Gallbladder Removal Surgery
What are gall stones?
The gallbladder is a small, pear-shaped bag that sits just below the liver. Bile, which helps to break down fatty food in the gut, is produced by the liver and then stored and concentrated in the gallbladder. During the digestion of a fatty meal, bile passes out of the gallbladder and into the small intestine, via a small duct called the cystic duct,
Sometimes stones begin to form within the gallbladder, and these can become lodged in the cystic duct, causing pain. If bile can’t circulate normally, it can build up, creating swelling and inflammation with the gallbladder, known as cholecystitis.
Attacks of cholecystitis and stones getting stuck in the duct leading to biliary colic can be extremely painful. The pain is often felt in the upper right-hand side of the abdomen and may refer up into the right shoulder. Some people experience bloating, vomiting and fever, and symptoms often occur after a large or particularly fatty meal.
Occasionally the build-up of bile due to slippage of gallstone from the gallbladder into the common bile duct can block it leading to jaundice (yellowing of the skin and the whites of the eyes).
Why might my gallbladder need to be removed?
The commonest reason a gallbladder is removed is because of pain due to gallstones (biliary colic) or recurrent episodes of infection of the gallbladder (cholecystitis).
Sometimes it’s necessary to remove a gallbladder because of polyps within the bladder. Large polyps (greater than 1.5cm in size) may sometimes develop into a cancer, and removal of the gallbladder may be advised. Cancerous change is very unlikely in small polyps.
Cholecystectomy may also be advised after careful consideration, for patients suffering from biliary dyskinesia – a kind of motility problem of the affecting the functioning of the gallbladder, which mimmicks gallstone disease.
Gallbladder removal surgery (cholecystectomy)
Cholecystectomy is a surgical procedure to move a diseased gallbladder.
Historically this has been done through a large incision, across the abdomen, known as an open procedure, but it’s now possible in 97% of cases to remove the gallbladder with keyhole surgery, which is far less invasive.
What happens during laparoscopic cholecystectomy (gallbladder removal surgery)?
This keyhole procedure is typically carried out through four, small, keyhole incisions, through which laparoscopic ports are placed, and one of these ports is placed through the umbilicus (belly button).
The ports allow for placement of camera and slender, long instruments to perform surgery and simultaneous insufflation of Carbon dioxide gas that is pumped into the abdomen often via the umbilical port.
A camera is passed through the umbilical port and images from the camera are displayed on a TV screen in the operating theatre. The surgeon can visualise the surgical field with great clarity and magnification. The instruments are passed through the ports to safely dissect the gallbladder from the liver, clip off the cystic artery and the cystic duct to finally disconnect the gallbladder. The gallbladder is then dropped into a small bag, which is safely withdrawn from the abdomen via one of the ports ensuring no bile or stone spillage from the gallbladder.
The carbon dioxide is allowed to escape via a port valve, deflating the abdomen, and then the port holes are closed with a stitch.
Occasionally (3%of cases) it is not possible to complete the procedure laparoscopically, and it may be necessary to convert the operation to an open procedure.
What are the risks of gallbladder removal surgery?
Whilst laparoscopic cholecystectomy is one of the most common planned surgical procedures undertaken across the world. It is extremely safe (risks are <3-5% for planned surgery)
As with all surgery, there is a small risk of potential complications, such as bleeding, infection, and blood clots.
One risk of removing the gallbladder is bile leakage. This may occur if the clips used to seal the duct connecting the gallbladder to bile duct slips. As a result bile may leak into the abdomen causing nausea, vomiting, severe abdominal pain and fever. This warrants investigations and possible surgery may be needed to wash the abdomen and seal the duct.
In extremely rare cases (<!%), damage may occur to surrounding structures, such as the main bile duct, blood vessels, the intestines or liver, and further surgery may be needed if this is discovered.
Recovering from laparoscopic cholecystectomy (gallbladder removal surgery)
Laparoscopic cholecystectomy is usually a day-case procedure, meaning that most patients can expect to go home the same day. Recovery and return to work will typically take a week or two. If an open procedure has taken place, a short stay in hospital of three to five days may be required, and it may take up to six weeks to recover fully.
Cholecystectomy is a very successful procedure, and for most people it brings permanent relief from gallbladder symptoms. In the short term, some mild gastric symptoms (such as the occasional loose stool) may be experienced, and if this is the case, eating smaller meals, avoiding very fatty foods, and increasing the amount of fibre in your diet can help.