The gallbladder is a pear-shaped organ that stores bile, the fluid that helps to digest food. If the gallbladder is not functioning properly (or your bile gets out of balance), hard fragments start to form – these are known as gallstones. These can be as small as a grain of rice or as big as a golf ball. But when do you know if you need surgery on your gallbladder? Mr Niteen Tapuria, Consultant General Surgery, Laparoscopy and Hepatobiliary, takes a closer look:
What is the gallbladder and can I live without it?
The function of gallbladder is to concentrate bile from the liver. Without a gallbladder, there’s no place for bile to collect. Instead, your liver releases bile straight into the small intestine. This allows you to still digest most foods. However, large amounts of fatty, greasy, or high-fiber food become harder to digest. This can result in gas, bloating, and diarrhea.
Gallbladder removal is called cholecystectomy. Once the gallbladder is removed the bile goes straight into the bowel. You can have your gallbladder removed for several reasons, including:
- inflammation, called cholecystitis
- gallbladder polyp
Initially some people may experience diarrhoea following gallbladder removal due to low bile salt concentration, but this eventually settles down. Some people may need oral bile salt supplements. While you can survive without a gallbladder, you’ll likely need to make some adjustments to your lifestyle and eating habits to avoid any further problems.
Do I need to have my gallbladder removed?
The first thing to determine is whether your abdominal pain is in fact due to gallstones. They typically cause pain on the upper right side or in the center of the abdomen just below the breastbone that radiates to the back or right shoulder. Sometimes gallstone pain is accompanied by sweating, bloating, nausea, or vomiting.
Usually if somebody is symptomatic due to gallstones an operation is recommended.
What if I choose to not have an operation?
It is entirely an individual’s choice whether to have an operation or not as long as they understand the risks of leaving gallstones untreated.
The risks of not treating gallstones may include:
- Unpredictable attacks of gallstone pain.
- Episodes of inflammation or serious infection of the gallbladder, bile ducts, or pancreas.
- Jaundice and other symptoms caused by blockage of the common bile duct. Jaundice makes your skin and the whites of your eyes yellow. It can also cause dark urine and light-coloured stools.
You may be able to prevent gallstone attacks by staying close to a healthy weight and getting regular exercise.
I don’t have symptoms, should I have an operation?
It’s generally not recommend for a patient without symptoms to have a gallbladder operation.
How is the operation done?
Laparoscopic gallbladder surgery is the most common surgery done to remove the gallbladder. The doctor inserts a lighted viewing instrument called a laparoscope and surgical tools into your belly through several small cuts. This is known as keyhole surgery and has a high success rate. Patients who have this surgery usually recover within 10 days.
Open gallbladder surgery involves taking the gallbladder out through one large incision in your belly. Open surgery may be done if laparoscopic surgery is not an option or when problems are found during laparoscopic surgery. The hospital stay is longer with open surgery.
What are the complications?
The overall risk from laparoscopic gallbladder surgery is very low. The most serious risks include:
- Injury to the common bile duct.
- Injury to the small intestine by one of the tools used during surgery.
Other risks include:
- A risk of bile duct injury
- Bile leak
- Hernia at the wound sites
- Deep vein thrombosis.
Occasionally a stone may slip into the bile duct needing an endoscopy to remove it.
What precautions do I need to take after surgery?
Generally speaking, after keyhole surgery you can:
- drive again after a week or so – but first make sure you can wear a seatbelt and practise an emergency stop without feeling any discomfort
- return to work after 10 to 14 days, depending on what your job involves
- eat a normal diet straight away – you can return to a normal diet even if you were advised to avoid certain foods before your operation, although you should try to have a generally healthy and balanced diet
- do gentle exercises, such as walking – but be careful not to push yourself too hard, too soon and ask your surgeon or GP for advice about returning to more strenuous exercise
- You can take a shower but not sit in a bath or pool for one week.
For more information on gallbladder surgery click here. You can find out more about Mr Tapuria on the Highgate website here.