There can be a lot of misinformation on the Internet regarding illnesses and surgeries. Gallbladder surgery is one of them. Many patients with gallstones either panic and think of the worst case scenario because of something they’ve read online, or avoid surgery due to the fear that they might lead a lower quality of life. In this blog post, I will share some of the top myths surrounding gallstones and gallbladder removal as well as my thoughts.
Your gallbladder is a pear-shaped organ that stores bile, the fluid that helps digest food. If it’s not working the way it should (or your bile gets out of balance), hard fragments start to form. These can be as small as a grain of rice or as big as a golf ball.
Gallstones don’t go away on their own. If they start to hurt or cause other symptoms, your doctor may decide to remove your gallbladder. This type of surgery is called a cholecystectomy. It’s one of the most common surgeries doctors perform.
About 80% of people who have gallstones will need surgery.
Before the surgeon removes the gallbladder, you may have a special X-ray procedure called intraoperative cholangiography, which shows the anatomy of the bile ducts.
You will need general anesthesia for this surgery, which usually lasts 2 hours or less.
After surgery, bile flows from the liver (where it is made) through the common bile duct and into the small intestine. Because the gallbladder has been removed, the body can no longer store bile between meals. In most people, this has little or no effect on digestion.
In 5 to 10 out of 100 laparoscopic gallbladder surgeries in the United States, the surgeon needs to switch to an open surgical method that requires a larger incision. Examples of problems that can require open rather than laparoscopic surgery include unexpected inflammation, scar tissue, injury, and bleeding.
Why Does Your Gallbladder Need To Be Removed?
You may need gallbladder surgery if you have pain or other symptoms caused by gallstones — small stones that can form in the gallbladder. They can block the flow of bile and irritate the gallbladder. Common symptoms of gallbladder problems include:
- Indigestion, with bloating, heartburn, and gas
- Sharp pain in your belly
- Nausea and vomiting
- Yellowing of the skin and the whites of the eyes (jaundice)
The good news? You don’t need a gallbladder to live, so if it’s causing severe problems, your doctor will likely recommend surgery to remove it.
Why Open Gallbladder Surgery Is Done
Unfortunately, the gallbladder isn’t always the most efficient organ. Bile can be thick and create blockages along the pathway where it typically empties. The gallbladder is also prone to develop gallstones in certain people.
Gallstones are hard deposits of substances in the bile that can get stuck inside the gallbladder and biliary ducts. They can be as small as a grain of sand or as large as a golf ball. Gallstones can also lead to acute or chronic gallbladder inflammation, sometimes with an associated infection, which can cause:
- further pain
A surgeon will remove your gallbladder if gallstones cause significant pain and other complications.
Other conditions that could make you a candidate for gallbladder removal include:
- Biliary dyskinesia. This occurs when the gallbladder doesn’t empty bile correctly due to a defect in its motion.
- Choledocholithiasis. This happens when gallstones have moved to the common bile duct where they may be stuck, causing a blockage that doesn’t allow the gallbladder or rest of the biliary tree to drain.
- Cholecystitis. This is inflammation of the gallbladder.
- Pancreatitis. This is inflammation of the pancreas.
A doctor will recommend gallbladder surgery if your gallbladder is causing a severe, acute problem or has become a chronic concern. Some symptoms that may indicate the need for gallbladder removal include:
- sharp pain in the right upper portion of your abdomen that can radiate to the middle of your abdomen, right shoulder, or back
- jaundice, or yellowing of your skin, which typically indicates a bile duct blockage when due to biliary disease
Sometimes a doctor will recommend watchful waiting to see if gallbladder-related symptoms lessen. Diet changes, such as reducing overall fat intake, may also help. If symptoms persist, a doctor may recommend surgery.
Gallbladder Surgery Risks
You can live without your gallbladder. Your liver can make enough bile on its own. This will naturally find its way into your small intestine even if your gallbladder is removed.
Doctors believe gallbladder surgery is safe, but some problems can still arise. These may include:
- Problems with anesthesia
- Bile leakage
- Damage to a bile duct
- Damage to your intestine, bowel, or blood vessels
- Deep vein thrombosis (blood clots)
- Heart problems
You also run the risk of a problem doctors call “post-cholecystectomy syndrome” (PCS). It can happen if any gallstones are left in your bile ducts or bile happens to leak into your stomach. The symptoms of PCS are similar to those of gallstones. They include belly pain, heartburn, and diarrhea.
How To Prepare for Open Gallbladder Surgery
Prior to surgery, you’ll undergo several tests to ensure you’re healthy enough for the procedure. These will include blood tests and imaging tests of your gallbladder.
You may need to have additional imaging studies, such as a chest X-ray or an EKG, depending on your medical history. A complete physical exam and record of your medical history will also be needed.
