Surgical removal of the gallbladder is most often performed due to obstruction of the bile ducts caused by stones formed inside the gallbladder. Surgery is the most effective treatment for gallstone disease. Surgery to remove the gallbladder (cholecystectomy) can in most cases be performed using a laparoscopic method. It is a much less invasive type of surgery than traditional open surgery. Laparoscopic removal of the gallbladder consists in making several small (up to 1.5 cm) incisions in the abdominal wall through which the surgeon inserts a camera (laparoscope) and surgical instruments into the abdominal cavity. The visible scars remaining after the procedure are very small. After laparoscopic removal of the gallbladder, the patient returns to normal activity much faster than after open surgery.
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What is the function of the gallbladder?
The gallbladder (commonly known as the "gallbladder") is a small reservoir located in the right hypochondrium under the liver. The gallbladder is pear-shaped and its capacity is approximately 50 ml. The role of the gallbladder is to collect the bile produced by the liver. Bile flows from the liver through the bile ducts to the duodenum, where it facilitates the processes related to the digestion of fats (bile breaks down fat into smaller portions, increasing the effectiveness of the pancreatic digestive enzymes). The excess bile is stored in the gallbladder, where the bile is also concentrated. After eating the meal, the gallbladder contracts, releasing more bile into the duodenum.
What are the indications for surgery to remove the gallbladder?
The most common indication for gallbladder removal is alveolar gallstone disease. In the gallbladder, deposits and stones are formed, made of cholesterol and bile acids. The mere presence of stones in the gallbladder does not necessarily cause symptoms. Only when the stone blocks the outflow of bile from the gallbladder does the so-called biliary colic. Stones can build up around the neck of the gallbladder or get stuck in the bile duct. Simultaneous contractions of the gallbladder under the influence of a food stimulus generate increased pressure and induce biliary colic. A typical symptom of an attack of gallstone disease is sudden abdominal pain in the right upper abdomen, which usually occurs 30 minutes to 2 hours after eating a meal. Gallbladder pain may be associated with gas, fullness, belching, nausea and vomiting. Relief in ailments is usually achieved by taking painkillers and relaxants. If severe abdominal pain persists for more than a few hours, and additionally develops a fever, see a doctor immediately. Persistent abdominal pain may result from acute cholangitis, an empyema of the gallbladder, or a bladder perforation with secondary peritonitis. Repeated episodes of mild bile colon are also an indication for medical consultation. Early diagnosis makes it possible to implement treatment quickly and avoid serious complications. Gall bladder stones (also asymptomatic) can be diagnosed during ultrasound of the abdominal cavity. After collecting a detailed history and analyzing the imaging examinations, the doctor decides whether and when to perform the operation to remove the gallbladder. The gallbladder removal procedure is most often performed in the case of:
- Symptomatic gallstone disease of follicular origin,
- Finding thickening of the gallbladder walls on ultrasound (a symptom of chronic cholecystitis secondary to urolithiasis),
- The presence of other complications related to urolithiasis and cholestasis (e.g. inflammation and stenosis of the bile ducts),
- In patients with gallstone disease at increased risk of developing gallbladder cancer.
Can the stones in the gallbladder be dissolved or broken?
Symptoms related to the presence of stones in the gallbladder often prompt patients to seek alternative treatments. So far, surgery to remove the gallbladder is the only effective method of permanent treatment of urolithiasis and avoiding its serious complications. Diet and oral medications cannot reduce the size of gallstones. Administration of an agent dissolving stones in the gallbladder has a low treatment effect and is associated with relapse (stones grow back in size over time). Attempts were also made to break up gallstones, using the so-called extracorporeal shock wave (ESWL). This method remains useful in breaking down urinary tract stones, but has not found much application in the effective treatment of gallstone disease.
Laparoscopic Gallbladder Removal - Benefits
Laparoscopic removal of the gallbladder is a minimally invasive procedure - instead of an extensive 15 cm long incision, the surgeon makes only 3-4 small holes with a diameter of 1-1.5 cm in the abdominal wall. The advantages of laparoscopic removal of the gallbladder include:
less post-operative pain and limitation of the use of painkillers after surgery,
the patient can leave the hospital on the second day after the surgery,
faster return to daily activities (usually it is already the second week after the procedure),
eliminating the risk of a hernia at the site of surgical access,
smaller scars - better cosmetic effect.
Who can be operated with the laparoscopic method?
The laparoscopy procedure has some limitations - not all patients can perform it and then it is necessary to perform open surgery using the traditional method. Contraindications for laparoscopic cholecistomy include:
adhesions after previous operations in the abdominal cavity,
acute inflammation of the bile ducts and / or pancreas, peritonitis,
gallbladder abscess,
neoplastic metastases in the abdominal cavity,
blood clotting disorders,
severe obesity.
Laparoscopy of the gallbladder - the course of the procedure
The gallbladder removal procedure is performed under general anesthesia (the patient is asleep and remains unconscious during the operation). In order to obtain optimal access to the operated area, gas (carbon dioxide) is introduced into the abdominal cavity. 3-4 incisions are made in the abdominal integuments (above the navel, on the side in the axillary line, under the right costal arch and slightly below the xiphoid process of the chest). Through the obtained holes with a diameter of 1-1.5 cm, the surgeon inserts a camera (laparoscope) and surgical instruments. The inside of the abdominal cavity is constantly monitored on the monitor screen. The surgeon separates the gallbladder from adjacent tissues and the liver. Then he prepares, clamps and cuts the alveolar duct. After the gallbladder is released, it is removed from the inside of the abdominal cavity through an access located above the navel. The surgeon checks if there are any trapped stones in the biliary tract. After all the required abdominal procedures have been performed, the instruments and the laparoscope are removed and the abdominal incisions are sutured. In some situations, it is necessary to switch from laparoscopic to open surgery. It is most often caused by the difficult access to the anatomical structures of interest to the surgeon. Before the operation, the patient is informed about the possibility of changing the method of surgery intraoperatively.
