Gallbladder Disease and Laparoscopic Cholecystectomy
The gallbladder is a small pear shaped organ that lies in the right upper quadrant of the abdomen underneath the liver. It is connected to the common bile duct, which carries bile from the liver to the small intestine. Its function is to store the bile made by the liver. During meals a hormone signal causes the gallbladder to contract and empty extra bile into the intestine to help with digestion.
When a gallbladder is inflamed or contains stones, it cannot function in its usual fashion. Anyone can develop gallbladder disease, but it is more common in women and in people who are overweight or over the age of 35. There also appears to be a strong hereditary component to gallbladder disease.
Symptoms of gallbladder disease can include abdominal pain, nausea, vomiting, diarrhea, indigestion, bloating, fever, and occasionally jaundice. The abdominal pain is most commonly experienced in the right upper portion of the abdomen or just below the breast bone. It typically occurs after eating fatty or greasy food and may radiate to the back or into the chest. The pain of a gallbladder attack may be severe.
Ultrasound is the most useful test to detect gallbladder disease. Ultrasound can identify gallstones as well as determine if acute inflammation is present by evaluating gallbladder wall thickness, presence of surrounding fluid and size of the common bile duct. A HIDA scan with or without CCK injection may also be used in a typical cases. CT scan may be helpful but it is less sensitive.
Surgical removal of the gallbladder is the treatment of choice when patients become symptomatic. The surgery can usually be performed with a laparoscopic camera. This means a camera with a magnified lens is inserted through an incision by the naval area. Three other incisions are made below the ribs in the right upper quadrant where instruments are inserted to perform the dissection using the camera. CO2 gas is used to distend the abdomen to create a working space. Often an x-ray test called cholangiogram is performed to evaluate the common bile duct. Occasionally, severe infection or scarring can prevent surgery from being completed with the laparoscope. In this situation the surgery will be completed through an open incision in the right upper quadrant.
Removal of the gallbladder is one of the most commonly performed operations. General anesthesia is utilized. The surgery is usually performed by laparoscopy, in which a camera is inserted through a small incision at the navel and used to view the gallbladder. Narrow instruments are inserted through three other small incisions. Carbon dioxide gas inflates the abdomen and creates space in which to work. The gallbladder is freed up and removed. A cholangiogram (x-ray test of the bile ducts) is frequently done as well.
Occasionally, severe infection or other problems can prevent completion of the operation with the laparoscope, In this situation, the operation will be completed through a standard “open” incision.
Laparoscopic surgery allows for a much quicker recovery and less post operative pain than traditional open surgery. Most patients are able to go home the same day of surgery. Some may stay over night if needed. Post operative pain is usually not severe, and is well-controlled with prescribed pain medications.
You may shower the day after surgery. There will be small tape “steri-strips” on your incisions. Leave those on until they fall off. The small gauze pads over the steri-strips may be removed before you shower. You can resume usual activities over the 3 to 5 days following surgery but should avoid strenuous activities for 2 weeks. You should also avoid greasy or fatty foods for two weeks. Follow-up with your surgeon 1 or 2 weeks after surgery.
Although complications from gallbladder surgery are not common, they may occur. Possible complications can include the following:
- Bleeding or infection
- Injury to organs (liver, stomach, intestines, bile ducts, others)
- "Bile duct injury leak", blockage, or retained stones
- Diarrhea or other post cholecystectomy symptoms
- Need for open surgery or other procedures, including endoscopic removal of bile duct stones
- Complications from anesthesia