Gallbladder removal Q&A

Two of our leading consultant surgeons answer common questions on gallbladder removal surgery including the risks, recovery and lifestyle changes you might need to make.

Professor Aali J Sheen
The Gallbladder is a small sac (usually 4-6 cm long), which stores bile made by the liver. It is located underneath the liver where it is attached and is connected to the small intestine (bowel) by a small tube called the bile duct through which bile passes into the bowel. The gallbladder contracts when the body needs more bile, which is required to digest fats or fat containing food.


Mr Neville Menezes

The gallbladder is a small sac like structure approximately 10x 4 cms in size attached to the under surface of the liver (Just under the right rib cage). It stores approximately 100 mls of concentrated bile and regularly ejects this bile into the bile duct to aid digestion of fatty foods.

Professor Aali J Sheen
Bile is made of water, bile salts, bile pigments as well as cholesterol. If one of these constituents is increased or decreased disproportionately then the gallbladder bile can form stones. The majority of stones formed are cholesterol stones but there are also pigment and mixed stones.


Mr Neville Menezes

Gallstones are crystals of cholesterol mixed with other elements like mineral forming particles, varying in size from sand or gravel to large marbles present in the gallbladder. Large stones tend to remain in the gallbladder whilst the small ones can migrate into the bile duct. Hence one can say “Big stones (equals)=small trouble; small stones (equals) = big trouble”.

Even tiny stones like gravel or sand can give rise to pancreatitis as they migrate through the bile duct.

Professor Aali J Sheen
Gallstones can be formed in any individual and for the majority of persons cause no problems. Gallstones have an increased risk of forming in women, as a result of pregnancy or taking the oral contraceptive pill.  People with a diet high in cholesterol or a diet high in fats are also at an increased risk. People who are over the age of 40 are much more likely to get gall stones and so are those with the presence of irritable bowel conditions such as Crohn’s disease or blood disorders such as sickle cell and haemophilia.


Mr Neville Menezes
Bile is a mixture of cholesterol, salts and waste matter secreted by the liver in a well- balanced proportion. A change in this balance results in super-saturation of cholesterol or other pigments or salts. This then results in precipitation of small crystals which enlarge with time to form stones. They are seen predominantly in the Western population possibly due to our diets. About 1 in 3 women, and 1 in 6 men, form gallstones at some stage in their life. They become more common with increasing age. The risk of forming gallstones increases with pregnancy, obesity, and if you take certain medicines

Professor Aali J Sheen

Gallstones can cause pain when the gallbladder contracts against a gallstone or the gallstone is impacted in the neck of the gallbladder, this is called ‘biliary colic’. The pain experienced is typically in the upper part of the abdomen and can move to the right hand side as well as into the right side of the back and right shoulder tip. On consumption of rich or fatty food the pain can be more pronounced as the gallbladder has to release extra bile into the bowel and so will contract more often. On occasion the bile can be prevented from being secreted (passed) out of the gallbladder as a result of a stone blocking its passage and bacteria can then colonise/grow in the stagnant bile and cause an infection; this condition is called acute cholecystitis. Sometimes a small stone can pass down the ducts and cause blockage of bile from the liver itself into the bowel. When this happens one can become jaundiced and experience a condition called ‘cholangitis’. A stone in the duct can also occlude/block the pancreas duct from releasing pancreas juice as both the bile and pancreas ducts combine before they enter the bowel and this condition is called ‘acute pancreatitis’. Pancreatitis can be very serious and normally presents with severe abdominal pain and vomiting.


Mr Neville Menezes

Incidentally detected gallstones in patients who are not symptomatic may be left alone. But if they are causing symptoms or presenting with complications one has to consider treatment. Gallstones can cause severe complications some of these have been mentioned here

Cholecystitis: Inflammation and infection of gallbladder.

Jaundice: Migration of stone from the gallbladder into the bile duct obstructing the flow of bile from the liver.

Pancreatitis: gallbladder stone having migrated into the bile duct causing obstruction of the pancreas duct and pancreatitis.

A gallbladder causing symptoms is like a warning sign before complications. 

Professor Aali J Sheen

Surgery is performed under a general anaesthetic (fully asleep) and the entire gallbladder is removed (cholecystectomy) after the small tube connecting the gallbladder to the main bile duct is carefully divided using special clips. Specialists in Gallbladder surgery ensure that there are no stones left in the main duct by performing a special X-ray (cholangiogram) before this small duct is divided and clipped. The blood supply to the Gallbladder is also identified and this blood vessel called an artery is divided using clips.

The surgery usually takes 30-60mins, but can take longer in more difficult cases especially if the gallbladder is very inflamed.

Mr Neville Menezes

This is a “key-hole” procedure with quick recovery. Laparoscopic instruments and telescopes are passed through the abdominal wall into the peritoneal cavity through tiny cuts (3-5 mm). The gallbladder is separated from the bile duct by placing titanium clips on the connecting cystic duct and dividing it. It is then separated from the liver bed with electro-cautery and removed. The blood supply to the gallbladder is also dis-connected.  A small tube is placed in the bile duct to inject contrast and take an X-Ray to confirm that no migrated stones are left behind (Intraoperative-cholangiogram). 

