Laparoscopic Gallbladder Surgery

The Normal Gallbladder

The gallbladder is a small, sac like, pear shaped organ. It sits under the liver in the upper right part of the abdomen. The liver produces a substance called bile, a fluid that breaks down fats in foods to aid in digestion, Some of this bile is stored in the gallbladder. The gallbladder concentrates the bile by removing the excess water. Hormones in your body signal the gallbladder to start doing its job after eating a fatty meal. The function of the gallbladder is then to aid in digestion by squeezing bile into the small intestine through the cystic duct to break down the fat. If a diseased gallbladder is removed, the liver still produces bile to aid in digestion.

Gallstones: The Most Common Gallbladder Problem

Sometimes there may be too much or too little of the bile or other liquid chemicals inside the gallbladder. When this happens, some of the chemicals start to crystallize (forming solid stones) called gallstones. If the stones stay in the gallbladder, they may irritate the gallbladder wall or they may be silent and not cause problems. But if they start to move into the ducts they will block them and this can cause the bile to back up. You may feel symptoms of heartburn or may want to vomit. This blockage may also lead to pain, nausea, jaundice, infections, or diseases of the liver. It may also lead to pancreatiiis (an inflamed pancreas).

Medical History And Physical Exam

Your doctor will ask you about your symptoms, health problems, and other factors that may point to gallbladder disease. You will also have a physical exam. This will help your doctor rule out other causes for your pain.

The Cause Of Your Pain

Gallbladder problems can cause many distressing symptoms. You may have felt severe stomach pain, shoulder pain, back pain, pain under your breastbone, heartburn, or an upset stomach. Symptoms may have started sometime after a meal. This may have been the first attack or you may have had other attacks in the past. Your doctor may be saying your pain is due to gallstones. These are linked to a diseased gallbladder. Because your symptoms are likely to worsen if not treated, you should start thinking of your options for relieving your pain.

Who Develops Gallbladder Problems

No one knows for sure why some people have gallbladder problems. These problems may be related to how the body handles cholesterol. Or problems may result from an infected gallbladder.
  • Women in their 40's
  • Women who have been pregnant
  • Men and Women who are overweight. (Also people who lose weight too quickly may increase the risk of forming gallstones.)
  • Parents, siblings, and children of people with a history of gallbladder problems.

Certain Foods Can Make Your Problems Worse

If you have gallbladder problems, it is best to avoid fatty or spicy foods. Eating these types may trigger pain or other symptoms. So before your gallbladder problems are treated, stay away from fried foods, high-fat dairy products, oils and spicy meals.

During Laparoscopic Surgery

First, you are given an anesthetic and medication through an IV tube. Your abdomen is then inflated with carbon dioxide gas. This helps your doctor to see and move instruments inside your body. The gas is removed at the end of the surgery.

Cholangiogram

During surgery a cholangiogram (a special type of x-ray) may be taken of your bile duct. The x-ray may reveal stones in the duct. Stones may be removed at this time or during the ERCP.

ERCP Treatment

This is a procedure performed by a Gastroenterologist that uses an endoscope (a small flexibe telescope) that is used to reveal and sometimes remove gallstones from the bile duct. A balloon at the tip of a catheter opens above the stone. The stone is then gently pulled out of the duct to then pass through your digestive tract and leave your body through stool.

Open Surgery

In rare cases, your doctor may feel it isn't safe to continue a laparoscopic cholecystectomy once it has begun. If this is determined, your gallbladder is then removed through a larger incision in your abdomen.

After Laparoscopic Surgery In the Hospital

When you wake up from surgery, you will find small bandages covering your incisions. The IV tube may stay in place briefly, until you are able to drink fluids. You may have some discomfort in your right shoulder for a short time. This will go away by itself. Within a few hours after surgery you may be drinking liquids and may be able to eat a light meal later that evening, if you wish.

At Home

When you return home, you can do a few things to help in speeding up your recovery. Take your temperature often during the first 2 to 3 days to be sure you don't have a fever. Don't do any heavy lifting or vigorous exercise. Follow your doctor's advice about showering driving and returning to work. You may be able to resume some normal activities in 3 to 5 days. Be aware that pain medicines can cause short-term changes in bowel habits such as constipation. Bruising near the incision site is normal.

Eating Normally

You may have some gas pains or other discomfort while your digestion returns to normal. During this short time, eat whatever was easy to digest before your surgery. You may experience loose stools for several weeks.

Following Up

During the first 7 to 10 days after surgery, your doctor will meet with you to check your progress and answer your questions. The gauze dressings can be removed in 48 hours and you may shower at that time. Please leave the steri-strips (tape) on for 1 week. The stitches are usually dissolvable. More appointments will be scheduled as needed.

When To Call Your Doctor

Call your doctor if you have any of these problems:
  • You have a fever (over 10l.0F or 38.3C) or chills.
  • You have an incision that drains for longer than a day.
  • You have increasing pain or redness at an incision site.

Treatment Plan

You can live a healthy life without your gallbladder. So your doctor may suggest that you have surgery to remove it. You and your doctor will discuss your options, including risks and complications of surgery. Many people can have laparoscopic cholecystectomy instead of open surgery. But it may not be right for you if:
  • You have major scarring from a past surgery.
  • You have any bleeding disorders.
  • You are pregnant and near your due date.
  • You may have a condition that will make it hard for your doctor to see with the laparoscope.

Risk And Complications

Any surgery has some risks and complications. For gallbladder surgery, they include:
  • Bleeding
  • Infection
  • Injury to surrounding organs
  • Injury to the common bile duct
  • Blood clots
  • Indigestion
  • Neuroma (painful spot) or numbness near the incision
  • Continued formation of stones in the common bile duct

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