Surgery for Gallbladder Disease

 

What is the Gallbladder?

  • Gallbladder

    The gallbladder is a small pear-shaped organ, located beneath the right side of the liver.
  • The main purpose of the gallbladder is to act as a reservoir, collecting and concentrating bile. Bile, a digestive liquid produced by the liver, is released into the upper portion of the GI tract (the duodenum) continuously via the bile ducts, and a portion is stored in the gallbladder until it is triggered to empty itself. The gallbladder is stimulated to release bile after eating, which aids digestion.
  • Removal of the gallbladder is not associated with any impairment of digestion in most people.

 

What causes gallbladder problems?

  • Gallbladder problems are usually caused by the presence of gallstones, small masses consisting primarily of cholesterol and bile salts that form in the gallbladder.
  • Gallstones are common in the American population, with the incidence being increasing with age. Women are more commonly affected than men, and the incidence increases with pregnancy. There appears to be a familial predisposition to gallstone formation, and certain disease states also predispose some patients to gallstone development.

 

What are the symptoms of gallbladder disease?

  • When the gallbladder is stimulated to empty, such as after eating a fatty meal, the gallstones may block the passage of bile out of the gallbladder. This results in a sharp upper abdominal pain, nausea, and indigestion; these symptoms are termed “biliary colic,” and may last from 30 minutes to a few hours.
  • In some patients, this results in an acute or even chronic infectious process, with fever and persistent pain being present.
  • Gallstones may pass out into the common bile duct, causing jaundice (a yellowing of the skin) or pancreatitis (severe inflammation of the pancreas).
  • Some patients suffer from typical gallbladder symptoms without the presence of gallstones; this problem is referred to as “biliary dyskinesia.”

 

How are gallbladder problems found and treated?

  • The most common method to diagnose gallstones is with an ultrasound of the upper abdomen.
  • Patients who have very typical biliary colic, but no stones on ultrasound, may undergo a nuclear medicine HIDA scan to evaluate gallbladder function.
  • Blood tests are important to identify patients who may have gallstones which have passed into the common bile duct.
  • Gallstone disease does not resolve by itself. Some symptoms can be temporarily managed by making dietary adjustments, such as reducing fat intake. However, symptoms will eventually continue unless the gallbladder is removed.
  • Surgical removal of the gallbladder is the time honored and safest treatment of gallbladder disease. This can be performed laparoscopically in most cases, using small incisions, video equipment, and long, narrow instruments.

 

What preparation is required before surgery?

  • Most laparoscopic cholecystectomies are performed on either an outpatient or “short-stay” basis, so you should be able to go home on the same day of the operation or the following morning. The procedure is reviewed with you during the preoperative visit, along with its risks, to allow you to provide written consent for surgery.
  • We see our patients preoperatively a day or so before surgery, and depending upon your age and other medical conditions, preoperative test may include blood work, an EKG, or a chest X-Ray.
  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery; if you are on Coumadin or Plavix, it is very important to review instructions regarding these medications with your surgeon. Diet medications or St. John’s Wort should not be used for two weeks prior to surgery.
  • You should not eat or drink anything after midnight the night before the operation. If your surgeon has stated they are permissible, you may take your routine medications with a sip of water the morning of surgery.
  • You should arrange to have a friend or relative drive you home after surgery and, if going home on the day of surgery, someone should stay with you on the first night.
  • You should shower the morning of the operation, and wear loose-fitting clothing and slip-on shoes.

 

Further information about laparoscopic cholecystectomy can be found on a PDF file here on our web site.