Introduction
- The gall bladder is a collapsible storage organ akin to a water balloon. It is attached to the undersurface of the liver on the upper right side of the abdomen (fig)
- It’s function is storage of bile (produced in the liver) and maintaining it in a liquid state.
- Any event adversely affecting the gallbladder can cause it to lose its function and one of the commonest outcomes is formation of stones.
- Gallstones are crystals of pigments and cholesterol which get precipitated inside the gallbladder. These coalesce and form stones. Once formed the stones act like a foreign body and make the gallbladder vulnerable to complications like infection, obstruction, jaundice and rarely cancer.
- Surgical removal is the only treatment for a diseased gallbladder.
- Laparoscopic cholecystectomy is the standard surgical procedure for gallbladder removal for last 30 years.
Signs and symptoms
- The most typical sign of gallstones is a pain (also known as biliary colic). The pain typically begins in the upper part of the belly and seems to move towards the back (spine). Relief usually follows antispasmodic medication, but often patient may require injectable painkillers for relief
- The pain is often accompanied by nausea and vomiting.
- Other symptoms are bloating especially following a fatty meal.
- Excessive burping
Diagnosis
- An abdominal ultrasound is the standard diagnostic test for gallstones
- Ultrasound is best done empty stomach.
- Other modalities are
- An MRCP (MRI specifically of the gallbladder and bile ducts). This is done if patient has jaundice due to gallstones.
- Abdominal CT scan –
- This is done if the gallbladder ruptures (pain all over the belly and the patient becomes very sick),
- Biliary pancreatitis (acute swelling/ festering of pancreas) develops due to gallstones and
- Suspected gallbladder cancer.
Treatment
Laparoscopic Cholecystectomy (LC)
- The term means removal of gallbladder by keyhole surgery.
- It is performed through 4 standard access ports as shown in the figure.
- The gallbladder is detached from its attachment to the drainage system of the liver and the its attachment to the liver under surface after securing its blood supply.
- It is removed from the body through one of the punctures (below the sternum) and sent for biopsy.
- The advantages of the procedure is minimal surgical pain, short hospital stay and a rapid recovery and return to routine day to day activities.
- Sometimes if there is severe infection in the gallbladder, a pipe is placed at the surgical site for a few days to help in draining out any residual infection.
- Following removal of gallbladder patient can have a normal diet second day onwards.
Post operative precautions
- There are no special restrictions following gallbladder removal.
- Most patients are able to resume normal daily routine activities in a few days
- There are no dietary restrictions.
- The surgery has no impact on the quality or longevity of the patients life.