During these appointments, tell your doctor if you’re taking any medications, including over-the-counter drugs or nutritional supplements. Certain medications can interfere with the procedure. You may have to stop taking them prior to surgery. Also, tell your doctor if you’re pregnant or may be pregnant.
Your doctor will give you complete instructions on the best way for you to prepare for surgery.
These instructions may include:
- Arrange to have someone stay with you immediately after surgery and drive you home.
- Fast (no eating or drinking) for at least four hours or more before surgery.
- Plan for a hospital stay in case of complications.
- Shower using a special, antibacterial soap.
How Open Gallbladder Surgery Is Performed
Gallbladder Surgery types
Whenever possible, laparoscopic surgery is preferred over traditional open surgery. This is because it’s less invasive and usually has a shorter recovery time.
However, certain complications can make open surgery a better choice, such as when the gallbladder is severely diseased. A severely diseased gallbladder can be more difficult to remove because it may have affected surrounding areas, which makes a laparoscopic procedure more difficult.
If someone has had prior abdominal surgeries that caused inflammatory changes near the gallbladder area, such as scar tissue adhesions, this may also make a laparoscopic cholecystectomy less possible.
Sometimes, a surgeon will begin using the laparoscopic method, but won’t be able to safely remove the gallbladder. In this case, they’ll finish the procedure in the open fashion. According to the American College of Surgeons (ACS), a surgeon starts with a laparoscopic method and converts to an open method if needed. The likelihood of an open method is:
- less than 1 percent of the time in young, healthy individuals.
- 1.3 to 7.4 percent of the time when gallstones are present in the common bile duct
- as high as 30 percent if you’re older than 50, male, and have complicating risk factors, such as acute gallbladder inflammation, previous abdominal surgeries, high fever, high bilirubin levels, or a history of frequent gallbladder attacks
At the hospital or surgery center, you’ll change into a hospital gown. An intravenous (IV) line will be inserted into a vein in your arm or hand for the purpose of anesthesia. An open gallbladder procedure is typically performed under general anesthesia, so you’ll be in a painless, deep sleep before the surgery starts.
Your abdomen will first be cleansed with an antiseptic solution to reduce infection risk. Your surgeon will then make an incision in your abdomen. There are two incision types your surgeon may choose. The surgeon might create a slanted incision just below the ribs on the right side of your abdomen. Or they could create an up-and-down incision on the right upper part of your abdomen. This is less common.
The skin, muscle, and other tissues are pulled back to expose your gallbladder. Your surgeon will then remove your gallbladder, close the wound with stitches, and then bandage the area.
According to the ACS, a laparoscopic gallbladder surgery procedure takes about one to two hours. An open procedure can take longer, but the length of time depends on the severity of the gallbladder disease.
After your surgery, you’ll be taken to the postoperative recovery area and then back to your hospital room. Your vital signs, pain levels, intake and output, and incision site will continue to be monitored until you’re released home.
What to Expect After Gallbladder Surgery
You can probably go home the day you have your surgery, or you might stay in the hospital overnight. You need to be able to drink liquids before you go home.
WILL I BE IN PAIN?
You will feel some pain after surgery. Pain at the incision sites and in your abdomen is common. You might also have pain in your shoulders. This is from the air put into your abdomen during the operation. The shoulder pain should go away in 24 to 48 hours.
You can take non-prescription medications to relieve pain, unless your doctor tells you not to. Acetaminophen (Tylenol®) and ibuprofen (Advil®) are examples of non-prescription pain medications. Putting ice on your incisions can also help. Ask your doctor or nurse about the correct way to use ice.
Your surgeon might prescribe a small amount of narcotic pain medicine to help you with pain. Many people recover from surgery without taking any narcotic pain medicine, but some will need narcotics for a few days. If you have questions about pain after surgery, ask the surgeon or your nurses. They should be able to tell you how long the pain will last and what to expect.
You might feel sick to your stomach (nauseated) or throw up (vomit) after your surgery. Having surgery and anesthesia can make this happen. You should feel better in a day or two. Tell your doctor or nurse if you keep vomiting or feeling nauseated.
You should be as active as your body allows. Doctors recommend walking. You can go up and down stairs on the day of your surgery. The next day, you may take your bandages off, if you have them, and take a shower. You can expect to feel a little better each day after going home. If not, please call your doctor.
You can probably go back to normal activity about a week after laparoscopic gallbladder surgery.
If you do a physical job with heavy lifting, ask your doctor when you can go back to work. You can drive 24 hours after you had anesthesia if you are not taking narcotic pain medicines.
If you had an open surgery with a large incision, you need more time to recover. You will probably need to stay in the hospital for a few days after surgery. Expect to go back to full activities in 4 to 6 weeks. You will probably recover more slowly in other ways, too. Your doctor can tell you what to expect.