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General Information
The gall bladder is a hollow organ located just under the liver. Its function
is to store bile and release it when stimulated by the intake of food. Bile
is used by the body help us digest our food.
Sometimes the concentrations of cholesterol and bile salts in the bile lead
to formation of crystals, which can become sludge or stones (calculi).
Symptoms/Causes
 Stones
in the gallbladder can lead to obstruction of the duct (tube) that drains the
bile from the gallbladder. When food is ingested, the gallbladder contracts,
trying to release bile. If the outlet is blocked with stones or sludge, patients
experience pain in the right upper abdomen. This pain can be severe. It usually
improves when the contraction stops.
The gallbladder can subsequently become inflamed due to prolonged obstruction.
This is a condition known as cholecystitis. The pain in this situation will
not let up. Another potential problem that can occur with stones is a blockage
of the main bile duct. This occurs when a stone or stones get out of the gallbladder
into the tubes that lead to the intestine. This can lead to jaundice (yellow
skin) and severe potentially life-threatening infection. The pancreatic duct
can also be obstructed at the point where it joins the main bile duct near the
opening to the intestine. This can lead to inflammation in the pancreas known
as pancreaitis. This, too, can be a severe life-threatening situation.
The gallbladder can also
have functional problems that can cause pain. If it does not contract or empty
properly (biliary dyskinesia) many of the same symptoms seen with gallstones
can occur.
Treatment
Gallstones will not go away on their own, and medical (non-surgical) therapies
are not successful in the management of gallstones.
Surgical removal of the
gallbladder is the standard of care.
You doctor can make the
diagnosis in most cases with a good history and physical exam and an ultrasound
of the gallbladder. If the ultrasound is normal, another study that tests the
function of the gallbladder is typically done (HIDA scan with kinevac).
Once the diagnosis is made,
patients are referred to a surgeon. Who should have their gallbladder removed?
Anyone who has symptoms from a gallbladder problem (stones or functional), or
a complication from gallstones (pancreatitis, obstruction of the common bile
duct, jaundice).
Surgery: Before
and After
The pre-operative period
Your SCOSA surgeon will review with you the risks and benefits of the procedure
at your clinic appointment. You will be sent for some routine lab work, X-rays,
and an EKG. In addition, your SCOSA surgeon will set up any further testing
required to evaluate your gallbladder before surgery.
On the day before surgery,
you should have only a clear liquid diet and nothing to eat or drink after midnight
with the exception of some medications. This will be clarified by your SCOSA
surgeon. You should shower the day before or the morning of your operation.
Medications such as aspirin,
coumadin, or other blood-thinning agents should be stopped at least seven days
prior to surgery. Vitamin E, diet medications and St. John’s Wort should
also be stopped at least one week prior to surgery.
Please go over any specific
questions with your SCOSA surgeon.
Patients are encouraged
to stop smoking and begin an exercise program in advance of any operation.
The day of operation
The day of operation
Your SCOSA doctor will give you detailed instructions about where and when you
should be the morning of your surgery.
Once you arrive at the hospital,
a nurse will start an IV, and you will meet with your anesthesiologist and your
SCOSA surgeon to answer any last-minute questions. You will likely receive some
pre-operative medications and then be taken to the operating room.
After surgery, you will
be in the recovery room until you are completely awake.
Depending on the severity of the gallbladder disease, you may spend time in
the hospital. Patients undergoing elective outpatient gallbladder surgery almost
always go home the day of the surgery.
The Surgery
There are different types of laparoscopic gallbladder surgery.
- Laparoscopic cholecystectomy
The gallbladder is removed using a camera and three or four tiny incisions.
Today, most surgeons are able to perform this operation. Patients may return
to work in about a week if the operation is performed in an elective situation.
For emergency surgery, the recovery time is variable depending on the severity
of the illness.
- Laparoscopic Common
Bile Duct Exploration
At times, the main bile duct can be blocked by stones. These can often be
removed by a gastroenterologist using a scope (ERCP). In some situations,
the stones cannot be extracted, or they are detected at the initial operation
done to remove the gall bladder. Most surgeons at this point would make a
large incision on the abdomen and explore the common bile duct removing the
stones or diverting the flow of bile. SCOSA surgeons have highly specialized
training and skills and are often able to perform these procedures without
making the big incision. This leads to a shorter hospital stay and recovery
time.
After surgery
You should schedule a routine follow up with your SCOSA surgeon two weeks after
the operation.
Some patients experience a transient diarrhea after their gallbladder is removed.
Although this operation is very safe and has a less than 1 percent mortality
rate, this is an important decision for you and your physician. Potential acute
complications are rare, but can include bleeding, infection, damage to internal
organs, damage to the common bile duct or intestine, bile leak, retained stone.
Other less common risks are hernia, wound problems, need for open surgery or
re-operation.
You should call your SCOSA surgeon immediately if you experience any of the
following after this procedure: persistent fever of more than 101 degrees, persistent
nausea or vomiting; worsening abdominal pain- uncontrolled by medication; increasing
abdominal swelling; chest pain; shortness of breath; redness around or pus coming
from incisions; or the inability to tolerate liquids.
Outcomes
Most patients have complete resolution or a significant improvement of their
symptoms. Typically, patients experience some soreness in the muscles of their
abdomen for one or two weeks. Most patients return to work in five to seven
days.
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