Gallbladder Removal Q&A
One of our leading consultant surgeons answer common questions on gallbladder removal surgery including the risks, recovery and lifestyle changes you might need to make after the operation
What is the gallbladder?
The gallbladder is a small sac like structure approximately 10 x 4 centimetres in size attached to the under surface of the liver (just under the right rib cage). It stores approximately 100 mililitres of concentrated bile and regularly ejects this bile into the bile duct to aid digestion of fatty foods.
What are gallstones?
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, while 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 the size of gravel or sand can give rise to pancreatitis as they migrate through the bile duct.
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.
What causes gallstones?
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
Why should your gallbladder be removed?
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. A gallbladder causing symptoms is like a warning sign before complications.
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 or 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.
What happens during gallbladder removal surgery?
This is a minimally invasive – 'keyhole' – 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.
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.
It is then separated from the liver bed with electro-cautery and removed. The blood supply to the gallbladder is also disconnected. 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).
The surgery usually takes 30-60mins, but can take longer in more difficult cases, especially if the gallbladder is very inflamed.
Can you live without your gallbladder? Do you need to make any lifestyle changes?
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.
The large majority of operations for the gallbladder (96%) are undertaken by the keyhole technique with the use of 3-4 small incisions.
How long does it take to recover from gallbladder removal surgery?
The large majority of operations for the gallbladder (96%) are undertaken by the keyhole technique with the use of 3-4 small incisions.
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 used are dissolvable and patients can shower over their plastic dressings on the day after the procedure.
Are there any risks to removing the gallbladder?
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).
Get help for gallbladder problems
If you are living with symptoms of gallstones or other gallbladder problems, it's time to speak to a specialist. Call or book online today to arrange an appointment with one of our consultant general surgeons to discuss laparoscopic gallbladder removal surgery among other available treatments.
Tags
How do I book an appointment?
If you're concerned about symptoms you're experiencing or require further information on this subject, talk to a GP or see an expert consultant at your local Circle Hospital.