Q. Who needs gallbladder surgery?

A. If you are having medical problems related to your gallbladder, it may be best for your health to have your gallbladder removed. The most common reason to have gallbladder surgery is because of gallstones. One out of ten people in the United States will develop gallstones and one out of ten people with gallstones will develop problems with the stones. Gallstones may cause intermittent pain called biliary colic, gallbladder inflammation and infection called cholecystitis, and inflammation of the pancreas called pancreatitis. When these problems occur, we recommend removal of your gallbladder, also called laparoscopic cholecystectomy.  Occasionally we will recommend removal of the gallbladder when there are signs of gallbladder infection or dysfunction but no gallstones.

Q. Are there alternatives to surgery?

A. Alternative treatments such as dissolving the gallstones with medicine or breaking them up with ultrasound waves are not generally successful and not generally recommended.

Some patients have very infrequent attacks of biliary colic and choose to accept the risks of recurrent attacks and avoid surgery.

Q. How is laparoscopic cholecystectomy performed?

A. Laparoscopic cholecystectomy is usually performed as out-patient day surgery. It is performed under general anesthesia. Carbon dioxide (CO2) is pumped into the abdominal cavity and a small telescope-like camera is placed inside to project a picture of the operation on a TV screen.  Four small incisions are made on the abdomen and your surgeon places long thin instruments through these incisions to do the operation.  We often also do an x-ray dye study of the bile ducts (called a cholangiogram) to be certain that no gallstones have been pushed down into the common bile duct. If gallstones have passed into the common bile duct, we will either remove them at the time of surgery (called a common bile duct exploration) or refer you to a gastroenterologist to remove them using a procedure called ERCP. Laparoscopic cholecystectomy usually takes less than an hour to perform, except in cases of severe inflammation or when common duct exploration is required.

Most patients go home two or three hours after surgery. Occasionally patients stay in the hospital overnight if they are having too much pain or nausea, or if they were already admitted to the hospital with cholecystitis or pancreatitis. Many people note pain in the shoulders and upper right abdomen after surgery in addition to pain at the incisions. This is due to the CO2 in the abdominal cavity and usually resolves in 1 to 3 days.  After surgery you are discharged with prescription pain medicine and advised to slowly resume a normal diet beginning with liquids, then a low fat diet. There are usually no restrictions to activity although most people dont feel up to returning to their normal activities for roughly two weeks. Recovery time is quite variable between individuals, with some recovering much faster and some much slower than 2 weeks.

Occasionally, the surgery can not be completed laparoscopically and a larger open incision is required. When this happens, patients generally stay in the hospital for 3 to 5 days after surgery and arent ready to resume normal activity for approximately 6 weeks.

Q. What are the risks of laparoscopic cholecystectomy?

A. Laparoscopic cholecystectomy is generally a very safe and effective operation. Occasionally a patient may continue to have gallbladder-like pain after surgery, either due to gallstones or sludge in the common bile duct or spasm of the bile duct sphincter. In these cases, patients usually require an ERCP to look for blockage in the bile duct.

Complications can occur during laparoscopic cholecystectomy even when a careful and skilled surgeon is performing the operation. Complications which may occur include bleeding, infection, injury to the common bile duct, unintentional injury to the intestines or blood vessels, bile leak after surgery from the liver bed or bile ducts, blood clots in the veins which can go to the lungs, or general medical problems such as heart attacks. Unless recognized and repaired at the time of surgery, injury to the common bile duct or intestine usually requires another operation to repair the injury. Simple bile leaks after surgery from the liver or bile ducts usually are treated by ERCP. The risks of these complications occurring are reported in the medical literature as:

Complication:	Risk:
Common duct injury	1 in 500
Intestine injury	1 in 500
Simple bile leak	1 in 100

Q. Are there long-term consequences of having your gallbladder removed?

A. Most patients have no long-term consequences after gallbladder surgery. The bile which was previously stored in the gallbladder is now stored in the common bile duct and continues to aid with digestion. You will be able to eat regular food without restrictions, although we do recommend a low fat diet for the first few weeks after surgery. Some patients will need to permanently decrease fat in their diet. Occasionally patients will have loose bowel movements or even diarrhea for the first month after surgery. This usually resolves on its own although rarely patients can have long-term tendencies to having chronic diarrhea. If this happens, you can take medication to control the diarrhea.

Because bile is now stored in the common bile duct, there is the possibility of forming stones in the common duct. This is fairly uncommon but when it does occur, it happens several years or even decades after your gallbladder surgery. Common bile duct stones can be treated without surgery by ERCP.