Gallbladder Disease

The gallbladder is a small pear-shaped storage organ located under the liver on the right side of the abdomen. It stores bile (yellowish-brown fluid) produced by the liver, which is required to digest fat. As food enters the small intestine, cholecystokinin (a hormone) is released, which signals the contraction of the gallbladder to release bile into the small intestine through the common bile duct (a small tube connecting liver and intestine).

Gallstones are caused by an imbalance in the concentrations of the components that makeup bile. This includes cholesterol and bile salts. Increased concentrations of particular components of bile then precipitate, crystalise and eventually form gallstones.

Gallstones are very common and usually do not cause symptoms. Risk factors for gallstones include age, female gender, ethnicity, body habitus and pregnancy.

Common complications of gallstone disease include pain (biliary colic), and cholecystitis (inflammation of the gallbladder). Other less common but more severe complications include pancreatitis and jaundice.

Although the gallbladder helps in digestion, it is not an essential part of the body as bile can reach the small intestine in many other ways. Therefore, gallbladder removal (cholecystectomy) is a safe treatment for gallbladder problems.

Major gallbladder diseases include gallstones (concentrated bile) that can block the ducts (biliary colic), and cholecystitis (inflammation of the gallbladder). The removal of the gallbladder is performed by a procedure called cholecystectomy and is the most effective way to treat gallstones or other gallbladder diseases.

Treatments of Gallbladder Disease

Treatments depend on the type of gallbladder disease. Most often this is caused by the formation of gallstones within the gallbladder.

• Non-Surgical - The initial treatment of cholecystitis may include antibiotics, however surgery may be recommended early.
• Cholecystectomy - Where patients experience multiple gallbladder episodes, an operation called cholecystectomy is often recommended. A cholecystectomy involves the surgical removal of the gallbladder. 

Fortunately, the gallbladder is an organ you can live without. Gallbladder removal most often results in complete recovery and does not require a specific diet after the surgery.

Indications for Gallbladder Removal

Gallbladder removal may be indicated when:

• an attack hasn't settled and/or there is presence of infection
• there are complications such as jaundice or pancreatitis
• a patient suffers recurrent pain

Laparoscopic Surgical Gallbladder Treatment

Of all the surgical procedures for which laparoscopy (key-hole surgery) is an option, cholecystectomy - gallbladder removal - is the most widely recognised and accepted.

The main benefit of this procedure is that it is a minimally invasive procedure. Minimally invasive surgery means "Less Pain" and "Faster Recovery".

There is less incisional pain that occurs with standard abdominal surgery, so the recovery time is much quicker. Also, the scars on the abdomen are much smaller when compared with traditional surgery. Laparoscopic surgery is now the standard method for removing the gallbladder.

Laparoscopic Cholecystectomy

A laparoscopic Cholecystectomy procedure involves

• Making four small incisions in the abdomen.
• Surgical instruments and a miniature video camera are inserted into the abdomen.
• The camera sends a magnified image from inside the body to a video monitor.
• The surgeon views the organs and tissue and uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures.
• An x-ray of the bile duct is taken to confirm the anatomy and identify if there are any gallstones that have moved into the bile duct.
• If there are stones in the bile duct they can either be removed during the laparoscopic operation or after the operation using a procedure called Endoscopic Retrograde Electroencephalography (ERCP).
• The gallbladder is then removed via one of the ports and sent to pathology for examination.
• The gas within the abdomen is then deflated, wounds closed using absorbable sutures and waterproof dressings applied.

Contraindications for laparoscopic Surgery

There are very few instances when laparoscopic surgery is not preferable to conventional surgery for cholecystectomy. This can be discussed further with Dr Manley.

Recovery from Gallbladder Surgery

Due to the less invasive lapascopic technique, recovery is swift and usually, the patient can go home usually the day after surgery. 

The incisions heal quickly with less pain and scarring than traditional methods of surgery. You can expect to be back to work within a week in most instances.

Open Gallbladder Surgery

In a few cases, the gallbladder cannot be safely removed by laparoscopy. Standard open abdominal surgery is then immediately performed. Open surgery involves the removal of the gallbladder through a larger incision. It may be necessary for some people due to

• Highly inflamed and scarred gallbladder
• Abnormal anatomy
• Extensive scar tissue (adhesions) due to previous surgery
• Other problems that obscure the view of the gallbladder

Open surgery is safe and effective. Conversion from laparoscopic to open surgery is not a complication of the procedure but rather done to protect the patient.

Recovery After Gallbladder Surgery

Practical recovery notes include:

Hospital Stay - Most people go home the morning after surgery. It is recommended that you be accompanied home by a carer who will stay with you (or very close by) for the first 24 hours.

Wound Care - Your wounds are closed with dissolvable sutures and covered with waterproof dressings. You can shower normally. Remove your dressings in 5 days - your wounds should be healed by then and you do not need further dressings.

Diet - There are no restrictions on your diet. However, some people can develop loose stools in the first few weeks after gallbladder removal.

If you are experiencing loose stools, try to

• Avoid greasy or fried foods
• Add soluble fibre to your diets, such as bran, nuts, seeds, lentils and peas
• Eat smaller, more frequent meals
• Limit foods that worsen diarrhoea such as caffeine, dairy and sweet foods

Driving - You should not drive for at least 24 hours after general anaesthesia. You can start driving as soon as you can safely control the vehicle, usually after a few days.

Physical Activity - You are encouraged to do as much walking as is comfortable. Limit your activities to light duties (no lifting over 5 kg) for at least 4 weeks, or until you are comfortable.

Risks With Cholecystectomy & Open Gallbladder Surgery

All surgery has risks despite the highest standard of practice.

Like any abdominal surgery, Gallbladder surgery carries some risks. Even though infrequent, they are no more than most other general surgery procedures.

Complications are rare, the following possible complications are listed to inform not to alarm, and there may be other complications that are not listed.

• Bile leak,
• Bleeding and Infection,
• Nausea and vomiting may occur after the surgery,
• Rarely, injury to the bile ducts, blood vessels, or intestine can occur, requiring corrective surgery,
• Retained stones in the bile duct requiring further treatment
• Postcholecystectomy syndrome