grow large enough to block bile ducts
Pigment stones – bile is greenish-brown in color, due to particular pigments.

Complications of gallstones

If gallstones cause no symptoms, you rarely need any treatment. Complications that may require prompt medical treatment include:

Biliary colic occurs when a gallstone moves from the gallbladder's body into its neck (cystic duct), causing blockage. Severe pain and fever are among the symptoms.
Gallbladder inflammation (Cholecystitis) occurs when a gallstone plugs the gallbladder duct, causing infection and inflammation of the gallbladder. Severe stomach discomfort, nausea, and vomiting are among the symptoms.
Jaundice occurs when a gallstone plugs a bile duct leading to the intestine, allowing blocked bile to reach the circulation rather than the digestive tract. Bile pigments turn the person's skin and eyes to yellow. Their urine may become orange or brown as well.
Pancreatitis is pancreatic inflammation caused by a clogged bile duct near the pancreas. Pancreatic enzymes irritate and burn the pancreatic, leaking into the abdomen.
Cholangitis is an inflammation of the bile ducts caused by a gallstone, which causes the bile to become infected. This causes discomfort, fever, jaundice, and rigors (shaking)
Infection of the liver
Cancer of the gallbladder (occurs rarely).

Treatment for gallstones

Gallstones that create no symptoms usually do not require medical attention. If you are at high risk of gallstone issues, surgeons may remove your gallbladder in specific circumstances (such as abdominal surgery for another ailment). Treatment options vary depending on the size and location of the gallstones, however they may include:

Dietary modifications – such as limiting or eliminating fatty foods and dairy products
Lithotripsy – Soundwaves are generated by a specific equipment to break the gallstones. This procedure is only utilized in a few clinics for a small number of persons who have tiny and soft stones.
Medications – Some drugs can remove gallstones, however due to adverse effects and a fluctuating success rate, this therapy is rarely used.
Surgery.

Surgical removal of the gallbladder or gallstones

Around 80% of persons with gallstone symptoms will require surgery. Surgeons may remove your whole gallbladder (cholecystectomy) or only the bile duct stones. The following methods are used to remove the gallbladder:

Laparoscopic cholecystectomy is referred to as "keyhole" surgery. The surgeon makes a series of tiny incisions (cuts) through the skin to provide access to various equipment. The gallbladder is removed by the surgeon through one of the incisions.
The gallbladder is reached by a larger abdominal incision during open surgery (laparotomy). If you have scars from previous procedures or a bleeding issue, you may require open surgery.
Medical factors to consider before cholecystectomy

Before the operation, you need to discuss some things with your doctor or surgeon, including:

Your medical history, since some pre-existing conditions may influence decisions on surgery and anaesthetic
Any medications you take on a regular basis, including over-the-counter preparations
Any bad reactions or side effects from any medications.

Laparoscopic cholecystectomy

The general procedure includes:

The surgeon creates many small incisions in your belly to allow narrow tools access to the abdominal cavity.
Inserted is a tube that emits a moderate stream of carbon dioxide gas. This divides the abdominal wall from the organs beneath.
Using a small camera linked to the laparoscope, the surgeon observes the gallbladder on a TV display.
During the surgery, special x-rays (cholangiograms) can be used to look for gallstones that have become lodged in the bile ducts.
The ducts and arteries that supply the gallbladder are severed. These clamps are not removable.
The gallbladder is removed through laser or electrocautery.
The gallbladder is removed from the body along with its burden of gallstones via one of the abdominal incisions.
The carbon dioxide gas and the equipment are withdrawn from the abdominal cavity. Sutures are used to seal the incisions, which are then covered with dressings.

Open gallbladder surgery

The overall process is the same as for laparoscopic surgery, except that the gallbladder is reached by a large, single incision in the abdominal wall. If the surgeon meets unanticipated complications, such as not being able to see the gallbladder correctly, a laparoscopic cholecystectomy may be converted to open surgery.

