Diseases of the Gallbladder
The gallbladder is a small egg-shaped organ in the right upper abdomen located on the undersurface of the liver. It is attached to the bile duct system of the liver and stores and releases bile, a green fluid produced by the liver that helps digest fats in the diet. Gallstones form when a chemical imbalance occurs and these stones may interfere with emptying of the gallbladder or bile ducts.
Symptoms of Gallbladder Disease
When your gallbladder is not working correctly or not emptying well then you may experience:
- Indigestion or bloating in the upper abdomen.
- Pain after eating in the right upper abdomen.
Symptomatic gallstones if left untreated can lead to serious complications. For example, if the stones move out into the bile ducts then jaundice (build up of bile in the blood) or pancreatitis (inflammation of the pancreas) can occur.
Evaluation of Gallbladder Disease or How the Diagnosis Is Made
- Abdominal ultrasound – an outpatient sonar test that is very sensitive (95% accurate) at detecting gallstones.
- CAT scan – This x-ray is more sensitive if stones are suspected to have moved into the bile ducts and can help evaluate for inflammation of the gallbladder (cholecystitis) or pancreas (pancreatitis).
- HIDA Scan – This study is done in Nuclear Medicine with a radioisotope taken up and excreted by the liver and then stored and excreted by the gallbladder. If the gallbladder does not visualize or empty properly then it suggests disease.
Gallbladder surgery is usually (99%) performed laparoscopically (minimally invasive technique). Most commonly three ports or small tubes (5-10 mm) are placed through the abdominal wall while the patient is under general anesthesia. One tube is for introduction of a lighted camera and the other two are for introduction of various medical instruments used to remove the gallbladder. Usually a cauterizing device and small clips are used to divide the bile duct blood vessels and structural attachments; then the gallbladder is removed through the largest (12 mm) port site usually near the umbilicus. As a part of the operation our surgeons will put dye into the bile duct system to clarify the anatomy and to make sure no stones have escaped into the bile ducts. If stones are seen in the bile duct (1-2% of the time) then special devices can be used to remove the stones or if not possible another endoscopic procedure called ERCP can be performed the next day. In our hospital this procedure is done by gastroenterology specialists and does not require incisions or general anesthesia. Gallbladder surgery is usually an outpatient procedure allowing the patient to go home the same day or the next day.
New Single Site Robotic Technique now Available
Single Site Gallbladder surgery using the Da Vinci Robot provides the same operation as can be done laparoscopically through ONE incision at the navel that is virtually INVISIBLE once it heals. Traditional laparoscopic methods of single site surgery are cumbersome and don’t provide the same visualization as can be accomplished with multi-port surgery. The platform provided by the Da Vinci robot overcomes many of these obstacles making the surgery more like what has been done for the last 20 years with multi port surgery, but all through one incision. The benefit to the patient is a more cosmetic outcome without compromising on safety. A short video has been provided demonstrating this technique.
Preparing For Gallbladder Surgery
Usually a few blood tests and an EKG (heart tracing) are required in addition to the diagnostic x-rays. Also patients should:
- Not eat or drink anything after midnight the night before surgery.
- Take selected or special medicines specified by your doctor the morning of surgery with a few sips of water.
- Make sure your doctor knows about any blood thinners that should be stopped several days before surgery to avoid bleeding problems.
- Shower the night before or the morning of your surgery and try to clean your umbilicus (belly button) as well as possible with a Q-tip, soap and water.
After Gallbladder Surgery
- Patients may often leave the hospital the same day as surgery.
- You will go from surgery to the recovery room for about an hour until you are awake and until the anesthetic effects wear off. There you will receive pain and nausea medicine intravenously as needed.
- Once adequately recovered you will be transferred to a regular hospital bed for a while.
- If your overall medical health will allow, then you may be able to be discharged when your pain is controlled, eating without nausea and emptying your bladder.
- You will receive detailed instructions for activities at home as well as prescriptions for pain medicines.
- Patients can usually return to a regular diet the day of surgery, a desk job in 1-2 weeks and heavy exercise in 4-6 weeks.
- There are usually no sutures (stitches) to remove and you will be followed up in your surgeon’s office in 2-3 weeks.