November 2004 Article: Gallbladder Surgery

No one knows for sure why some people have gallbladder problems. Often the tendency to form gallstones runs in families and is very common in Native Americans. Gallstones are most often formed from crystals of cholesterol due to an imbalance in the ingredients of bile. Bile is a digestive substance made in the liver and delivered to the intestine in small tubes called ducts. The gallbladder is a small oval sac lying under the liver on the right side of the abdomen and connected to the main bile duct. Some of the bile made in the liver is sent to the gallbladder where it is stored until needed to digest fats that we eat. When we eat fatty foods, some bile is sent from the gallbladder down the bile duct into the intestine to break down fat so our body can use it for energy.

When gallstones are present in the gallbladder, they can get stuck at the outlet of the gallbladder and cause pain and infection. Sometimes the stones move into the main bile duct and cause a blockage of bile and appearance of jaundice, a yellow color of the eyes and skin. Gallstones in the main bile duct can also cause pancreatitis, a severe inflammation of a digestive gland that empties into the intestine near the main bile duct. For any of these reasons, the gallbladder may need to be removed surgically.

When someone has problems that seem likely to be due to gallstones, an ultrasound examination is done. This painless test uses sound waves to create an image of the gallbladder and gallstones, if present. It also shows the size of the main bile duct. Less commonly, a special radioactive scan can be done to see if the gallbladder is working normally.

Surgery to remove the gallbladder has been done for many years and is still the most common treatment for gallstones that are causing trouble. However, the type of surgery has changed dramatically in the last 15 years. The development of a microchip video camera has allowed surgeons to “see” in the abdomen through very small cuts (“laparoscopic”) and so do surgery that is much less painful. This is the way most gallbladder surgery is now done, also using new highly specialized tools inserted through small tubes with valves (“ports”). Carbon dioxide gas is fed into the abdomen to create a space in which to work. The duct and blood vessel to the gallbladder are divided and it is removed from its attachments to the liver. The gallbladder is then placed in a small plastic bag and pulled out of one of the small incisions. X-rays of the bile ducts can also be done during surgery, if needed, using this approach. If the gallbladder is not infected at the time of surgery, most patients can go home the same day their surgery is done. Sometimes a larger incision is still needed to remove the gallbladder, and this type of surgery does require several days in the hospital afterwards.

Recovery from gallbladder surgery is much quicker if the small incision approach can be done. Patients can return to light duty after 1 week and even more strenuous work after 2-3 weeks. This is about ½ the time usually needed to recover from large incision gallbladder surgery.