Immediately after gallbladder surgery

After a gallbladder operation, you can expect to:

Feel mild pain in your shoulder from the carbon dioxide gas
Receive pain-relieving medications
Be encouraged to cough regularly to clear your lungs from the general anaesthetic
Be encouraged to walk around as soon as you feel able
Stay overnight in hospital, if you had a laparoscopic cholecystectomy
Stay up to eight days in hospital, if you had open surgery.

How Should I Prepare for Laparoscopic Gallbladder Removal?

You will require a thorough physical examination. You may require certain tests to ensure that you are in good enough health to have surgery. The surgeon who will perform your laparoscopic gallbladder removal will discuss the risks and advantages of surgery with you. Then you'll sign a document stating that you understand and consent to the procedure. Before surgery, your surgeon's office will advise you on what to do and what to avoid. Your surgeon will give you specific instructions, but here are some general guidelines.

Shower the night before or the morning before operation. Your surgeon may advise you to use antibiotic soap. Please do not shave your stomach.
Before surgery, stop eating and drinking at the time your doctor specifies.
You may take drugs prescribed by your doctor on the morning of your operation. Take one with a sip of water.
Certain medications may need to be discontinued prior to surgery. These include blood thinners, vitamins, and immune-suppressing medications. When you arrange your laparoscopic gallbladder ectomy, consult with your surgeon.

You will require transportation home following surgery. You will also require someone to accompany you overnight. Inquire with your doctor or nurse about how much assistance you may require.

What happens during Gallbladder Removal?

Gallbladder removal is often performed by keyhole surgery, which eliminates the need for your surgeon to make a major incision in your belly. Keyhole surgery to remove your gallbladder typically lasts 30 to 90 minutes. In most cases, your surgeon will make four tiny incisions in your belly. He or she will use harmless carbon dioxide gas to expand your belly and make it easier to observe your interior organs. A laparoscope (a long, narrow telescope with a light and camera lens at the tip) will then be passed into one of the wounds by the surgeon to observe your inside organs on a monitor.

Then, via the other wounds, your surgeon will introduce specially designed surgical equipment to remove your gallbladder. X-rays may be taken during the procedure to ensure that there are no gallstones in the bile duct. The carbon dioxide gas is allowed to escape at the end of the process, and the instruments are removed. Your surgeon will use stitches or metal clips to seal the wounds and cover them with a dressing.

What is Robotic Cholecystectomy?

Your surgeon may employ a surgical robot to do your procedure. It is done in the same manner as described earlier. Instead of controlling the devices by hand, your doctor directs the robot. This is usually known as robotic surgery.

During surgery, you may be given a specialist X-ray of your gallbladder and bile duct. Gallstones in the common bile duct can be detected with this X-ray. If you have them, your surgeon may need to perform extra treatments during the procedure. Alternatively, you may require a different process to remove them afterwards. Before your operation, it is critical to understand your doctor's training and experience. Inquire about their expertise with laparoscopic and open gallbladder removal.

What if I Cannot Have Laparoscopic Gallbladder Removal?

Some people are not candidates for laparoscopic gallbladder removal. If you are one of these folks, you may require open surgery. Some of the reasons for having or transitioning to open surgery are as follows:

Your gallbladder has a lot of damage – Such as scars or inflammation.
You have scar tissue in your abdomen from earlier surgery.
You have obesity – This means being very overweight.
The surgeon cannot see very well inside your body through the laparoscope.
You have bleeding problems during surgery.

If your surgeon decides to perform open surgery, it is not a complication (issue). If open surgery is the safest choice for you, they will switch. Your surgeon may not be aware of this until the laparoscopy begins. They will make the greatest decision for you based on their experience.

What are the alternatives to Gallbladder Removal?

If you have gallstones but they aren't causing you any symptoms, or if surgery to remove them isn't an option for you, there may be other options. Medicines can sometimes clear gallstones, however gallstones commonly reappear after this sort of therapy, therefore it is seldom utilized.

