Gallbladder surgery: a guide
The gallbladder, located underneath the liver, is an accessory organ that can be afflicted by conditions which necessitate its removal. In this article, a consultant gastrointestinal and general surgeon, Mr Noman Zafar, explains the purpose of the gallbladder, how issues can occur, and the approach to correcting them surgically.
Why would the gallbladder need surgery?
The gallbladder is a small, pear-shaped sac that stores and concentrates the bile produced in the liver, received via the common hepatic duct. When we eat, the gallbladder begins contracting, releasing bile into the small intestine via the common bile duct. This aids in breaking down substances like fats within food so that they can pass through the digestive system.
Gallbladders can commonly be afflicted by gallstones, which are hard crystalline deposits of excess cholesterol and bilirubin. Typically, they are very small and do not cause symptoms and may pass through the body easily, but they can also be as large as a ping pong ball, which can cause obstruction and a great deal of pain, leading to further complications that are typically treated with the surgical removal of the gallbladder in what is called a cholecystectomy.
These complications include:
- Cholecystitis: gallstones block the flow of bile from the gallbladder, which causes inflammation, leading to pain, fever, and possibly sepsis.
- Biliary colic: gallbladder contracts around gallstones, which causes debilitating pain that can flare-ups after eating, lasting for hours at a time.
- Gallstone pancreatitis: inflammation of the pancreas due to a gallstone passing through the common bile duct and becoming stuck in the pancreatic duct.
Gallbladder cancer is also a probable cause for gallbladder surgery, but it is rare.
What happens during a cholecystectomy?
The gallbladder is not an essential organ, so surgery to remove it will not cause major disruption to bodily function and patients who have had their gallbladder removed can still live a normal life and enjoy a normal diet. When removed, instead of bile being stored in the gallbladder, bile will be transferred directly into the small intestines.
A cholecystectomy can be performed using three different approaches: openly, with one large incision; laparoscopically (also known as a keyhole procedure) through a collection of small incisions in the abdomen; and a robotically, which is similar to a laparoscopic technique but uses robotic consoles piloted by trained surgeons. Laparoscopic and robotic approaches are preferred nowadays as they are minimally invasive, resulting in less blood loss and less scarring – but, there are some complex cases that require an open approach.
Through the abdominal incisions, the surgeon uses fine surgical tools to separate the gallbladder from the liver, bile ducts, and surrounding blood vessels, which is then extracted through one of the incisions.
Afterwards, the incisions are sealed with sutures, surgical staples, or surgical tape and dressed. Many can return home on the same day as surgery and expect to return to their normal activities within one to two weeks.