Cholecystectomy

About your Gallbladder...

The gallbladder, located in your upper abdomen on the right side, is part of the digestive system. The gallbladder stores and concentrates bile that is produced by the liver. When you eat food containing fat, the gallbladder contracts, sending the bile into the small intestine to help your body absorb the fat. 

What Diseases Occur in the Gallbladder?

• Gallstones are the most common disorder of the gallbladder. Gallstones can cause inflammation of the gallbladder or block the flow of bile through the ducts from the liver or gallbladder to the intestine. Bile trapped in these ducts can cause inflammation and infection in the duct itself, the gallbladder, or the liver.
• Gallstone pancreatitis is an extremely painful inflammation that can occur when gallstones block the pancreatic duct and trap digestive enzymes in the pancreas.
• Biliary dyskinesia is a condition which can cause pain, nausea, and belching when the gallbladder does not empty appropriately.
• Cancer can also occur in the gallbladder, but this is very rare.

What are the Common Signs and Symptoms?

• Pain in the right upper mid abdomen that starts after eating and lasts from 30 minutes to several hours. Patients who do not have stones, but have a dysfunctional gallbladder may have constant pain which is not related to eating.
• Pain in the back between the shoulder blades or under the right shoulder.
• Nausea or vomiting.
• Low grade fever and chills.
• Gallstone attacks often follow large or fatty meals and may wake a patient during the night. About 50% of people with gallstones never experience any symptoms. These patients are said to be asymptomatic.

How are Gallstones & Gallbladder Disease Diagnosed?

If symptoms are absent, gallstones are sometimes found by accident during tests for other problems. When symptoms occur, diagnosis is usually made through the following workup:

• A medical history is taken and a physical examination is performed by your doctor.
• Lab work is ordered.
• An ultrasound is usually done to evaluate for gallstones and ductal dilatation.
• Sometimes a HIDA Scan is ordered. A HIDA Scan is a nuclear medicine test that checks bile flow. At the end of the test, a hormone is injected to measure the function of the gallbladder. This hormone, CCK, is the same hormone that your body naturally produces to stimulate the gallbladder to release bile.

How are Gallstones & Gallbladder Disease Treated?

• Surgery to remove the gallbladder is the standard treatment for symptomatic gallstones or gallbladder disease. The most common surgery is a Laparoscopic Cholecystectomy.

How is a Cholecystectomy Performed?

• For a laparoscopic cholecystectomy, the surgeon makes 3 to 5 tiny incisions in the abdomen and inserts surgical instruments and a miniature camera. The camera sends an image from inside the body to a video monitor. While watching the monitor, the surgeon separates the gallbladder from the other structures and removes it through one of the small incisions. The operation usually takes about 1½ hours.
• Sometimes the surgeon may encounter obstacles to the laparoscopic procedure, such as inflammation, abnormal anatomy, or scarring from other operations. At this point, an open surgery may be necessary. An “open” surgery requires a 5 to 8 inch incision to remove the gallbladder. It is a major surgery and may require a 2 to 7 day stay in the hospital and several more weeks at home to recover. In some cases obstacles are known before surgery, and an open procedure is planned. Open surgery is required in about 5 percent of gallbladder operations.

Are All Stones Removed with the Gallbladder?

• Gallstones can travel out of the gallbladder and lodge in the common bile duct. Sometimes this is apparent prior to surgery from your ultrasound and laboratory tests. At other times, a picture of the common bile duct is taken during surgery to check for gallstones. This is called a cholangiogram. To remove the stones you may require either a surgical common bile duct exploration or an ERCP. During an ERCP the stones are removed through a fiber optic scope. This is done by a gastroenterologist either before or after the cholecystectomy.

What Are the Possible Complications/Risks?

• Bile duct injury
• Infection
• Bleeding
• Bowel Injury

Are There Potential Long Term Negative Effects After a Cholecystectomy?

• Initial fatty food intolerance
• Diarrhea
• Post-cholecystectomy syndrome

Patient Instructions for Surgery

• Click here for Patient Instructions for Surgery...