GALL BLADDER

WHAT IS A GALL BLADDER AND WHAT DOES IT DO?

  • The gall bladder is a small sac attached to the underside of your liver which stores bile

  • Bile is a liquid produced by the liver and stored in the gall bladder

  • When you eat, especially a fatty meal, a message is sent to the gall bladder which squeezes bile out into the main bile tube (common bile duct) and through to the intestine

  • Bile acts as a detergent – it dissolves grease or fat, just like when you’re washing the dishes using detergent soap

  • Bile helps dissolve the fat in you food so you can absorb it through the intestine into your body

 

WHAT ARE GALLSTONES?

  • In some people, the bile is unbalanced and stones may form within it

  • This most commonly happens in the gall bladder

  • Most gall stones don’t cause any problems but in some people, stones can lead to medical problems

 

WHO GETS GALLSTONES?

  • About 10% of people in western countries have gallstones

  • Whilst it’s unclear exactly why some develop gallstones and others don’t, risk factors include:

    • Being female

    • Multiple pregnancies

    • Obesity and/or rapid weight loss

    • Increasing age

    • Family history

  • Ultrasound is the best test to look for gallstones.

 

ARE GALLSTONES ALWAYS BAD?

  • Whilst 10% of people of people may have gallstones, up to 80% of those will never develop any symptoms or a gallstone related medical problems

  • If you have gallstones, 1-2% will develop symptoms per year

 

DO I NEED SURGERY FOR MY GALLSTONES?

  • If your gallstones are not causing you any problem, surgery is not usually recommended

  • The exceptions to this may include:

    • Large stone/s (>3cm)

    • Multiple small stones filling gall bladder

    • Young age

    • A history of diabetes

  • If you have symptomatic gallstones, surgery will usually be recommended

 

WHAT SYMPTOMS/CONDITIONS DO GALLSTONES CAUSE? 

  • Gallstones can cause a variety of conditions and thus a variety of different symptoms

 

  • Biliary colic

    • Most common cause of gallstone related symptoms

    • Stones block up the gall bladder outlet so when it tries to empty – typically after a meal – you may develop upper and/or right sided abdominal pains

    • Pain may radiate around to the back or to the chest

    • Can be mistaken for heart pain and vice versus

    • May be associated with nausea and/or vomiting

    • Typically self limiting, lasting up to a few hours

 

  • Cholecystitis

    • If the stone continues to block the gall bladder in biliary colic, the gall bladder becomes inflamed and potentially infected

    • Pain persists and goes from colicky to constant

    • There may be fever and/or jaundice (yellowing of the eyes and skin)

 

  • Cholangitis

    • A bile infection caused by blockage of the main bile duct from stones which either formed there or have entered there from the gall bladder

    • May be associated with right or central upper abdominal pain, fevers, rigors and/or jaundice

 

  • Pancreatitis

    • Inflammation of the pancreas which can also be caused by stones in the bile duct

    • Characterised by sever upper central abdominal pain penetrating through to the back and may be associated with nausea and vomiting

 

  • Gall bladder cancer

    • Only very rarely associated with gallstones

 

MY GALLSTONES ARE CAUSING ME TROUBLE; WHAT CAN I DO?

  • The safest, most effective way of dealing with symptomatic gallstones is surgical removal of the gall bladder – known as cholecystectomy

  • This is usually done via “keyhole” surgery, but occasionally open surgery via a longer cut is necessary for your safety

 

WHAT IS LAPAROSCOPIC CHOLECYSTECTOMY?

  • “Keyhole” surgical removal of the gall bladder – performed with you asleep under general anaesthetic, in an operating theatre

  • It’s usual for 4 small incisions to be made, ranging from 5mm to 2cm

  • A long camera-telescope and long instruments are passed through these incisions so Mr Jassal can operate from outside the abdomen whilst seeing what he’s doing inside via camera-telescope

  • The gall bladder is detached from the liver and biliary system and removed via one of the small incisions

 

WHAT IS OPEN CHOLECYSTECTOMY?

  • Before “keyhole” surgery, cholecystectomy was always performed via a longer incision allowing the surgeon direct access to the gall bladder (ie; not via camera-telescope and long instruments)

  • Sometimes open cholecystectomy may still be necessary or Mr Jassal may start your operation laparoscopically (“keyhole”) but convert to open surgery midway through if it is the safest course (<5% risk)

 

CAN I JUST HAVE MY GALLSTONES REMOVED BUT KEEP MY GALL BLADDER?

  • This is not recommended

  • Higher risk and less effective operation

  • Gallstones are at high risk of reforming in the gall bladder

 

ARE THERE ANY NON-SURGICAL WAYS TO FIX MY GALLSTONES?

  • Laparoscopic cholecystectomy is the safest way of effectively dealing with symptomatic gallstones

  • Medical treatments to dissolve stones and ultrasound shockwave treatment to break up stones have not been shown to be reliably effective but can have a role in specific situations

 

WHAT IS INTRA-OPERATIVE CHOLANGIOGRAM?

  • During cholecystectomy, Mr Jassal routinely performs a cholangiogram

  • This is an X-ray performed on you during the operation in the operating theatre

  • Dye is squirted into the bile duct to outline it’s exact location and course, and to show up any stones which might be in it

  • Cholangiogram makes your operation safer and minimises the chance of leaving stones behind in the bile system after removal of the gall bladder

 

WHAT SHOULD I DO BEFORE SURGERY?

  • The usual pre-operative recommendations apply (see Preparation for surgery)

  • Notify Mr Jassal of any previous abdominal operations

 

ARE THERE ANY POST-OPERATIVE INSTRUCTIONS?

  • The usual post-operative advice applies (see Post operative instructions)

  • Assuming your operation is completed laparoscopically (“keyhole”), you will usually be home by the next day

  • You can expect mild to moderate soreness initially which should improve rapidly within a few days – paracetamol +/- an anti inflammatory such as ibuprofen may be all that is required

  • Notify Mr Jassal of increasing pain, fever or any wound problem

  • One to two weeks off work is usual

  • Avoid strenuous activity for four weeks

  • Open cholecystectomy is a bigger operation as the abdominal cut is larger – your hospital stay and overall recovery will be longer

 

WILL I NOTICE A DIFFERENCE AFTER SURGERY?

  • You may notice some reduced tolerance to fatty foods, with more frequent bowel motions or even diarrhoea initially

  • If this occurs, it should improve in the first few weeks as your body adapts to the operation

 

ARE THERE ANY RISKS OR POTENTIAL COMPLICATIONS OF SURGERY?

  • Cholecystectomy is a common, safe and effective procedure, however all surgical procedures carry some risk

  • Whilst complications are uncommon, they can include:

    • Anaesthetic complications (including heart and lung problems), allergy to something in the operating theatre, bleeding, infection and development of blood clot

    • Bile leak (1%)

    • Bile duct injury (<0.5%)

    • Injury to nearby organ/bowel (very rare)

    • Gas embolism (very rare)

 

The above information is a general guide only – please feel free to seek further information and/or clarification from Mr Jassal

Melbourne Breast and Endocrine Surgeons Mr Sunil Jassal
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