Gallbladder surgery is the most frequent procedure that most general surgeons perform.
The most common reason that patients are referred to a surgeon regarding their gallbladder is because they have gallstones. The medical word for gallstones is cholelithiasis. Less commonly patient are referred for gallbladder type symptoms, and there are no gallstones on imaging. If we are convinced that the symptom are coming from a dysfunctional gallbladder, then we call it biliary dyskinesia.
The usual way that patients are diagnosed with gallstones, is by having an ultrasound of their abdomen. Sometimes gallstones are large enough to be seen on a CT scan, and thus an ultrasound is not necessary. A negative CT scan does not rule out gallstones. In most cases no other diagnostic tests are necessary after gallstones are identified on any imaging study.
When gallstones are not seen on ultrasound, and a patient has very classic gallbladder symptoms (biliary colic), depending on mutiple factors, we may recommend proceeding directly to removal of the gallbladder, or sometime a nuclear medicine study called a HIDA scan is performed with injection of CCK (a hormone that causes gallbladder contraction) to evaluate the function of the gallbladder by determining the ejection fraction (EF) of the gallbladder. This may seem like a very precise test, but unfortunately it isn’t, and needs to be considered as a tool in the overall clinical picture. A low gallbladder EF on CCK-HIDA correlates with about an 85% chance of improvement of symptoms with gallbladder removal.
Once we have decided that you are an appropriate candidate for gallbladder surgery (cholecystectomy), we can schedule you to have this done laparoscopically in the operating room under general endotracheal anesthesia. This is called a laparoscopic cholecystectomy.
This involves making 3 small holes in the abdomen, which is then inflated with CO2, allowing a space to work. The duct that drains the gallbladder is tied off, and the blood vessels to it are cauterized. I use a laparoscopic ultrasound to evaluate the bile ducts, to be sure there are no stones in them, and that they have not been compromised by tying off the gallbladder duct. At that time I cut the duct between the ties , separate the gallbladder from the liver and remove it from the abdomen through the small hole at the navel. These sites are closed with sutures under the skin, and a glue like dressing is placed on the skin. In general this is done as an outpatient, so that after you recover from anesthesia, you are able to go home.
For specifics about your post-op course, please refer to the posted post-op instructions for laparoscopic cholecystectomy.
If at the time of laparoscopic cholecystectomy, I find gallstones in the common bile duct, I can usually remove them at that setting laparoscopically utilizing baskets, wires and a small flexible fiber-optic scope. Sometimes the anatomy precludes this approach, and in that case I would keep you in the hospital overnight, and perform a special endoscopy (ERCP) the next day to remove them.
Operative risks of laparoscopic cholecystectomy include bleeding, infection, injury to the surrounding structures (intestines, liver and other bile ducts), bile leak, DVT and cardiopulmonary risks of general anesthesia (which are increased if you already have heart or lung disease). These complications are all, thankfully quite uncommon.
Post-operative risks are prolonged pain, persistent symptoms, and there are a small number of people who have a change in their bowel habits (usually diarrhea) or diet tolerance after having cholecystectomy.