Gallbladder Surgery is Common
Gallbladder problems are the most common issue we see other than hernias. Most people have heard about gallbladder stones and understand gallstones cause problems. Occasionally patients do not have gallbladder stones, but have gallbladder dysfunction. Gallbladder dysfunction can be very painful and disruptive. If you have gallbladder dysfunction but not stones, you may choose to delay surgery. Although, most people seem to end up having surgery once they have dysfunction as the condition tends to worsen over time. If you are having these symptoms, the best option is to have your gallbladder removed.
My Advice Has Changed Over the Years
In medical school, I was taught about 10% of the population has gallstones and not all of those patients become symptomatic. Therefore, an operation was not necessary unless the patient had symptoms and pain. At this point in my career, I recommend considering gallbladder surgery since it is so minimally invasive, and such a safe operation in the right hands.
Three Common Scenarios With A Bad Gallbladder
1. You have gallstones and symptoms of pain
If you are having symptoms and have stones, removing the gallbladder is your best option.
2. You do not have gallstones but you have pain
This is caused by gallbladder dysfunction.
3. You have gallstones and no symptoms of pain
If imaging reveals stones without symptoms, you should consider finding a good surgeon and getting your gallbladder removed instead of waiting for the stones to become a problem in the future.
Gallbladder Emergencies
I’ve been called to perform many emergency gallbladder surgeries for patients that ignored their condition. Frequently patients who need urgent gallbladder surgery have known about gallstones for years, but never did anything about it. These patients were in excruciating pain in the emergency room and I was called to evaluate them and admit them to the hospital for their gallbladder disease. Emergency gallbladder surgery is always more difficult for the surgeon to perform, more likely to have complications and overall, financially costs more to the patient. I can tell you, each of these patients wished they could have scheduled their surgery to their convenience. More importantly, they could have avoided being very sick. Despite our improvements in critical care and medical technology, many people still die from gallstone pancreatitis each year. This condition is the result of a gallstone migrating down the duct and becoming an obstruction.
Anatomy of the Gallbladder
The gallbladder is located just under your right rib cage. This area is referred to as the right upper quadrant of the abdomen. The right upper quadrant of the abdomen is the most common site of gallbladder pain. Surprisingly, gallbladder pain can even present in the left upper quadrant of the abdomen or in the right lower quadrant of the abdomen. Additionally, gallbladder pain can be felt in the right shoulder, in the back near the scapula, or even across the entire upper abdomen.
Function of the Gallbladder
The gallbladder is connected to the liver by the bile ducts. The liver creates bile. Bile helps break down fats from the foods we eat. It is necessary to digest any oils or fat which we eat. The gallbladder's job is to store and release extra bile. Normally, bile flows down the bile ducts, into the intestine, and through the digestive system. Therefore the gallbladder is a storage organ. Most people do not even miss this extra storage capability when the gallbladder is removed. Many patients are concerned about having digestive problems after have their gallbladder is removed. Fortunately, in my experience, this is a rare occurrence . Most patient's digestive function normalizes within a few weeks, if not immediately after surgery.
Gallbladder Imaging
A workup for suspected gallbladder problems usually includes an abdominal ultrasound. One of the benefits of ultrasound is the patient receives no radiation. Ultrasound is actually better at finding small stones than a cat-scan. If the patient does not have gallstones, but gallbladder dysfunction is suspected, the next test in the diagnostic tree is usually a HIDA scan. This tests the function of the gallbladder and a drug is given to stimulate the gallbladder during the scan. If the patient experiences symptoms when the gallbladder is stimulated, the gallbladder is the culprit of their discomfort and they will benefit from surgery.
Surgical Technique
With extremely rare exception, all gallbladders should be removed with a laparoscopic approach. The laparoscopic approach utilizes very tiny incisions in the abdomen. The standard laparoscopic approach uses four trocars, which are small hollow plastic or metal tubes. Trocars are placed through the abdominal wall to give access to the gallbladder. Surgeons use telescopic cameras and long tools to reach the gallbladder. About 95% of surgeons use this approach.
Over the last 10 years I have performed gallbladder surgeries with only three incisions. This benefits patients by having one less incision, one less scar, and one less weak point on the abdominal wall. The three incision method also reduces the chances of a hernia at the site of the fourth port.
Single Site Laparoscopic Approach
da Vinci Surgical Technology
Gallbladder surgery can be performed with the da Vinci robot. In January 2013, I was the first to perform single site robotic laparoscopic cholecystectomy in the State of Idaho at Saint Alphonsus in Boise.
This surgery is performed through only a single incision, which is called single-site gallbladder surgery. The da Vinci single-incision does require a somewhat larger incision which is usually 2.5 centimeter, or 1 inch. In my experience, patients with a larger umbilicus benefit more from this single-site approach as I am able to hide the entire incision in the lower umbilical fold. My standard laparoscopic approach (without the robot) utilizes three trocars, but the incisions are much smaller. They measure only 1-centimeter at the umbilicus and two smaller 5-millimeter incisions in the upper abdomen. This also results in a near scar-less cholecystectomy.
An open incision for a gallbladder surgery is very rarely required, even when it‘s an emergency. This is the reason a patient should seek out an experienced laparoscopic surgeon. Your surgeon should perform a lot of laparoscopic gallbladder surgeries. Although gallbladder surgery is common, harm to the surrounding anatomy including the common bile duct can have disastrous effects for the patient. It’s been clinically proven that patients who have damage done to their common bile duct during surgery have shortened lives compared to patients who are not harmed.
Gallbladder surgery is an outpatient surgery, meaning overnight stay is not required. Our patients are usually in and out within about a three-hour window. About half of our patients choose to return to work in two or three days. The other half usually take about a week off to recuperate.
Post-Op Reasons to Call Your Surgeon's Office
You should be up and moving around easily the day after surgery, but you will most likely feel soreness at the trocar site positions as well as the right upper quadrant of your abdomen. Some reasons to call in and be seen early after surgery are:
- Increasing Pains
- Unrelenting Nausea and Vomitings
- Fever greater than 101 degrees Fahrenheits
- Increasing redness at the incision sites
Low-grade fevers such as 100.4 Fahrenheit are common on the evening of surgery or the next day due to the lungs not being fully expanded. This low-grade fever is not necessarily a reason to be seen early. It can be treated by breathing deeply and stretching your lungs. This condition is called atelectasis. After any surgery in which you undergo general anesthesia, the lungs need to be fully expanded again by breathing deeply and coughing and a low-grade fever often results if the lungs are not fully expanded. General anesthesia is required for gallbladder surgery.