The gallbladder is a pear-shaped organ, connected with the bile ducts arising from the liver and adjoining the small bowel. The gallbladder stores and concentrates bile which is produced by the liver and helps in digestion of fats and certain waste products by releasing the bile into small bowel. Bile is a yellow-green liquid, composed of water, lecithin, cholesterol, bile salts, and bilirubin. Bile acts as a detergent to turn greasy fat into emulsion
Gallstones (bile salt crystals) may develop in the gallbladder due to improper ratio in the bile of cholesterol, bile salts, or bilirubin. This can result in blockage of the gallbladder or liver. This can cause severe pain in the upper abdomen (biliary colic). Furthermore, stone formation may produce gallbladder inflammation, a condition known as cholecystitis. Gallbladder dysfunction can also occur without gallstones or polyps may form in the gallbladder. In rare cases, gallstone formation may result in cancer development in the gallbladder and biliary ducts.
Why consider Gallbladder surgery?
Gallstones may not cause any symptoms but when symptoms appear, they usually are sudden and often referred to as a "gall bladder attack or biliary colic". Typical symptoms include:
- Severe abdominal pain
- Back pain near shoulder blades
- Nausea and vomiting
- Abdominal bloating and belching
- Intestinal colic or reflux
- Stomach upset
What are the advantages of laparoscopic Gallbladder surgery?
Gallbladder surgery is considered the best option for troublesome gallstones. Most people can live a normal life without their gallbladder, as gallbladder removal results in direct passing of the bile from the liver into the small intestines through the bile ducts.
The surgery to remove the gallbladder is called a cholecystectomy and is, usually performed through minimally or even micro invasive operation called a laparoscopic cholecystectomy.as compared to open abdominal surgery which requires a long incision
How is gallbladder surgery performed?
Surgical removal of the gallbladder can be done one of two ways:
Open method involves a 5-7-inch incision in the upper right-hand side of the abdomen, below the ribs. Your surgeon removes the gallbladder through the large, open incision.
Laparoscopic cholecystectomy is a less invasive surgical method that uses a small, thin video camera attached to UHD monitor) to visualize inside the abdomen during the operation.
The surgery is performed under general anaesthesia. A 12mm incision is placed in the curve of the bellybutton and a plastic trochar inserted for the camera. Low pressure carbon-dioxide is introduced into the abdomen to inflate the abdominal cavity so that the gallbladder and other adjacent organs can be visualized easily. 2-3 very small (3-5mm) incisions are inserted for specialised laparoscopic instruments. Dr Gandy first identifies the critical anatomy of the gallbladder, before dividing the duct from the gallbladder, blood vessels leading to the gallbladder, and then removes the gallbladder.
Your surgeon may also perform a procedure called a cholangiogram during the surgery, which uses X-rays and an x-ray dye to view the bile ducts. This is done to identify gallstones that could have escaped from the gallbladder, narrowing of the bile ducts or abnormal anatomy.
The gallbladder is placed in a soft plastic bag and removed from the abdomen via the umbilical incision. The incisions are closed with dissolving sutures placed under the skin before waterproof dressings are applied.
After Gallbladder surgery?
After surgery most people experience some pain around the incisions or in the right shoulder blade. This can be controlled well with painkilling tablets. If your surgery occurs in the morning you may be able to go home the same day, otherwise a single night in hospital is required. You will be able to eat immediately after the surgery, but it is a good idea to avoid very fatty foods for a couple of weeks. You can return to normal activities within 24 hours and resume work and drive a car after one week. However, you should not engage in strenuous activities for a few more weeks.
What are the risks of gallbladder surgery?
The removal of the gallbladder is generally a safe procedure, but like all operations, there are risks and complications associated with the procedure. Some of these include bleeding, infection, leakage of bile fluid, and damage to the bowel and large blood vessels.
Up to 15% of patients may have short lived post cholecystectomy syndrome. This is a strange constellation of symptoms that may include loose-ish bowel motions, bloating, reflux or even phantom gallbladder pain
The most serious (but rare) complication of gallbladder surgery is injury to the bile ducts that can result in leakage of the bile inside the body and may cause pain and infection. This is rare but can require a second larger operation to correct this.
In cases where gallstones are present inside the bile ducts they can be removed by the laparoscopic technique during the surgery or by endoscopic technique called ERCP.