Gastroenterology

What is a Gall Bladder Surgery ?

Laparoscopic gallbladder surgery (cholecystectomy) removes the gallbladder and gallstones through several small cuts (incisions) in the abdomen. The surgeon inflates your abdomen with air or carbon dioxide in order to see clearly. The surgeon inserts a lighted scope attached to a video camera (laparoscope) into one incision near the belly button. The surgeon then uses a video monitor as a guide while inserting surgical instruments into the other incisions to remove your gallbladder.

Before the surgeon removes the gallbladder, you may have a special X-ray procedure called intraoperative cholangiography, which shows the anatomy of the bile ducts.

You will need general anesthesia for this surgery, which usually lasts 2 hours or less. After surgery, bile flows from the liver (where it is made) through the common bile duct and into the small intestine. Because the gallbladder has been removed, the body can no longer store bile between meals. In most people, this has little or no effect on digestion.

Laparoscopic gallbladder surgery is the best method of treating gallstones that cause symptoms, unless there is a reason that the surgery should not be done.

Laparoscopic surgery is used most commonly when no factors are present that may complicate the surgery.

The laparoscopy has many benefits but the procedure may not be suitable for those patients who earlier had upper abdominal surgery. The patients who had some pre-existing medical condition is also not appropriate for gallbladder surgery. A thorough examination of the patient is done in order to determine whether or not the procedure is right for you.

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Gallstones

Gallstones are small stones made from cholesterol, bile pigment and calcium salts, which form in your gallbladder. Medical treatment may not be needed unless the gallstones cause symptoms such as pain, jaundice and fever. Treatment may include changing your diet, and surgery. Your gallbladder may be removed (a cholecystectomy) if gallstones (or other types of gallbladder disease) are causing problems.

Symptoms of gallstones

In approximately 70 per cent of cases, gallstones cause no symptoms. The symptoms of gallstones may include:

pain in the abdomen and back. Pain is generally infrequent, but severe

increase in abdominal pain after eating a fatty meal

jaundice

fever and pain, if the gallbladder or bile duct becomes infected.

Types of gallstones

There are three main types of gallstones being:

mixed stones - the most common type. They are made up of cholesterol and salts. Mixed stones tend to develop in batches

cholesterol stones - made up mainly of cholesterol, a fat-like substance that is crucial to many metabolic processes. Cholesterol stones can grow large enough to block bile ducts

pigment stones - bile is greenish-brown in colour, due to particular pigments. Gallstones made from bile pigment are usually small, but numerous.

Diagnosis of gallstones

Doctors diagnose gallstones by using a number of tests, including:

general tests - such as physical examination and x-rays

ultrasound - soundwaves form a picture that shows the presence of gallstones

endoscope test - endoscopic retrograde cholangiopancreatography (ERCP). A thin tube is passed through the oesophagus and injects dye into the bowel to improve the quality of x-ray pictures

hepatobiliary iminodiacetic acid (HIDA) scan - a special type of nuclear scan that assesses how well the gallbladder functions

magnetic resonance cholangiopancreatography (MRCP) - a form of the body-imaging technique magnetic resonance imaging (MRI). The person’s liver, biliary and pancreatic system is imaged using an MRI unit. The image is similar to an ERCP test.

Treatment for gallstones

Gallstones that cause no symptoms, generally don’t need any medical treatment. In certain cases (such as abdominal surgery for other conditions), doctors may remove your gallbladder if you are at high risk of complications of gallstones.

Treatment depends on the size and location of the gallstones, but may include:

dietary modifications - such as limiting or eliminating fatty foods and dairy products

lithotripsy - a special machine generates soundwaves to shatter the gallstones. This treatment is used in certain centres only, for the minority of people with small and soft stones

medications - some medications can dissolve gallstones, but this treatment is only rarely given, due to side effects and a variable success rate

surgery

Around 80 per cent of people with gallstone symptoms will need surgery. Surgeons may remove your entire gallbladder (cholecystectomy), or just the stones from bile ducts.

Techniques to remove the gallbladder include:

Laparoscopic cholecystectomy - 'keyhole' surgery - the surgeon makes a number of small incisions (cuts) through the skin, allowing access for a range of instruments. The surgeon removes the gallbladder through one of the incisions. The general procedure includes:

The surgeon makes a number of small incisions into your abdomen, so that slender instruments can reach into the abdominal cavity.

A tube blowing a gentle stream of carbon dioxide gas is inserted. This separates the abdominal wall from the underlying organs.

The surgeon views the gallbladder on a TV monitor by using a tiny camera attached to the laparoscope.

Special x-rays (cholangiograms) during the operation can check for gallstones wedged in the bile ducts.

The ducts and artery that service the gallbladder are clipped shut. These clips are permanent.

The gallbladder is cut free using either laser or electrocautery

The gallbladder, along with its load of gallstones, is pulled out of the body through one of the abdominal incisions.

The instruments and the carbon dioxide gas are removed from the abdominal cavity. The incisions are sutured (closed up) and covered with dressings.

Open surgery (laparotomy) - the surgeon reaches the gallbladder through a wider abdominal incision. You might need open surgery if you have scarring from prior operations or a bleeding disorder. The general procedure is the same as for laparoscopic surgery, except that the surgeon reaches the gallbladder through a large, single incision in the abdominal wall. Sometimes, an operation that starts out as a laparoscopic cholecystectomy turns into open surgery if the surgeon encounters unexpected difficulties, such as not being able to see the gallbladder properly.