Gallbladder Surgery

Gallstones are hard deposits that form in the gallbladder when the substances in bile, such as cholesterol and bile pigments, become out of balance. They are very common, and many people have gallstones without ever knowing it. Problems arise when a stone blocks the outlet of the gallbladder or moves into the bile duct.

The most common symptom is biliary colic: a severe, steady pain in the upper abdomen or beneath the right ribs, often spreading to the back or right shoulder blade, typically occurring after a fatty meal and lasting from thirty minutes to several hours. Other symptoms include nausea, vomiting, bloating and intolerance of fatty foods. Gallstones are usually diagnosed by an ultrasound scan, and blood tests are checked to look for signs of inflammation or blockage of the bile duct.

Gallstones that cause no symptoms generally do not need treatment. Surgery is recommended once stones begin to cause symptoms or complications, because further attacks are likely and each carries a risk of more serious problems. These complications include:

• Cholecystitis - inflammation or infection of the gallbladder, causing persistent pain and fever
• Bile duct stones - a stone passing into the bile duct, which can cause jaundice (yellowing of the skin and eyes) and infection
• Gallstone pancreatitis - inflammation of the pancreas caused by a stone blocking its duct

Because the gallbladder is not essential for digestion, removing it is the definitive way to prevent these attacks. Stones cannot be reliably dissolved or broken up, and the gallbladder tends to keep forming new stones, so removing the gallbladder rather than the stones alone is the standard treatment.

Laparoscopic (keyhole) cholecystectomy is the standard operation to remove the gallbladder. It is performed under general anaesthesia through four small incisions in the abdomen and usually takes around one hour. A camera and fine instruments are used to free the gallbladder from the liver, seal the duct and artery that supply it, and remove it through one of the small incisions. An X-ray of the bile ducts (cholangiogram) may be taken during the operation to check that no stones have passed into the duct.

Occasionally, because of scarring, severe inflammation or unclear anatomy, it is safer to convert to an open operation through a larger incision under the right ribs. Your surgeon will discuss this possibility with you beforehand. If a stone is found in the bile duct, it may be removed during surgery or by a separate endoscopic procedure.

Many patients go home the same day or the following morning. Some discomfort at the incisions and shoulder-tip pain from the gas used during keyhole surgery are common for the first few days and settle with simple pain relief. You can shower the next day and are encouraged to walk early.

Most people return to light activities within a few days, to desk-based work within one to two weeks, and to heavy lifting and strenuous exercise within two to four weeks. Recovery after open surgery takes longer.

You can eat normally after surgery. Some people find that rich or fatty meals cause bloating or loose bowel motions in the first few weeks, so it is sensible to reintroduce these foods gradually. The liver continues to produce bile, which now flows directly into the bowel, and no long-term dietary restrictions are needed.

Complications after gallbladder surgery are uncommon, but it is important to know when to seek help. Before your operation, seek urgent medical attention if you develop severe abdominal pain that does not settle, fever or shaking chills, or yellowing of the skin or eyes, as these can indicate infection or a stone blocking the bile duct.

After surgery, contact the practice or go to your nearest emergency department if you notice:

• Worsening abdominal pain rather than gradual improvement
• Fever, or increasing redness, swelling or discharge from a wound
• Jaundice (yellow skin or eyes), dark urine or pale stools
• Persistent vomiting or inability to keep fluids down
• Increasing abdominal swelling or shortness of breath

Mild discomfort and tiredness are normal in the first week; the warning signs above are not.