The gall bladder is a pear shaped organ located below the liver that stores bile produced by the liver to digest fat in the gut. When eating, a chemical messenger sends a signal to the gallbladder to contract and release its bile content into the intestine, via a long conduit called the common bile duct (CBD).
The most common gall bladder disease is cholelithiasis, or gallstone formation. It affects around 10% of adults in the population. This pathology is more common in female patients and may also occur in those with similar past family history (parents, siblings).
Gallstone disease can cause symptoms such as severe upper abdominal pain, often related to food intake and occurring mainly in the evening or at night. These symptoms may last for several hours prompting patients to present to the hospital on emergency. They are commonly known as biliary colic.
Other complications related to gallstone if left untreated include:
- Cholecystitis: inflammation and thickening of the gallbladder wall that may occur when a gallstone blocks the flow of bile (acute cholecystitis) or due to repeated attacks of acute inflammation (chronic cholecystitis).
- Pancreatitis: acute inflammation of the pancreas due to the migration of a gallstone into the main bile duct (CBD), as the CBD joins the pancreatic duct before entering the small bowel. On rare occasions, this condition can become severe and potentially life threatening.
- Cholangitis: severe bile infection due to the migration of stone into the CBD that creates a blockage of the flow of bile. Often, patients require emergency decompression of the CBD before gallbladder removal.
Other types of gall bladder disease:
- Acalculous gallbladder disease: it is a condition where patients may experience identical symptoms of biliary colic, but without evidence of gallstones on ultrasound (US) imaging. This results as an inability of the gallbladder to contract and empty its bile content into the CBD.
- Gallbladder polyp: is a growth of tissue that develops from the lining (mucosa) of the gallbladder. A large polyp >10mm in diameter is more likely to develop into cancer if left untreated.
- Gallbladder cancer: is a rare condition that is usually discovered incidentally during the gallbladder removal (cholecystectomy). Untreated gallstone disease may predispose to cancer formation.
Who needs cholecystectomy (gall bladder removal surgery)?
- Patients with symptomatic gallstone (cholelithiasis) disease
- Patients who developed any complications related to gallstone (cholecystitis, cholangitis, pancreatitis)
- Gallbladder polyps>10mm in diameter
- Symptomatic acalculous gallbladder disease
How is gall bladder surgery performed?
- The procedure is performed under general anasthaesia and the patient stays in hospital overnight.
- The treatment of choice is laparoscopic (keyhole) as it offers to the patient the best post-operative outcome with minimal discomfort and excellent cosmetic result.
- Preference is to perform the procedure via 4 small (5mm diameter) skin cuts. On some occasions, the cuts may be even smaller (3mm) and referred to as needlescopic or minilaparoscopic surgery.
- The aim of this procedure is to safely remove the entire gallbladder and preference is to perform a routine cholangiogram (imaging of the entire biliary tree) to all the patients in order to reduce to a strict minimum the potential risk of bile duct injury.
- Once the gallbladder has been retrieved from the abdominal cavity (with a single use sterile bag to reduce the risk of infection), a small drain (plastic tube) is left overnight to ensure that no blood or bile fluid collects in the abdomen.
- Once discharged home, the small waterproof dressings covering the wounds can be safely removed 5 days later and there is no need to remove the stiches as they spontaneously dissolve within few weeks.
- Patient may eat and drink normally and follow-up appointment is made for 2 weeks after surgery.