Professor Aali J Sheen

You can manage very well without the gallbladder and lead a perfectly normal life. The main tube connecting the liver with the small intestine called the main bile duct into which the gallbladder drains is normally 3-5mm in width. This duct increases in width to about 9-10mm to compensate for the loss of the extra bile, which the gallbladder provided when needed. It is advised to stay on a low fat diet for at least 2-3 weeks after gallbladder surgery until the body compensates for life without the gallbladder. Some individuals do experience diarrhoea and on-going pain but this does settle in about 4-6 weeks after surgery.


Mr Neville Menezes

One can live a normal life without the gallbladder. For a short period (4-6 weeks) one might experience slight looseness of bowel which returns to normal and is seen in 1-2 percent of patients. One really does not need to make any life style changes.

When one considers life with constant or intermittent severe pain, indigestion, bloating, referred pain to back and chest, as well as the risk of complications, it is not difficult to decide, that on balance, it is better and safer to undergo this laparoscopic procedure. 

Professor Aali J Sheen

The large majority of operations for the gallbladder (96%) are undertaken by the keyhole technique with the use of 3-4 small incisions. In one week you should be able walk freely with minimal pain, after two weeks drive (so long as an emergency stop is possible) and after three weeks at least 96% of patients are fully recovered.


Mr Neville Menezes

The recovery is extremely quick and patients do not experience much pain after they wake up from their general anaesthetic, as they have pain relief from the local anaesthetic injected around the small cuts that have been made. Some will experience discomfort around the left or right shoulder from referred pain which settles quickly. Patients are able to mobilise within 2-3 hours of returning to their rooms, are eating a light meal and quite a few are ready to be discharged in 4 to 6 hours. Some need to stay overnight and go home after breakfast the following day with mild oral analgesics.

Patients are able to drive in 4-5 days and are back to normal within 10 days to 2 weeks’.

The stitches are dissolving and patients can shower over their plastic dressings on the day after the procedure.

Professor Aali J Sheen

The main risk is conversion to open surgery from keyhole and this is usually for safety reasons, which may need to occur in 2-3% of patients. There is also a very small and rare risk to injury of the main duct connecting the liver to the small intestine (main bile duct) (<0.3%).

Like any other operation there is always a small risk of wound infection and re-operation as well as DVT (clots in legs) and PE (clots in lungs).


Mr Neville Menezes

The recovery is extremely quick and patients do not experience much pain after they wake up from their general anaesthetic, as they have pain relief from the local anaesthetic injected around the small cuts that have been made. Some will experience discomfort around the left or right shoulder from referred pain which settles quickly. Patients are able to mobilise within 2-3 hours of returning to their rooms, are eating a light meal and quite a few are ready to be discharged in 4 to 6 hours. Some need to say overnight and go home after breakfast the following day with mild oral analgesics.

Patients are able to drive in 4-5 days and are back to normal within 10 days to 2 weeks’.

The stitches are dissolving and patients can shower over their plastic dressings on the day after the procedure.

Professor Aali J Sheen

I went to medical school in Scotland and when I started working as a Doctor, I found operating suited my persona and temperament as well as being very rewarding as the result was obvious. My supervising Consultants advised me at the time that I should pursue a career in surgery. This was an easy decision for me and I managed to become a fully trained Consultant in just over 11 years after finishing medical school.


Mr Neville Menezes

As a surgical trainee surgeon, I was fortunate to work in busy tertiary care teaching hospitals gaining significant experience and knowledge. I was able to learn advanced techniques in laparoscopic surgery and endoscopy, working with renowned professors in this field at the Lister Department of Pancreatic Surgery, Minimal Access Therapeutic Training Unit (MATTU) and King’s College Hospital in London. By being a Consultant Surgeon, I feel I can serve my patients better as well as impart this knowledge and experience to other trainee surgeons who will follow in my foot-steps.

Professor Aali J Sheen

The main reward in my career has always been seeing a patient go home safely and feeling better after an operation has treated their condition. I am and will always be very grateful to all my patients that have and continue to trust me to operate on them to make them better. Last year I undertook my 1000th Gallbladder operation as a Consultant.


Mr Neville Menezes

As a surgeon specialising in the management of pancreatic cancer I have been able to offer my patients a broad spectrum of diagnostic and therapeutic techniques involving laparoscopy and advanced endoscopy.  These skills are difficult to learn and I am very pleased to be able to teach & train my junior doctors in these procedures. I have been one of the founding members & trustee of the charity “Pancreatic Cancer Action”. The main objective of this charity is to bring about an early diagnosis of pancreatic cancer and prolong patient survival.

To find out more about gallbladder removal surgery call us on 0808 101 0337 or make an online enquiry

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