Gallstones in the bile duct, rather than the gallbladder, can be removed during ERCP. An endoscope is inserted into your mouth and down to your bile duct using X-ray guidance. In addition, special equipment can be placed through the endoscope to allow the surgeon to remove the gallstones from your bile duct. Only gallstones discovered in your bile ducts can be removed using ERCP. If you have gallstones in your gallbladder, you may need gallbladder surgery as well. Your surgeon will go through any alternate therapies with you.

What to expect following the procedure?

Going Home

You will most likely be able to go home the same day as your operation, or you may be required to stay in the hospital overnight. You must be able to swallow beverages before returning home.

Will I be in pain?

You will have some discomfort following surgery. It is usual to have pain at the incision sites and in your belly. You may also have shoulder ache. This is due to the air that was injected into your abdomen during the procedure. Shoulder soreness should subside in 24 to 48 hours.

Unless your doctor instructs you otherwise, you can take non-prescription pain relievers. Non-prescription pain treatments include acetaminophen (Tylenol®) and ibuprofen (Advil®). Applying cold to your incisions might also be beneficial. Inquire with your doctor or nurse about the proper technique to use ice.

To alleviate discomfort, your surgeon may prescribe a modest dosage of narcotic pain medication. Many individuals recover from surgery without using narcotic pain relievers, although some will require them for a few days. Ask the surgeon or the nurses if you have any queries about pain following surgery. They should know how long the pain will persist and what to expect.

Following surgery, you may feel ill to your stomach (nauseated) or vomit. This can be accomplished by surgery and anesthetic. In a day or two, you should feel better. If you continue to vomit or feel sick, notify your doctor or nurse.

Activities

You should exercise as much as your body allows. Walking is advised by doctors. On the day of your operation, you will be able to go up and down the stairs. You may remove your bandages and shower the next day, if you have them. You might anticipate to feel a bit better after returning home each day. Please contact your doctor if this is not the case.

After laparoscopic gallbladder removal, you should be able to resume regular activities within a week. If you perform a physically demanding profession that requires heavy lifting, see your doctor about when you may return to work. If you are not using narcotic pain relievers, you can drive 24 hours after having anesthesia.

You will need longer time to heal if you underwent open surgery with a huge incision. You will most likely need to stay in the hospital for a few days following surgery. Expect to resume normal activities in 4 to 6 weeks. You will most likely heal more slowly in other ways as well. Your doctor will be able to inform you what to expect.

What are the risks of Gallbladder Removal?

Gallbladder removal, like any other treatment, carries inherent hazards. We have not listed the possibility of these occurring because they are unique to you and vary from person to person. Inquire with your surgeon about how these risks relate to you. Side effects are the unwelcome but usually transitory side effects of the operation. Potential adverse effects include:

Shoulder pain
Abdominal pain
Diarrhea

Complications

Complications occur when issues arise during or after the surgery. An unanticipated response to the anaesthesia, severe bleeding, or the development of a blood clot, generally in a vein in the leg, are all possible risks of any treatment (deep vein thrombosis)

There is a potential that your surgeon will need to convert from a keyhole treatment to open surgery during the process. He or she will have to create a larger incision in your abdomen. This will only be done if the keyhole approach cannot be used to perform your procedure safely. This sort of surgery will most likely take you longer to recover from than keyhole surgery, and you may need to spend more time in the hospital.

Other possible complications may include:

Pain in your abdomen, bloating, wind and diarrhea
Accidental damage to your bile duct or other organs
Infection
Bleeding (haemorrhage)
Leakage of bile from your bile duct or liver

Conclusion

The gallbladder is not a necessary organ, which means you may survive without one. It is a bile storing organ. Bile aids in the digestion of lipids. The most frequent therapy for gallstones is gallbladder removal. When the surgeon removes your gallbladder, the bile that was previously contained in it drains into the hepatic and common bile ducts. It then travels directly to the duodenum, the first section of your intestine.