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The gallbladder is a pear-shaped organ that sits beneath the liver in the right-upper abdomen. It's function is to store bile. It is attached to the bile ducts that come from the liver. These ducts carry bile from the liver to the gallbladder and intestine where the bile helps digest food. The gallbladder is not necessary to maintain good health.
A diseased gallbladder can occur when stones are present (cholelithiasis) in the gallbladder or cystic duct. At the same time, the gallbladder may be inflamed (cholecystitis) secondary to presence of stones. In some cases, the gallbladder can be inflamed without stones being present and bacteria can cause this. Gallstones can cause irritation or they can cause no symptoms at all. When irritation occurs people may experience abdominal pain, back pain, nausea, vomiting, heartburn, and even jaundice (yellowing of the skin) if a stone becomes lodged in the common bile duct.
Surgical removal of the Gallbladder
Surgical removal of the gallbladder, known as cholecystectomy, is one of the oldest and commonest operations performed. There are two basic methods of gallbladder removal, namely laparoscopic (keyhole) cholecystectomy and open cholecystectomy.
Laparoscopic (Keyhole) Cholecystectomy
Laparoscopic or "keyhole" surgery has existed for decades, but its use has vastly expanded in the past decade. Laparoscopic cholecystectomy is now the gold standard treatment for gallstones and has significant advantages over open surgery, including :
- Reduced hospital stay
- Reduced post operative pain
- Improved recovery time
- Decreased post operative complications
- Better cosmetic result
Reduced post operative pain means that patients are able to mobilise sooner. Poor mobilisation after surgery is a significant contributor to complications such as lung infections, deep vein thrombosis and wound infections.
Figure : The position of the gallbladder and surrounding structures
The possible complications of open gallbladder surgery include:
- Injury to the common bile duct.
- Excessive bleeding.
- Infection of the surgical wound.
- Injuries to the liver, intestines, or major abdominal blood vessels.
- Blood clots or pneumonia related to the longer recovery period after open surgery.
- Risks of general anesthesia.
Only 10% of patients with gallstones will experience symptoms. Gallstones that are confined to the gallbladder usually cause only intermittent episodes of pain, known as biliary colic - commonly occuring after eating a fatty meal. When a stone occludes the exit of the gallbladder the flow of biliary fluid becomes stagnant, predisposing to infection and inflammation of the gallbladder, called acute cholecystits. The patient may have a temperature, symptoms of more severe upper / right sided abdominal pain and may vomit.
When gallstones enter the common bile duct they can cause jaundice , cholangitis and pancreatitis .
Jaundice is caused by the stone blocking the flow of bile into the duodenum. This leads to the absorption of bilirubin into the bloodstream causing yellow pigmentation of the skin and eyes.
In addition to a stone in the bile duct causing jaundice an infection in the biliary system, called cholangitis , can occur. This is again caused by stagnant flow of bile. The infection can reach the liver if not treated appropriately, leading to severe inflammation of the liver and eventually to liver abscesses if not treated.
Pancreatitis can occur when a gallstone passing through the bile duct temporarily occludes the pancreatic duct leading to inflammation of the pancreas. The condition is usually self limiting and responds to analgesia and resting of the bowel. However in a small proportion of patients the pancreatic damage triggers a cascade of worsening inflammation leading to a severe critical illness.
Rarer complication of gallstones include perforation of the gallbladder, erosion of the gallbladder into bowel ( cholecysto-enteral fistula ) and passage of a gallstone into the bowel leading to bowel obstruction ( gallstone ileus ).
Most people can return to their normal activities within a week to 10 days. People who have laparoscopic gallbladder surgery are sore for about a week, but within 2 to 3 weeks they have much less discomfort than people who have open surgery. No special diets or other precautions are needed after surgery.
- Pain in your shoulder and belly that lasts 24 to 72 hours (from gas used to inflate the abdomen during surgery). It may last as long as a week.
- Widespread muscle aches from anesthesia.
- Minor inflammation or drainage at the surgical wound sites.
- Loss of appetite and some nausea.
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