The gallbladder is an organ that is adjacent to and underneath the liver. Its primary function is to store bile, a liquid that is made by the liver and helps to digest fatty foods.
Problems can arise when stones form in the gallbladder. The most common reason for the formation of stones is a change in the bile salts that make up bile. Many people have gallstones. Approximately one-half of people with gallstones will experience symptoms and/or problems.
Symptoms of gallbladder disease or stones include pain in the middle or the right side of the upper abdomen right underneath the rib cage. This pain often follows a fatty or spicy meal and can be associated with nausea and vomiting. Some people do not experience pain but may have stomach upset, gas, and bloating. Pain that does not go away and that is associated with fever may require more immediate attention.
Gallbladder disease that is causing the symptoms above can best be treated with removal of the gallbladder known as a cholecystectomy. There are oral medications but they take a long time to dissolve the stones and often the stones often recur.
Common gallbladder ailments include cholecystitis (inflammation of the gallbladder), symptomatic cholelithiasis (gallstones causing symptoms), choledocholithiasis (gallstones trapped in the bile duct), and gallstone pancreatitis (gallstones in the main bile duct causing inflammation of the pancreas).
Most patients who need a cholecystectomy (gallbladder removal) can have the procedure done laparoscopically. Three or four little incisions are made and the gallbladder is removed with the assistance of a camera that is placed inside the abdomen. The advantages of a laparoscopic cholecystectomy are smaller incisions, faster healing time, and less pain. There are a small number of people who will still need an open procedure.
Persons who have are suspected to have stones in their bile duct or have had pancreatitis because of gallstones may need a cholangiogram. A cholangiogram is an x-ray taken during surgery to show the anatomy of the bile duct leading from the liver to the small intestine as well as any blockage that may be present.
A small number of people who do not have gallstones may still benefit from a cholecystectomy. Some diabetics can have severe cholecystitis (inflammation of the gallbladder) without stones. A poorly functioning gallbladder (biliary dyskinesia) may also cause pain and these patients can benefit from cholecystectomy.
A laparoscopic cholecystectomy is often an outpatient procedure. The patient would come to the hospital, have the surgery, and then return home all in the same day. A prescription for pain medicine is given as well as other instructions. Recovery time is variable. Most people can return to work in 2 weeks and some even sooner.
- No eating or drinking after midnight the night before surgery.
- Please stop taking aspirin, Plavix, coumadin, or any other blood thinners at least 5 days prior to surgery. (Please check with your primary care physician prior to stopping any prescribed medications.)
- Patients taking other prescription medications should check with their primary care physician or anesthesia as to whether or not to take their usual medications the day of surgery.
- Please make sure you have a ride home from surgery (not a taxi or bus).
- Lab work may be required prior to surgery. You will be notified if this is the case.
- Some patients may need clearance from their primary care doctor or a heart doctor prior to this procedure. Please bring any notes regarding surgery with you to the office or to surgery on the day of the procedure.
- Please stay well hydrated by drinking plenty of liquids on the day of surgery. A low-fat diet should be maintained for 2 weeks following surgery.
- Driving is allowed when pain is controlled on a non-narcotic pain medication (not Vicodin) and when you can safely step on the gas and the accelerator quickly in an emergency. Refraining from driving for several days is recommended.
- No heavy lifting (greater than 20 lbs.) for at least 2 weeks.
- Regular exercise can be resumed as desired with no heavy lifting as above.
- Incisions will be covered with an outer bandage as well as an inner bandage. The outer bandage can be removed the day after surgery. The inner bandages resemble band-aids and are called steri-strips. These bandages should be left in place and will fall off on their own. You can shower when the outer bandages are removed. No baths or swimming for 2 weeks.
- Stitches are usually underneath the skin and dissolve on their own. Occasionally, some people feel the end of a suture. This piece will dissolve over time. No special ointments are needed for the incisions. Keep them clean and dry. Band-Aids can be placed for comfort or cleanliness.
- Constipation can occur following surgery. Milk of magnesia is available over-the-counter and may be a good option. Use as directed.
- Fevers greater than 100 degrees occurring greater than 2 to 3 days following surgery should be reported to the office.
- Severe pain, nausea, or other symptoms may represent a problem. Please call the office if you have questions or go to the emergency room.
- Please call the office with questions and to set up a follow-up appointment.