Surgery of the Gallbladder
Making gallbladder removal easier to undergo
The primary cause of gallbladder disease is hard deposits called gallstones, which can obstruct the biliary system and are the most common disorder of that system. When gallstones are present in the gallbladder itself, the condition is called cholelithiasis.
When gallstones are present in the bile ducts, it is called choledocholithiasis. Gallstones that obstruct bile ducts can lead to severe or life-threatening infection of the bile ducts, pancreas, or liver. Pancreatitis frequently accompanies gallstones.
If gallstones cause no symptoms (are asymptomatic), treatment is usually not necessary. However, if symptoms persist, patients may be evaluated in Aria’s respected Division of Gastroenterology, where gastroenterologists can provide such critical diagnostic and interventional procedures as ERCP. With this capability, the GI specialist can take such steps as sphincterotomy, in which the team endoscopically opens the ring of muscle around the end of the bile duct to capture the stones or permit them to pass into the intestine.
If additional treatment is indicated for gallstones, it can take a number of different forms, including:
• drugs to dissolve the stones;
• solutions injected into the gallbladder to dissolve the stones;
• or shockwave therapy (lithotripsy) to break up the stones.
If these treatments are not successful or are not indicated for some reason, or if the patient’s symptoms are acute, surgery may be called for. The goal is to remove the source of inflammation and restore the flow of bile fluid into the intestine.
Other conditions and disorders of the biliary system, such as liver disease or ductal scarring, can also block the bile duct. A number of interventional radiologic bile duct procedures offer additional options for addressing blocked bile ducts.
Surgery to remove the gallstones and gallbladder (an operation called cholecystectomy) is a standard and common approach to treating acute gallbladder disease. In this procedure, the surgeon typically removes the gallbladder laparoscopically (using small incisions and endoscopic tools).
Alternatively, the surgeon may remove the gallbladder through an open, surgical incision. Surgeons chose this approach when, for various reasons, laparoscopic surgery would be too difficult or too dangerous for a particular patient.
The biliary system can also be an area of growth for malignant tumors as well. Treatment may require removing the gallbladder (and sometimes the pancreas and a portion of the liver). (For more on surgical treatment of cancer in these organs, see Aria’s Division of Surgical Oncology.)
An open cholecystectomy requires one incision of several inches in length. A laparoscopic cholecystectomy requires three much smaller puncture wounds. In either case, blood transfusion is usually not necessary. Since less abdominal healing is required after a laparoscopy, this approach means less pain and faster recovery. After a successful laparoscopic cholecystectomy, patients can usually leave the hospital the next day and return to normal activities within two weeks. For the open surgery, patients remain in the hospital for at least five days, and return to normal activities after six to eight weeks.
Patients can do well and live healthy lives without their gallbladder. Bile fluid, no longer stored in the gallbladder, flows directly from the liver to the small intestine.