Overview

In gallbladder removal surgery, a surgeon makes a large incision (cut) in your belly to open it up and see the area. The surgeon then removes your gallbladder by reaching in through the incision and gently lifting it out.

Surgery is done while you are under general anesthesia (unconscious and unable to feel pain).

The surgeon will make a 5 to 7 inch incision in the upper right part of your belly, just below your ribs. The surgeon will cut the bile duct and blood vessels that lead to the gallbladder. Then your gallbladder will be removed.

A special x-ray called a cholangiogram will be done during the surgery. This involves squirting some dye into your common bile duct. This duct will be left inside you after your gallbladder has been removed. The dye helps locate other stones that may be outside your gallbladder. If any are found, the surgeon may be able to remove these other stones with a special medical instrument.


What Are Gallstones?

Gallstones are collections of cholesterol, bile pigment or a combination of the two, which can form in the gallbladder or within the bile ducts of the liver. In the United States, the most common type of gallstones is made of cholesterol. Cholesterol stones form due to an imbalance in the production of cholesterol or the secretion of bile. Pigmented stones are primarily composed of bilirubin, which is a chemical produced as a result of the normal breakdown of red blood cells. Bilirubin gallstones are more common in Asia and Africa but are seen in diseases that damage red blood cells such a sickle cell anemia.


How Do Gallstones Cause Problems?

If gallstones form in the biliary system they can cause blockage of the bile ducts, which normally drain bile from the gallbladder and liver. Occasionally the gallstones can also block the flow of digestive enzymes from the pancreas since both the bile ducts and pancreas ducts drain through the same small opening (called the Ampulla of Vater) which is held tight by a small circular muscle (called the Sphincter of Oddi). This is known as gallstone pancreatitis. Blockage of the bile ducts may cause symptoms such as abdominal pain, nausea and vomiting. If the bile duct remains blocked bile is unable to drain properly, jaundice (yellow discoloration of the eyes and skin) can develop and an infection known as cholangitis may also develop.

Figure 1: Anatomy of liver, bile duct, pancreas duct and sphincter of Oddi. Note that a stone can impact at the sphincter of Oddi and block both the bile duct and pancreas duct.


Who Is At Risk For Gallstones?

Female gender, older age, obesity, high cholesterol levels, treatment with estrogen containing medications, rapid weight loss, diabetes and pregnancy are all risk factors for developing cholesterol gallstones. Disorders that lead to the destruction of red blood cells such as sickle cell anemia are associated with the development of pigmented or bilirubin stones. The occurrence of gallstones varies widely among different ethnic groups. For example, Pima Indians and Hispanics have high occurrence rates of developing gallstones compared to Asians, who overall, have a very low rate.


What Are The Symptoms Of Gallstones?

Gallstones that are not causing symptoms generally do not cause problems and do not require further evaluation. Many times gallstones are found by chance on an abdominal x-ray or ultrasound done for other reasons. Unless symptoms of pain, nausea, vomiting or fever are present, no additional testing or intervention may be needed. Symptoms arise when a gallstone blocks the flow of bile out of the gallbladder or through the bile ducts.
A gallstone in the common bile duct is called choledocholithiasis and may cause intermittent or constant discomfort. The pain of choledocholithiasis is usually localized in the upper abdomen, and can radiate (be felt in another location) in the right shoulder, may last many minutes to hours, and be associated with sweating, nausea, vomiting, and. Gallstone attacks can produce chest pain that may feel like a heart attack. If a pain is new and different than other pains the symptoms should be discussed with a physician.

An inflamed gallbladder (cholecystitis), infected material trapped within the common bile duct (cholangitis), or a stone blocking outflow of pancreatic juice (gallstone pancreatitis) can result in fever, chills, severe abdominal pain or jaundice. Individuals with these complaints should have an urgent evaluation by a physician.


How Are Gallstones Diagnosed?

The diagnosis of gallstones is suspected when symptoms of right upper quadrant abdominal pain, nausea or vomiting occur. The location, duration and “character” (stabbing, gnawing, cramping) of the pain help to determine the likelihood of gallstone disease. Abdominal tenderness and abnormally high liver function blood tests may be present. An abdominal ultrasound examination is a quick, sensitive, and relatively inexpensive method of detecting gallstones in the gallbladder or common bile duct. This is the test most often used.


What Is The Treatment For Gallstones?

The treatment for gallstones that obstruct the common bile duct is endoscopic retrograde cholangiopancreatography (ERCP) or surgery. ERCP involves passage of a thin flexible scope through the mouth and into the duodenum where it is used to evaluate the common bile duct or pancreatic duct. Tiny tubes and instruments may be used to further evaluate the ducts and remove stones if necessary. Gallbladder surgery may be performed if there are stones found in the gallbladder itself, as these cannot be removed by ERCP. This operation, known as cholecystectomy, is frequently done using a laparoscope, another thin scope that resembles an endoscope, and is inserted into the abdomen through several small incisions under general anesthesia. If a gallbladder operation is not possible, a medicine known as ursodiol, may be used to dissolve cholesterol gallstones but this can take months, and the stones recur in many people once the treatment is stopped.



Other Gallbladder And Biliary Procedures :


Radical cholecystectomy

Resection of Klatskin tumors and cholangiocarcinoma

Bile duct reconstruction

Common bile duct exploration

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