What Causes Gallbladder Problems?
What are the symptoms of gallbladder problems?
Before the procedure
How long does it take to recover from gallbladder surgery?
How serious is getting your gallbladder removed?
Is a gallbladder surgery a major surgery?
Is gallbladder surgery necessary?
What are the side effects of having your gallbladder removed?
What should you expect after gallbladder surgery?
How painful is gallbladder surgery?
A cholecystectomy is a surgical procedure to remove your gallbladder (a pear-shaped organ that sits just below your liver on the upper right side of your abdomen. Your gallbladder collects and stores bile) a digestive fluid produced in your liver.
A cholecystectomy may be necessary if you experience pain from gallstones that block the flow of bile. A cholecystectomy is a common surgery, and it carries only a small risk of complications. In most cases, you can go home the same day of your cholecystectomy.
A cholecystectomy is most commonly performed by inserting a tiny video camera and special surgical tools through four small incisions to see inside your abdomen and remove the gallbladder. Doctors call this a laparoscopic cholecystectomy
In some cases, one large incision may be used to remove the gallbladder. This is called an open cholecystectomy.
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Medical use
Pain and complications caused by gallstones are the most common reasons for removal of the gallbladder. The gallbladder can also be removed in order to treat biliary dyskinesia or gallbladder cancer.
Gallstones are very common but 50–80% of people with gallstones are asymptomatic and do not need surgery; their stones are noticed incidentally on imaging tests of the abdomen (such as ultrasound or CT) done for some other reason. Of the more than 20 million people in the US with gallstones, only about 30% will eventually require cholecystectomy to relieve symptoms (pain) or treat complications.
- Biliary colic
Biliary colic, or pain caused by gallstones, occurs when a gallstone temporarily blocks the bile duct that drains the gallbladder. Typically, pain from biliary colic is felt in the right upper part of the abdomen, is moderate to severe, and goes away on its own after a few hours when the stone dislodges. Biliary colic usually occurs after meals when the gallbladder contracts to push bile out into the digestive tract. After a first attack of biliary colic, more than 90% of people will have a repeat attack in the next 10 years. Repeated attacks of biliary colic are the most common reason for removing the gallbladder, and lead to about 300,000 cholecystectomies in the US each year.
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- Acute cholecystitis
Cholecystitis, or inflammation of the gallbladder caused by interruption in the normal flow of bile, is another reason for cholecystectomy. It is the most common complication of gallstones; 90-95% of acute cholecystitis is caused by gallstones blocking drainage of the gallbladder. If the blockage is incomplete and the stone passes quickly, the person experiences biliary colic. If the gallbladder is completely blocked and remains so for a prolonged period, the person develops acute cholecystitis.
Pain in cholecystitis is similar to that of biliary colic, but lasts longer than 6 hours and occurs together with signs of infection such as fever, chills, or an elevated white blood cell count. People with cholecystitis will also usually have a positive Murphy sign on physical exam - meaning that when a doctor asks the patient to take a deep breath and then pushes down on the upper right side of their abdomen, the patient stops their inhalation due to pain from the pressure on their inflamed gallbladder
5-10% of acute cholecystitis occurs in people without gallstones, and for this reason is called acalculous cholecystitis. It usually develops in people who have abnormal bile drainage secondary to a serious illness, such as people with multi-organ failure, serious trauma, recent major surgery, or following a long stay in the intensive care unit.
People with repeat episodes of acute cholecystitis can develop chronic cholecystitis from changes in the normal anatomy of the gallbladder. This can also be an indication for cholecystectomy if the person has ongoing pain.
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- Cholangitis and gallstone pancreatitis
Cholangitis and gallstone pancreatitis are rarer and more serious complications from gallstone disease. Both can occur if gallstones leave the gallbladder, pass through the cystic duct, and get stuck in the common bile duct. The common bile duct drains the liver and pancreas, and a blockage there can lead to inflammation and infection in both the pancreas and biliary system. While cholecystectomy is not usually the immediate treatment choice for either of these conditions, it is often recommended to prevent repeat episodes from additional gallstones getting stuck.
