Gallbladder

The gallbladder is part of our body’s bile system, which is intimately related to the liver and digestion. To understand gallbladder disease, you need to start with the liver. The liver filters almost everything we eat and processes nearly everything, from fats to sugars to processing chemicals and many medications. The liver then excretes bile and we make about 1 liter of bile every day.

The gallbladder takes that bile and concentrates it and stores it. When we eat, especially certain fatty meals, the gallbladder squeezes the concentrated bile to aid with digestion. Especially on a western diet, the gallbladder is prone to forming stones over the years (though diet is not the only reason patients can form stones). The overwhelming majority of people with stones don’t actually experience any symptoms. Stones by themselves are not a reason to have gallbladder surgery.

When stones cause problems

However, stones can go on to cause problems, and when they do removing the gallbladder with surgery can be an important part of the treatment.

Gallbladder disease, especially that caused by stones, exists on a spectrum. On the mild side, stones can cause intermittent pain known as biliary colic. The hallmark of colic is that it comes, and goes. This can be a severe pain usually in the mid chest or on the right side. It can radiate to the shoulder and back. It’s not uncommon for people to think they have severe heart burn or even a heart attack with an angry gallbladder.

People who experience pain that comes and goes from stones are diagnosed with “symptomatic cholelithiasis.” This is medical lingo for “stones that cause pain.” This alone can be an indication for gallbladder surgery.

Cholecystitis

If the pain comes and now fails to go away, this now can progress to cholecystitis, or inflammation of the gallbladder. This can be further classified as acute, chronic, or acute on chronic. Cholecystitis is an indication to have surgery for those patients who are fit for surgery. For some patients whose risk for surgery is too high, treatment can be attempted with a drain placed by radiology doctors. However, there are pros and cons to this method. The main pro is that it is much less invasive than surgery and still has decent odds of treating the problem. The main cons are that it usually commits patients to having a drain for several weeks and that the root cause of the problem stays in place (the gallbladder). The decision to proceed with drain vs surgery is a complex one undertaken by your surgeon that depends on a number of clinical factors.

Surgery

Gallbladder surgery can be done as an old-school open operation via an incision under the right rib cage or up and down the middle, or via a minimally invasive approach using either laparoscopic or robotic instruments. This usually means 3-5 small incisions (most commonly 4) with one of the incisions being slightly bigger through which the gallbladder is actually removed. The placement of the incision depends on how the surgery is done (lap or robotic).

Recovery

Most people recover very well from gallbladder surgery and the overwhelming majority are back to light duty work within a week, though recovery depends on a number of patient and clinical factors.

How will my body change after gallbladder surgery?

This is mostly an extremely well tolerated procedures with many patients noticing no change at all after the healing period. Some patients tell me they notice more runny bowel movements and yet others complain of more constipation. Some notice no change at all. Whatever the change, this tends to go back pretty much to base line over several months post operatively.

What about a drain?

For patients with severe inflammation, we will sometimes place a drain after gallbladder surgery. This most often can be taken out before patients go home, but some times we have to keep the drain for longer periods.

Pain medication

Many patients can recover from gallbladder surgery with over the counter pain medicines alone. For some patients however, we will prescribe narcotics. It always best to take these judiciously as they can slow down the GI tract and have a constipating side effect that lasts longer than the pain relief effect.