After gallbladder excision
Pain may occur after gallbladder surgery. Thanks to the laparoscopic method, it is mild and passes quickly. Transient nausea may also occur, which is related to the specific nature of abdominal surgery and general anesthesia. The patient is usually able to get up and walk on the same day or the day after surgery. It is also then that the patient is discharged from the hospital. On day 10-14, the patient should report for a check-up to remove the sutures. Most patients return to their daily activities and light work as early as 1-2 weeks after the procedure (driving a car, using stairs, lifting light objects). When the operation was performed using the open method, the recovery period is longer and lasts about 4-6 weeks.Life without a gallbladder
Many patients are concerned about the long-term effects of gallbladder removal. However, cholecystectomy in most patients does not require a major lifestyle change. A special diet after gallbladder resection is indicated for the first few weeks after surgery. You should eat easily digestible products, in smaller portions and eaten more often. You should also avoid high-fat foods. This will allow the digestive system to adapt to new conditions after surgery (bile flows directly from the liver through the bile duct to the duodenum). However, the absence of a gallbladder does not impair digestion. Most patients return to a normal diet after a few months, maintaining the general principles of healthy eating.
Possible complications after surgery
Complications after surgery are very rare, but you should be aware of their possible occurrence. Consultation with a doctor is recommended in the following situations:
fever,
worsening abdominal pain, flatulence and inability to eat
redness and purulent discharge oozing from postoperative wounds,
yellowing of the skin or the whites of the eyes.
Source:
- Hassler KR, Jones MW. Gallbladder, Cholecystectomy, Laparoscopic. [Updated 2017 Oct 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448145/
- Dzieniszewski J, Godziemba Maliszewska E. Kolka żółciowa – banalny problem czy poważna choroba? Medycyna i pasje 2009(6): 16-21.
Important information
|
Duration of the procedure (depending on the method) |
1 hour |
| Tests required for surgery | Morphology, urea, creatinine, glucose, ionogram, INR, ABTT, Bilirubin, Blood Group, Anti HCV, HBS |
| Anesthesia | general |
| Hospital stay | up to 24 hours |
| A period of significant dysfunction | 1 -2 days |
| A period of limited dysfunction | up to a week |
| Removal of stitches - first visit | 7 days |
| Change of dressings | daily |
| Contraindications to the procedure |
circulatory failure |
Frequently asked questions about gallbladder removal:
The presence of stones in the gallbladder (gallbladder) may initially be asymptomatic. Only when the accumulated deposits impede the outflow of bile from the gallbladder, symptoms typical of the so-called biliary colic. The pain is localized in the right upper abdomen and usually begins up to 2 hours after eating a fat-rich meal. Pain relief is achieved by taking painkillers and relaxants. Due to the location of the gallbladder, the symptoms associated with urolithiasis are often interpreted as a symptom of liver dysfunction. In order to diagnose the problem, visit a gastroenterologist or perform an ultrasound examination of the abdominal cavity.
The only effective method of removing stones is surgery, which involves the complete excision of the gallbladder (cholecystectomy). The absence of a gallbladder does not disturb the digestive functions and does not significantly reduce the quality of life after surgery.
A laparoscopy of the gallbladder takes about an hour. The duration of the procedure depends on the patient's individual anatomical conditions and the surgeon's proficiency in performing this type of surgery.
The removal of the gallbladder by laparoscopy allows you to get up and walk quickly and reduce pain after the procedure. The discharge usually takes place on the second day after surgery.
Pain ailments result from the healing of disturbed tissues within the abdominal cavity and are a natural phenomenon. Mild abdominal pain may persist for up to a week after the procedure, but should be of a decreasing nature. If pain worsens, flatulence or vomiting occurs, consult a doctor.
In the period of 4-6 weeks after the procedure, it is advisable to follow a low-fat diet. An easily digestible diet based on natural ingredients is recommended. Purees of boiled vegetables and fruits without peel, lean meat, fish, light bread, natural yoghurts are allowed. Highly bloating vegetables such as beans and cabbage should be avoided. Foods fried in fat, carbonated drinks, spicy spices and alcohol are forbidden. A few months after the surgery, you can gradually return to your normal diet, maintaining the general principles of healthy eating.
W okresie 4-6 tygodni po zabiegu wskazane jest stosowanie diety ubogotłuszczowej. Zalecana jest lekkostrawna dieta oparta na naturalnych składnikach. Dozwolone są przeciery z gotowanych warzyw i owoców bez skórki, chude mięso, ryby, jasne pieczywo, jogurty naturalne. Należy unikać warzyw wzdymających takich jak fasola czy kapusta. Zakazane są potrawy smażone na tłuszczu, napoje gazowane, ostre przyprawy oraz alkohol. Po kilku miesiącach od zabiegu można stopniowo powrócić do normalnej diety z zachowaniem ogólnych zasad zdrowego odżywiania.