- Gallbladder cancer
Gallbladder cancer (also called carcinoma of the gallbladder) is a rare indication for cholecystectomy. In cases where cancer is suspected, the open technique for cholecystectomy is usually performed.
- Liver transplantation
In living donor liver transplantation between adults, a cholecystectomy is performed in the donor because gallbladder interferes with removal of the right (lateral) lobe of the liver and to prevent the formation of gallstones in the recipient. The gallbladder is not removed in pediatric transplantations as the left lobe of the liver is used instead.
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What Causes Gallbladder Problems?
Gallstones are often the cause. These small, hard deposits form in the gallbladder. They can also get into the bile duct, which connects the gallbladder with your intestines.
You are more likely to get gallstones if you:
- Are a woman,
- Have had children,
- Are overweight, or
- Are over 40.
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What are the symptoms of gallbladder problems?
Symptoms can include:
- Sharp pain in your abdomen,
- Nausea and vomiting,
- Indigestion,
- Fever, and
- Yellow skin – Jaundice is the medical term for skin and eyes that look yellow. You might get jaundice if gallstones block your bile duct.
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How you prepare
Food and medications
To prepare for a cholecystectomy, your surgeon may ask you to:
- Eat nothing the night before your surgery.You may drink a sip of water with your medications, but avoid eating and drinking at least four hours before your surgery.
- Stop taking certain medications and supplements.Tell your doctor about all the medications and supplements you take. Continue taking most medications as prescribed. Your doctor may ask you to stop taking certain medications and supplements because they may increase your risk of bleeding.
Clothing and personal items
Most people go home the same day of their cholecystectomy, but complications can occur that require one or more nights in the hospital. Plan ahead in case you need to stay in the hospital by bringing personal items, such as your toothbrush, comfortable clothing, and books or magazines to pass the time.
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Before the procedure
A cholecystectomy is performed using general anesthesia, so you won't be aware during the procedure. Anesthesia drugs are given through a vein in your arm. Once the drugs take effect, your health care team will insert a tube down your throat to help you breathe. Your surgeon then performs the cholecystectomy using either a laparoscopic or open procedure.
During the procedure
Depending on your situation, your surgeon will recommend one of two surgical approaches:
Minimally invasive (laparoscopic) cholecystectomy
During an open cholecystectomy, the surgeon makes a 6-inch (15-centimeter) incision in your abdomen below your ribs on your right side. The muscle and tissue are pulled back to reveal your liver and gallbladder. Your surgeon then removes the gallbladder. During a laparoscopic cholecystectomy, the surgeon makes four small incisions in your abdomen. A tube with a tiny video camera is inserted into your abdomen through one of the incisions. Your surgeon watches a video monitor in the operating room while using surgical tools inserted through the other incisions in your abdomen to remove your gallbladder.
Next you may undergo an imaging test, such as an X-ray or ultrasound, if your surgeon is concerned about possible gallstones or other problems in your bile duct. Then your incisions are sutured, and you're taken to a recovery area. A laparoscopic cholecystectomy takes one or two hours.
A laparoscopic cholecystectomy isn't appropriate for everyone. In some cases, your surgeon may begin with a laparoscopic approach and find it necessary to make a larger incision because of scar tissue from previous operations or complications.
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Traditional (open) cholecystectomy
During an open cholecystectomy, the surgeon makes a 6-inch (15-centimeter) incision in your abdomen below your ribs on your right side. The muscle and tissue are pulled back to reveal your liver and gallbladder. Your surgeon then removes the gallbladder.
After the procedure
You'll be taken to a recovery area as the anesthesia drugs wear off. Then you'll be taken to a hospital room to continue recovery. Recovery varies depending on your procedure:
- Laparoscopic cholecystectomy. People are often able to go home the same day as their surgery, though sometimes a one-night stay in the hospital is needed. In general, you can expect to go home once you're able to eat and drink without pain and are able to walk unaided. It takes about a week to fully recover.
- Open cholecystectomy. Expect to spend two or three days in the hospital recovering. Once at home, it may take four to six weeks to fully recover
Cholecystectomy surgery risks
All surgery carries risk of serious complications including damage to nearby structures, bleeding, infection, or even death. The operative death rate in cholecystectomy is about 0.1% in people under age 50 and about 0.5% in people over age 50. The greatest risk of death comes from co-existing illness like cardiac or pulmonary disease.
