Gallbladder Surgery

Indications for removing the gallbladder include not only the presence of gallstones, but also the development of symptoms associated with gallstone disease. At present, we do not recommend removing the gallbladder for patients who are found to have gallstones incidentally, and who do not experience any symptoms from them. A fair number of patients can have gallstones and never develop symptoms.

With the development of laparoscopic surgery, gallbladder removal (or cholecystectomy) has become a very common operation. Laparoscopic surgery involves operating with long instruments and a camera in a more minimally invasive fashion. The results are smaller incisions, usually four, and a faster recovery. Laparoscopic cholecystectomy is now an outpatient procedure. However, there are still indications for proceeding with open cholecystectomy, which would necessitate a hospital stay and a longer incision and recovery. Since we rely primarily on vision during laparoscopic surgery, anything that may obscure visibility during surgery can make the laparoscopic approach unsafe. For example, adhesions from a previous surgery or significant inflammation from an acute gallbladder infection may make laparoscopic surgery unsafe. In such an instance, conversion to open surgery may be necessary.

Although laparoscopic surgery has made the recovery from gallbladder surgery easier, any surgical procedure involves risks. The primary risks for gallbladder surgery include bleeding, infection, and an injury to the bile ducts. In order for the gallbladder to be removed, the cystic duct and cystic artery must be identified and divided. The common bile duct (CBD), which is the duct into which the cystic duct empties, should not be disturbed. The risk of injury to the CBD is < 1%, and care must be taken during every surgery to avoid injury to this structure.

Patients often ask if the gallstones themselves can be removed without removing the gallbladder. While technically this can be done, it is a futile procedure because the gallstones will recur if the gallbladder is left in place. When gallstones develop, it is the environment within the gallbladder that leads to stone formation. In most cases, it is an imbalance in the ratio of the cholesterol in the bile compared to the bile salts and lecithin that allows the gallstones to crystallize from the bile. Other options, which have been tried in the past, include dissolving the stones with either medication or sound waves. Once again, neither procedure is definitive because the gallstones have a tendency to redevelop once the medication is stopped. Also, the medication can become quite costly

Most patients have no permanent disability from losing their gallbladder. I have found that the majority of patients can go back to eating without restriction. Because the gallbladder does not have a critical function, a patient can live quite comfortably without a gallbladder. The role of the gallbladder in simple terms is to store and concentrate bile, which is a substance necessary to digest fats and protein. However, it is the liver that actually makes the bile, and the liver continues to do so once the gallbladder is removed. In a small number of cases, patients who have underlying digestive problems may find that removal of the gallbladder may exacerbate bloatedness and diarrhea with certain types of food. In those instances, avoidance of those foods becomes the treatment.

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