The gallbladder serves as a reserve for bile that gets secreted by the liver. The bile gets secreted by the liver so that it can go into the intestine to help with the digestion of food, mainly the protein and fat contents of the food. The liver continues to secrete bile and the bile gets diverted into the gallbladder and the gallbladder reserves that bile until we have a meal and after the meal a hormone called cholecystokinin is secreted. Once the food is in the duodenum, cholecystokinin is secreted and it travels in the blood to order the gallbladder to contract and once the gallbladder contracts it will push all of the bile that has been secreted down the bile duct and in then into the intestine to help with the digestion and absorption of fatty food and protein material along with pancreatic enzymes. The gallbladder itself sits just underneath the liver on the right side of the abdomen underneath the rib cage and is attached to the main bile duct with what we call the cystic duct.
Gallstones are very common affecting 10% of the population. Surgical removal of the gallbladder is one of the most common operations performed by a general surgeon. This operation is usually performed laparoscopically in most cases. Gallbladder, unlike other organs is not essential for general health. When the gallbladder is removed the bile still flows to the intestine as usual.
This operation is usually conducted under general anaesthesia in a keyhole approach which gives you a faster recovery and earlier return to work. The surgeon makes a small cut around the belly button to insert the camera under direct vision; 2-3 other small (5mm) cuts are made in the upper part of the abdomen, the peritoneal cavity is insuffulated with co2 for visibility , diathermy current is used to identify the important structures, there is an artery that provides blood supply that will need to be controlled with synthetic clips’ also the cystic duct is controlled in same manner. Prior to occluding the duct, usually an Xray test is needed to ensure there are no stones in the bile duct. Then the gallbladder is removed from its liver attachment and retrieved in a bag via the belly button.
Sometimes the surgeon will choose to leave in a plastic drain that is usually removed the next day or the day after. This occurs in cases when the gallbladder is extremely inflamed and a difficult operation was needed.
If there are stones in the bile duct your surgeon has two options, either removing the stones at the same operation or chooses to refer you for an endoscopy test called ERCP, in this procedure the stones are removed by endoscopy with no wounds.
1. Hospital stay is overnight usually can be longer if the operation is complicated
2. You are reasonably pain free within a few days and may only require paracetamol
3. You can drive and resume work once the pain settles
4. It is common to feel tired after the operation and that may take a week to ten days to settle.
5. You don’t need to modify your diet after the operation, only about 10% of patients will develop loose bowel motions, in that case they need to reduce fat intake. It usually settles down but may take a few months.