Last updated April. 11, 2018
Gallbladder removal is one of the commonest surgical procedures. Generally referred to as cholecystectomy, it is performed to remove the gallbladder when it becomes necessary.
The gallbladder is a pear-shaped little organ that rests beneath the right side of the liver where it collects and concentrates bile (a digestive liquid produced by the liver).
As part of the digestive system, the gallbladder releases bile after an individual must have eaten.
Bile travels to the small intestine, where it facilitates digestion, through narrow tubular channels known as bile ducts.
Doctors recommend gallbladder removal most especially when someone develops gallstones. Gallstones are normally small but hard, consisting of cholesterol and bile salts.
They normally form in the gallbladder or the bile ducts and will disrupt the flow of bile out of the gallbladder, making it swell and cause discomfort to the patient.
When a gallstone blocks the common bile duct, a condition known as jaundice can occur. Other conditions that can result from gallstones include indigestion, abdominal pain, vomiting, and fever.
Generally, it is uncertain why people develop gallstones, but it is most common in women, overweight people, people who are over 40 years, and those that have a family history of gallstones.
Gallstones and related problems are diagnosed using ultrasound scanning. In some instances, other forms of x-ray tests like CT scan can also be used. Another specialized scan known as gallbladder nuclear medicine scan can also be used to evaluate gallbladder problems.
When doctors find out that a patient has gallstones, they will have to decide if there is a need for surgery or not. If the gallstone is not showing any symptom or is not causing the patient any problem, there may be no need to remove the gallbladder.
If the stones are still small and less serious, there are some management measures that can be taken to slow down their development such as dietary adjustment to reduce fat intake.
However, this measure will only slow down the growth of the gallstones. Once a gallstone goes into a bile duct or blocks it, it becomes necessary to start preparing for a surgical engagement.
This is because cholecystectomy remains the only viable way to handle the condition at this point.
If the stones are left untreated, they can lead to other complicated conditions like cholecystitis (an inflamed gallbladder), pancreatitis (an inflamed pancreas), and cholangitis (inflamed bile ducts).
It is always better to go for a gallbladder removal surgery before the condition deteriorates.
There are two approaches to cholecystectomy, namely laparoscopic cholecystectomy (minimal invasion) and traditional cholecystectomy (open surgery).
This is the most commonly used method of gallbladder removal. It involves the surgeon making tiny incisions in the abdomen.
A tube with a tiny video camera is pushed through one of the incisions into the abdomen, allowing the surgeon to watch the inside of the abdomen on a monitor.
The doctor will proceed by inserting surgical tools through the other little incisions and use them to remove the gallbladder while still being guided by the video in the monitor. The entire process can take between one to two hours.
This is also referred to as open cholecystectomy and involves the doctor making a 6-inch incision in the abdomen, just below the right ribs in order to remove the gallbladder.
The muscles and tissues around the region are normally pulled back to reveal the liver and the gallbladder, making it easy for the surgeon to remove the gallbladder.
The incision is sutured afterwards. The entire process can last between one to two hours.
The approach a surgeon will take to remove your gallbladder will depend on a number of factors. Ideally, laparoscopic cholecystectomy is preferred to open surgery.
Patients who undergo this method of gallbladder removal normally have minimal post-operation pain and will recover quicker. In most cases, they are able to return to their homes same day they had the surgery.
In spite of the various advantages it has, laparoscopic gallbladder removal may not be ideal for certain kinds of patients.
Depending on the severity of the gallbladder disease or accompanying complications, surgeons may decide to go for open gallbladder removal.
In any case, a thorough medical evaluation will have to be carried out by your physician and the surgeon to determine which of the methods will be ideal for your case.
Though it may differ slightly from one surgeon to another, what to expect before a cholecystectomy is the same. A medical evaluation, blood tests, and an EKG may have to be done first.
After reviewing the potential risks of the procedure, you will have to sign a written consent for the surgery. You may be required to stop certain medications, so it is important that you discuss openly with the surgeon about whatever medications you are taking.
You may also be required to modify your diet a bit in preparation for the surgery. Some surgeons may advise you to shower with an antibiotic soap the night before the surgery.
Ideally, you may not be permitted to take any food on the day of the surgery. Whatever medication the surgeon permits you to use should be taken with a sip of water.
As has been explained earlier in the article, there are two approaches to removal of the gallbladder. Both methods of surgery involve the use of anaesthesia, so you will not be aware of how the procedure will go.
Due to the various advantages it has, the laparoscopic method is the preferred approach. In this method, once the anaesthesia takes effect, a tube will be forced down your throat to help you breathe. The surgeon will then proceed to make an incision of about 2 – 3cm by your belly button.
Two or three smaller incisions of 1cm or less will be made on the right side of your abdomen. A tiny tube will be inserted into one of the incisions and carbon dioxide gas will be pumped into your abdomen to inflate it and grant the surgeon easy access to your liver and gallbladder.
Once your tummy is in the right shape, a laparoscope (long, thin telescope with a light and camera at the end) will be inserted through the incision by your belly button. This will enable the surgeon to view the inside of your abdomen on a monitor as he or she performs the surgery.
The special surgical instruments needed for the operation will then be inserted through the other tiny incisions and used to remove the gallbladder.
If the process runs smoothly and the gallbladder is removed successfully, the incisions will be stitched and dressed. The patient can return home that same day and recovery is always quick.
In some cases, cholecystectomy may not be completed through the laparoscopic method and the surgeons may decide to switch to an open surgery.
The risk of this is expected to be explained to the patient before the commencement of the process. In open surgery gallbladder removal, an incision of about 15cm is made below the right ribs.
The muscles and tissues around will be pulled back until the surgeon has enough access to the gallbladder and successfully removes it.
After the removal, the incision will be stitched and dressed. The patient will not be strong enough to return home after the surgery that day. Full recovery will take upward of 2 weeks.
After a successful gallbladder removal surgery, it is ideal to experience mild postoperative pain. You may also experience nausea and vomiting as a result of the surgery and the medication used for anaesthesia. If the minimal incision method is used, you should be able to walk around the same day of the surgery.
Activity, however, should be dependent on how you feel. Recovery should happen between 1 – 2 weeks. In most cases, people who had laparoscopic cholecystectomy usually resume their normal activities after one week.
There are some complications that may occur after gallbladder removal surgery. Contact your doctor if you experience any of these:
These signs may be indicative that something went wrong during the procedure or afterwards and your gastroenterologist will be in the right position to decide on the next step to take.
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