Bile is secreted by the liver and helps us in the digestion of fat. The gallbladder serves as a storage bag for the bile made by the liver. When fat is eaten, hormones stimulate the gallbladder to contract and release bile through the ducts to the intestine, where it helps break down food. Not only does the gallbladder store bile, but concentrates it by removing the water from it. This process also can cause the bile to form crystals, which may play a role in the formation of gallstones. When the gallbladder is removed, the liver continues to make bile to aid in digestion.
Pain is often the first symptom of a gallbladder problem. Pain may occur after eating or in the evening when a gallstone becomes stuck in either the junction of the gallbladder and the bile duct, or in the bile duct itself. The muscles in the walls of the ducts squeeze and try to push the stone out, causing pain. Often the pain is under the ribs on the right-hand side of the abdomen, but the location can vary. Sometimes the patient has nausea, vomiting and bloating. Usually, after a while, the stone drops back into the gallbladder and the pain subsides. However, in some cases, it may become lodged in the neck of the gallbladder, and these episodes of pain recur.
About 20% of patients who develop gallbladder symptoms suffer from acute gallbladder inflammation. This happens when a stone gets stuck and blocks the exit of bile from the gallbladder. The gallbladder becomes tense and inflamed, and the trapped bile may become infected. The pain of acute cholecystitis is constant and quite severe and often is felt across the center and right parts of the upper abdomen and under the right shoulder. The patient usually vomits and is ill and feverish. Jaundice can occur if the bile duct becomes swollen and the bile cannot drain into the intestines.
When gallstone symptoms occur, most physicians agree that removing the gallbladder is the best approach. The “gold standard” procedure to remove the gallbladder is a laparoscopic cholecystectomy. A conventional open cholecystectomy is major surgery and involves a large open incision and a longer hospital stay and recovery, while laparoscopic cholecystectomy typically results in a speedier recovery with less pain and fewer complications.
Laparoscopic cholecystectomy is performed through several small puncture incisions using hollow tubes called ports. These ports allow instruments to be moved in and out and allow the doctor to manipulate the gallbladder. A long scope with a camera attachment also is placed through one of these ports. This allows the doctors to work while watching a video screen. Once the attachments of the gallbladder have been disconnected, the surgeon removes the gallbladder through one of the small incisions. The surgery may take one to two hours and usually requires a very brief hospital stay. Once your gallbladder is removed, you should be able to eat normally and quickly return to a normal, active lifestyle.
What are potential complications?
Any surgery has the potential for complications such as bleeding or infection. There is less risk in the laparoscopic cases because of smaller incisions and reduced healing time.
William G. Hawkins, MD, Section Chief
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