Once an invasive surgical procedure, gallbladder removal now has
patients going home just hours after surgery
The gallbladder, a golf ball-sized sac that sits just below the liver, aides in the digestion of rich foods, but when it becomes diseased, surgical removal is the best course of treatment, according to the Centers for Disease Control. If that should happen, don’t worry. Most procedures today are simple and quick, and have patients back up and around in a matter of hours.
Pain in the upper right abdomen, just below the rib cage, is considered a classic sign of gallbladder disease, according to the National Institutes of Health, but in most cases, gallbladder disease is asymptomatic.
In normal cases, the gallbladder stores bile – a combination of cholesterol, bile salts and a chemical called bilirubin – which is released into the intestine as an enzyme to ease the digestion of fatty foods. When these elements get out of balance, the components can create solid crystals, commonly known as gallstones. Should the stones slip out of the gallbladder, they can block the flow of bile into the intestines or cause jaundice, and if they slip too far down, they can irritate the pancreas causing pancreatitis.
But having a stone low enough to cause pancreatitis is rare, said Dr. Ghulam Moheyuddin, a Hollister-based general surgeon who practices at both Hazel Hawkins Memorial Hospital and Saint Louise Regional Hospital. “There are special methods for that, but most are more simple.”
In most cases, gallbladder removal surgery is actually quite simple, said Moheyuddin, allowing patients to go home after a couple of hours’ recovery time.
The most common procedure performed today is a laparoscopic gallbladder removal, which doesn’t require large cuts into the skin. Instead, physicians make a series of small incisions, then use a tiny video camera to complete the surgery.
“After a sterile prep of the abdomen, we make a small incision in the belly button,” said Moheyuddin. “We put a needle into the belly and insert carbon dioxide to create a space. It pushes the intestine up away from the liver, which exposes the gallbladder.”
When the air is inserted, doctors place a camera called a laparoscope into the incision, lighting up their viewing area with a small lamp and providing feedback through a tiny camera.
Two to three other small incisions allow tools into the area, according to MedlinePlus, an online medical encyclopedia published by the National Institutes of Health, and small metal clips are then put in place to pinch off the flow of bile.
“We use cautery to separate the gallbladder from its attachment to the abdomen, to divide the cystic duct and the (blood) vessels that go to the gallbladder,” said Moheyuddin. “The clips stay inside of you, so once the gallbladder has been separated and taken out through the opening in the belly button, we close those small wounds with a stitch or Band-Aid, or Steristrips.”
More than 90 percent of the gallbladder removals that Moheyuddin performs are done laparoscopically at this point, and most patients go home a few hours later. Those with diabetes, hypertension and heart problems may be kept overnight, he said, but a determined person with a desk job can often go back to work the next day.
“People who do heavy lifting and hard physical work usually take a week to 10 days off, but some people take a couple of pain killers and don’t ever need another dose,” said Moheyuddin. “They can start eating and walking around the same day, and by the next they can drive, so they can usually resume their regular activities pretty quickly.”:
Those who have recently undergone surgery should stick to low-fat foods for the first two weeks, then slowly work their way back up to a normal diet, said Moheyuddin.
Risk factors for gallbladder disease include age, weight, sex and ethnic background. Women of childbearing age and patients over 40 are most likely to develop gallbladder disease, but being Native American or Mexican-American is also an increased risk factor. Obesity and rapid weight loss are both linked to development of gallbladder disease, as are estrogen intake and lipid-lowering medication, according to the National Institutes of Health.
The disease is usually diagnosed through an abdominal ultrasound or an abdominal CT scan, a computer constructed X-ray image, according to MedlinePlus. If a laproscopic procedure cannot be safely or expediently performed, doctors may choose to create a larger incision requiring a longer hospital stay, said Moheyuddin.
Complications that can result from the surgery include bleeding, infection and injury to the surrounding internal structures, said Moheyuddin, but these are rare, occurring in only 1 or 2 percent of cases, he said.