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How long does it take to recover from gallbladder surgery?
How long it takes to recover from gallbladder removal surgery (cholecystectomy) depends on whether you had a laparoscopic (keyhole) or open procedure.
Most people who have keyhole surgery are able to leave hospital on the same day as the operation. It'll usually take around 2 weeks to return to your normal activities.
After open surgery, you'll usually have to stay in hospital for 3 to 5 days, and your recovery time will be longer. It can take around 6 to 8 weeks to return to your normal activities.
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How serious is getting your gallbladder removed?
The gallbladder is a small organ located just below your liver in your right upper abdomen. A gallstone can move from the gallbladder and block a bile duct, causing irritation, pain and swelling of the gallbladder (cholecystitis).
Gallbladder removal surgery is considered to be a safe procedure, but, like any type of surgery, there's a risk of complications.
Possible complications include:
- wound infection
- bile leaking into the tummy
- damage to one of the openings (ducts) carrying bile out of the liver
- blood clots
Is a gallbladder surgery a major surgery?
Laparoscopic cholecystectomy is a common but major surgery. It carries a few risks and potential complications and may not be the best solution in particular situations.
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Is gallbladder surgery necessary?
A cholecystectomy is most commonly performed to treat gallstones and the complications they cause. Your doctor may recommend a cholecystectomy if you have:
- Gallstones in the gallbladder (cholelithiasis)
- Gallstones in the bile duct (choledocholithiasis)
- Gallbladder inflammation (cholecystitis)
- Large gallbladder polyps
- Pancreas inflammation (pancreatitis) due to gallstones
What are the side effects of having your gallbladder removed?
Side effect of removal of the gallbladder are:
Difficulty digesting fat
It may take your body time to adjust to its new method of digesting fat. The medications you were given during surgery may also cause indigestion. This doesn’t typically last long, but some patients do develop longer-term side effects, usually caused by bile leaking into other organs or gallstones that were left behind in the bile ducts.
Diarrhea and flatulence
Indigestion can cause diarrhea or flatulence, often made worse by excess fat or too little fiber in the diet. Bile leakage can mean having an insufficient amount of bile in the intestines to digest fat, which loosens stool.
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Constipation
Although removal of a diseased gallbladder usually reduces constipation, surgery and anesthesia used during the procedure can lead to short-term constipation. Dehydration can make the constipation worse.
Intestinal injury
During gallbladder removal, it’s rare but possible for a surgeon to damage the intestines. This may result in cramping. Some pain is normal following any surgery, but if it continues beyond a few days or gets worse instead of better, speak to your doctor.
Jaundice or fever
A stone that remains in a bile duct after gallbladder removal surgery can cause severe pain, or jaundice, which is the yellowing of the skin. A complete blockage can cause an infection.
It’s possible you’ll experience digestive side effects when your gallbladder is removed.
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What should you expect after gallbladder surgery?
After your surgery, you will likely feel weak and tired for several days after you return home. Your belly may be swollen. If you had laparoscopic surgery, you may also have pain in your shoulder for about 24 hours.
You may have gas or need to burp a lot at first. A few people get diarrhea after gallbladder. The diarrhea usually goes away in 2 to 4 weeks, but it may last longer.
For a laparoscopic surgery, most people can go back to work or their normal routine in 1 to 2 weeks, but it may take longer. For an open surgery, it will probably take 4 to 6 weeks before you get back to your normal routine. How quickly you recover depends on whether you had a laparoscopic or open surgery.
For a laparoscopic surgery, most people can go back to work or their normal routine in 1 to 2 weeks. But it may take longer, depending on the type of work you do.
For an open surgery, it will probably take 4 to 6 weeks before you get back to your normal routine. However, each person recovers at a different pace.
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How painful is gallbladder surgery?
You might feel some pain around your incisions, or in your shoulders from the air pumped into your body during surgery. Icing can help with this. With your doctor's approval, you can take nonprescription pain meds like ibuprofen or acetaminophen. They can prescribe meds for the pain, if you need them.
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