WHAT IS A GALLBLADDER?

Gallbladder is a pear shaped organ present close to the liver. Its function is to store and concentrate bile juice which is produced in the liver. It does not produce bile as many people think.

What is Bile?

Bile is a liquid produced by the liver which helps the body to digest fat. On eating a meal, the gallbladder pushes this bile into the common bile duct which carries it to the intestine.

What Causes Gallstones?

The exact cause for their formation is not known, however, risk factors include:

• Gender: women between 20 and 60years of age are twice as likely to develop gallstones as men.
• Age: practically all age groups but more common in the 30’s &40’s Obesity
• Excess estrogen (women on oral contraceptive pills etc.)
• Cholesterol – lowering drugs
• Diabetes
• Rapid weight loss
• Prolonged fasting
• Hereditary blood disorders

Notable points

• Gallstone are common among women and people who are over weight
• Gallstone attacks often occur after eating fatty meals.
• Accurate diagnosis is important because systems can point toward other problems, including heart attack. Diagnosis can be made in majority of the patients by simple ultrasound conducted in a fasting state.
• Gallstones can cause serious problems if they become trapped in the bile ducts such as jaundice and pancreatitis
• Laparoscopic surgery to remove the gallbladder is now the ‘Gold Standard’’ for treating gallstones
• The surgery can be done in practically all the patients including patients with a previous abdominal operation/cardiac history/asthma/diabetes etc.

Can the surgery be performed as a day case procedure?

Yes, day case surgery may be performed in young and selected patients. The patient is supposed to be fasting and would be called to operating theatre in the morning. The operation will be performed and the patient will be observed for 4-6hours post operatively. The patient would normally be discharged the same day. However, if the need arises, he/she could be admitted overnight as well.

What happens after admission for surgery?

The patient is normally admitted to the hospital a day prior to surgery or on the day of surgery. After admission, the patient is examined and investigations reviewed by one of the team members. Also, a member of the Anaesthesia team would conduct the pre-anaesthetic check-up. Pre-operative investigations are performed, if needed. The patient would need to be fasting overnight or for 8 hours for surgery but can take his/her regular dose of medicines with sips of water. (please follow the instructions given by the attending staff.)

Next morning the patient is moved to the operating theatre about an hour or so prior to the surgery. After surgery, the patient is moved to the recovery ward under the care and supervision of our Anaesthesia team.

Post operative instructions and information.

• You will be sleepy immediately after the operation due to sedation given during anaesthesia and during the recovering period.
• You may have some discomfort when coming out of the effect of sedation. It gradually reduces to a tolerable level within a few minutes without any pain killer. However, if necessary you may ask for pain killer injection/tablets. You should try to avoid these drugs because they produce drowsiness and you may sleep for a longer period which is not desirable.
• You may feel nauseated in the immediate post-operative period, and you may even vomit which should not cause any worry. This generally gets over after few hours.
• You are generally allowed to have sips of water immediately after the operation and liquids on the day of operation. In case of vomiting the liquid intake may be stopped and restarted after 30 minutes. The liquids may include water/cold drinks/tea/coffee/milk/juices or some clear soups.
• You should have small frequent meals for few days after operation following which you can resume your normal diet gradually. This is vital because you feel bloated and distended if the quantity of food is in large quantities at a time.
• You should try to move the limbs and can sit up immediately after operation. You should also go to the toilet on your own. There are no restrictions whatsoever for the physical movement. In fact majority of the patients will feel much better after they have started the movement. The pain also dramatically reduces once you start sitting up, moving and working.
• There is no restriction on your physical activity. You are allowed to walk as soon as you recover from your sleep. There is no restriction on climbing of stairs, lifting weight etc. you may even drive two wheelers or car as soon as you fill fit. This in fact is one of the major advantages of the laparoscopic procedure.
• In very few cases there may be some blood/ whitish discharge from the wound in the post operative period. This should not bother you because it is generally harmless. You can wipe the discharge and apply band-aid so as to avoid staining the clothes. if it is more you should report to the surgeon during the next visit. Please feel free to ask any question that may come to your mind.

Who is at risk for gallstones?

• Women are more prone than men
• People in their 30’s and 40’s
• Overweight men and women
• People who fast frequently or lose a lot of weight quickly
• Pregnant women, women on hormone therapy and women who use birth control pills for a prolonged period.

What are the symptoms?

Symptoms of gallstones are severe abdominal pains often called a gallstone ‘attack’ (colic) because they occur suddenly. Gallstone attacks often follow fatty meals, and they may occur during the night. A typical attack can cause the following:

• Pain in the right upper abdomen that increases rapidly and lasts from few minutes to several hours
• Pain in the back between the shoulder blade
• Pain under the right shoulder
• Nausea or vomiting

Other symptoms of gallstones include:

• Abdominal bloating (gas formation)
• Recurring intolerance to fatty foods
• Belching
• Indigestion

People who also have the following symptoms should see a doctor right away:

• Sweating
• Chills (shivering)
• Low-grade fever
• Yellowish colour of the skin or whites of the eyes
• Clay-coloured stools

Many people with gallstones have no symptoms. These patients are said to be a symptomatic and these stones are called ‘silent stones’.

What complications can these stones cause?

• Recurrent severe abdominal pain or vomiting
• Pus formation in the gallbladder (Emphysema)
• Cholangitis (life threatening infection of biliary system)
• Gangrene and perforation of the gallbladder
• Acute pancreatitis (swelling of pancreas) which can have a catastrophic sequel of multi-organ failure and other serious complication.
• Jaundice due to blockage of the common bile duct due to stones
• Associated with cancer of gallbladder in the long term.

What is the treatment?

Medical: Treatment of symptoms of pain with injectable or oral painkillers. No medical therapy is available for gallstones as such which can cure the disease. Though, injectable or oral antibiotics and supportive medications are available for treating the infection.

Surgery: Surgery to remove the gallbladder (cholecystectomy) is the only way to treat gallstones. This can be done by conventional (open) method or a well established endoscopic (laparoscopic) method which is now the gold standard.

The surgery is called laparoscopic chelecystectomy (lap. Chole). For this operation, the surgeons make few tiny incisions in the abdomen and insert surgical instruments and a miniature telescope with a mounted video camera into the abdomen. The camera sends magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. While watching the monitor, the surgeon uses the instrumens to carefully separate the

gallbladder from the liver, ducts and vessels. The gallbladder is then removed through one of the small incisions. Recovery usually occurs within a day in the hospital, followed by few days of rest at home.

Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer wound complications. If the surgeon finds any difficulty in the laparoscopic procedure, the operating team may decide to switch over to open surgery. It is called ‘open’ surgery because the surgeon has to make a 5 to 8 inch incision in the abdomen to remove the gallbladder.

Non-surgical treatment

Non-surgical approaches are used only in special situations such as when patient’s condition is not fit for anaesthesia and surgery. This does not cure the patients as it only provides symptomatic relief.

Don’t people need their gallbladder?

Fortunately, the gallbladder is an organ that people can live without. Losing it won’t even require a change in diet. Once the gallbladder is removed, bile flows out of the liver through the hepatic ducts into the common bile duct and goes directly into the small intestine, instead of being stored in the gallbladder.