Gallbladder Surgery (Cholecystectomy) New Jersey
Gallbladder surgery, also known as a cholecystectomy, is the surgical process in which the gallbladder is removed from the abdomen. Gallbladder surgery is most often performed because of gallstones, which can form in the gallbladder as well as the common bile duct, causing significant discomfort and pain. Since obesity is a significant risk factor for gallstones, the gallbladder can often be removed during a primary bariatric surgery procedure.
What is the Gallbladder?
The gallbladder is a small-sized organ under the liver. Its purpose is to store bile, a fluid made by the liver to metabolize the fats we consume during meals. Bile is also known as gall, hence the name of the organ. The gallbladder is pear-shaped and changes in size based on the amount of bile being stored at any given time.
As food passes through the stomach and into the small intestine, the gallbladder secretes this bile into the common bile duct, a tube spanning the liver and the small intestine. This secretion is a direct response to food entering the GI tract. The gallbladder acts as a sort of pump, pushing the bile though the ducts that connect it to the small intestine. As the bile mixes with the food, it breaks down the fats into a form that is more easily absorbed into the blood stream as nutrition.
Do I need a Gallbladder?
The gallbladder is not an essential organ to life. As such, most patients have no problems whatsoever after a gallbladder removal. Indeed, cholecystectomies have become a routine procedure and many people live without their gallbladder. After the procedure, bile will still be transported from the liver to the small intestine, but the gallbladder will no longer be available for storage.
A minority of patients will experience some short or longer-term discomfort associated with the removal of the gallbladder. For most, this is a temporary result of additional bile flowing into the small intestine causing GI issues. These possibilities should be discussed with your physician.
What Are Gallstones?
Gallstones are small, hard particles that develop in the gallbladder. They form as a result of the bile hardening and tend to block the common bile duct. In some cases they can cause severe symptoms including vomiting, pain in the abdomen or back pain, often requiring gallbladder surgery. For others, gallstones do not cause any discomfort at all.
There are two forms of gallstones: those formed by the hardening of cholesterol, which represent the vast majority of gallstone cases and those formed by the hardening of bilirubin. Cholesterol gallstones are usually lighter in color while bilirubin gallstones are darker.
Interestingly, there is no direct relationship between the size and quantity of gallstones and the symptoms that they cause. Some patients have large gallstones with no symptoms and others have small gallstones and severe pain. Generally, symptoms include:
- Significant recurrence of indigestion
- Infection of the gallbladder
- Serious nausea or vomiting attributed to gallbladder stones
- and significant abdominal pain
Causes of Gallstones
The bottom line is that there is no guarantee that you can avoid gallstones, since they become more common as we age. In fact, the single greatest risk factor for gallstones is advanced age – those over the age of 40 are most susceptible. Further, women are more susceptible to gallstones than men. This may be a cause of extra estrogen in the body from pregnancy, birth control pills or hormone replacement.
Specific ethnic and racial populations also have a higher risk of developing gallstones. American Indians and Mexican Americans both have a higher rate of gallstones than the general population of the United States
Other conditions can also contribute to gallstones, the most common of which is excess weight and obesity. Extreme weight loss and diets high in calories and refined carbs can contribute to the problem.
Diagnosis of Gallstones
The diagnosis of gallstones is relatively straightforward, especially if the gallstones are symptomatic – i.e. giving the patient serious discomfort. The signs of gallstones are very clear and pronounced. They usually occur shortly after a meal that contains a significant amount of fat. Your doctor will discuss your medical history as well as the symptoms you are feeling. If there is any doubt as to the source of the problem, an ultrasound may be ordered to show the gallstones in the gallbladder.
However, not all cases of gallstones are symptomatic and patients may not always complain of pain. As such, many patients find out they have gallstones as a result of testing for other conditions. Ultrasonography (ultrasound) is the most common way to see gallstones. CT scans and MRIs can also be used to visualize gallstones.
Generally, if a patient has asymptomatic gallstones, no treatment is necessary and the gallstones will be monitored.
Minimally Invasive Gallbladder Removal
In preparation for gallbladder surgery, patients will be evaluated in order to determine if they are candidates for the laparoscopic approach. Today, a cholecystectomy is now most often performed in a laparoscopic manner, using four tiny incisions in the abdomen and allowing the surgeon to access the gallbladder with specially made surgical tools including a high definition camera called a laparoscope.
As a result of this minimally invasive entry into the abdomen, patients often recovery faster, have a shorter hospital stay, feel less pain and experience less blood loss.
While the minimally invasive approach has its advantages, not all patients will qualify. Some procedure may have to be converted to open surgery.
Conversion to Open Gallbladder Surgery
There is a possibility, as with any laparoscopic surgery, that the procedure will have to be converted to an open procedure during surgery. In certain cases, a special x-ray process called a cholangiogram will be performed during the course of the procedure. The surgeon will inject contrast dye into the common bile duct to see if there are any additional stones. If additional stones are found in the common bile duct, the surgeon may not be able to remove them as part of the minimally invasive procedure. At that point, the surgeon could decide to convert the surgery to an open procedure in order to remove those stones along with the gallbladder.
Complications Associated with Gallbladder Removal
Some patients will have short or longer term conditions associated with their gallbladder removal. These usually revolve around the gastrointestinal tract and may include diarrhea, gas, bloating, nausea, and pain. With that said, surgery is the only effective treatment for larger, symptomatic gallstones. Further, not all symptoms are a direct cause of the removal of the gallbladder and may be caused by other as yet undiagnosed conditions. Please speak to us to learn more about the risks associated with a gallbladder removal.
Alternatives to Surgery
While there are non-surgical techniques that may benefit a patient with gallstones, these are often unreliable, temporary and less effective than surgery. A consultation with your medical team can determine the best course of action based on your unique circumstances.
Patients who are having gallstone attacks should speak to a qualified laparoscopic surgeon such as those at Advanced Surgical Associates to understand more about qualification criteria. Please contact us to schedule a consultation with one of our general surgeons.