Gallbladder surgery

The gallbladder is an organ that is located under your liver. If you have an attack of biliary colic or acute cholecystitis you probably need gallbladder surgery. Ignoring symptoms can lead to more frequent and severe attacks as well as potential complications which can rarely be life threatening.

 
If you have had gallstone attacks, it’s important to seek advice from an experienced gallstone specialist.
Mr Krishna Epari
Gallbladder specialist Perth
 

Gallstones: do I need gallbladder surgery?

Few people pay much attention to their gallbladder. It’s an organ that resides under the liver at the top right side of the abdomen. It plays an important role in concentrating and storing the bile that the liver produced to help digest fat.

When food is eaten, hormonal signals cause the gallbladder to contract releasing the concentrated bile into the duodenum and on to the food as it passes down the intestine. The bile helps break down and dissolve the fat in food.

Bile is a yellow green in colour and looks and and effectively acts like washing up liquid. If bile were to be poured over dirty plates it would dissolve the fat off the plates.

"Most of the time, your gallbladder carries out its function without any issue. But you can have a gallstone attack causing spasms (biliary colic) or gallbladder inflammation (acute or chronic cholecystitis).

A gallstone attack occurs when stones are formed in your gallbladder (gallstones) and get lodged in any of the bile ducts. The muscle in the gallbladder spasms (biliary colic) to try and move the partial or complete blockage. Bile builds up in your gallbladder and inflammation of the wall can occur (cholecystitis). The result is a painful attack of varying duration and severity.

If the trapped bile gets infected then the gallbladder effectively becomes a pus filled balloon (empyema). High temperatures are experienced and you may feel cold and shake uncontrollably (rigors)

Also if stones pass down the ducts they can cause inflammation of the pancreas (pancreatitis) or they can block the ducts causing jaundice (yellow skin and eyes and pale stools with dark urine). If the blocked duct becomes infected cholangitis occurs, (Jaundice, fevers, rigors). This is a life threatening surgical emergency".

Mr Alan Thomas
Gallbladder specialist Perth

There are three main types of gallstones:

  • Cholesterol stones
  • Pigment stones
  • Mixed stones

Gallbladder surgery

Having completed at least an additional two years of fellowship training, specifically in surgery of the Upper GI tract, the surgeons at Upper GI West are experienced in both open and laparoscopic gallbladder surgery.

Several of our Surgeons also perform ERCP to gain access to the bile ducts through the mouth. All our surgeons can explore the bile ducts with a miniature camera called a choledochoscope and remove small stones from the ducts during laparoscopic or open surgery if required.

Do I need to have gallbladder surgery?

The need for surgery will depend on whether the gallstones have caused symptoms and your general health and individual circumstances.

"The decision to operate should not depend on the severity of the attack or the number of attacks. Essentially, surgery is indicated to prevent recurrent issues. And more importantly to remove the stones before they can cause more severe complications."
Mr Krishna Epari
Gallbladder specialist Perth

Once gallstones cause symptoms they will continue to do so. If they are not symptomatic then up to 4% become symptomatic per year. Once symptoms do occur the chances of the gallstones causing further complications rises markedly.

Complications include blockage of the ducts and or gallbladder causing cholangitis or empyema, Or blockage of the ducts causing backflow of bile into the pancreas and activation of digestive enzymes too soon causing pancreatitis. These complications can be life threatening.

So, what symptoms should you watch out for?

  • Pain in your upper abdomen that increases rapidly. This attack can last from 30 minutes to several hours
  • Pain between your shoulder blades or under your right shoulder
  • Nausea and vomiting
  • Indigestion, belching and bloating
  • Intolerance to fatty foods
  • Yellow colour of the white of the eyes
  • Pale stools and very dark urine
  • Itchy skin with a yellow tinge

If you have had a gallstone attack, it’s important to seek advice from an experienced gallstone specialist. Ignoring symptoms can lead to more  serious complications.

"It can also result in an infection of your gallbladder or bile duct. There are conservative measures you can take that may help you avoid your gallstones becoming symptomatic and hence avoid surgery. However once the gallstones become symptomatic they will continue to be so.The conservative measures are to maintain a healthy weight with a good quality low fat diet and regular exercise."
Assoc Prof Mo Ballal
Gallbladder specialist Perth

Gallbladder surgery

If you have experienced painful gallstone symptoms, surgery is usually the best option. There are two main types of gallbladder surgery:

Laparoscopic cholecystectomy

This is the most common form of surgery and usually would only involve three tiny incisions under the rib cage on the right side of the abdomen and one under or just above the umbilicus (belly button). Over 99.5% of patients are suitable for this type of surgery.

Open cholecystectomy

This involves an incision across the right upper abdomen than is about 10cm on average. Sometimes a smaller incision can be used but the cut needs to be as big as required to get the gallbladder out safely. Our surgeons are also experienced in removal of the gallbladder by laparoscopic and by open surgery when required.

If gallstones have passed into the bile ducts there are several methods to remove them. Sometimes a skilled laparoscopic surgeon can remove them at the same time as taking out the gallbladder.

"Alternatively, a telescope is passed through the mouth, down the oesophagus, along the stomach and into the duodenum to access the bottom end of the bile duct as it enters the intestine.

X rays are used to locate the stones and various tiny wire baskets pass down the scope to pull the stones out and unblock the ducts. This is known as endoscopic retrograde cholangiopancreatography (ERCP). We have both experienced ERCPists in our team and skilled laparoscopic surgeons with laparoscopic bile duct exploration capability"

Mr Krishna Epari
Gallbladder specialist Perth
Our experienced team at Upper GI West recommends laparoscopic surgery in most instances. Keyhole surgery reduces risks for many patients, especially in:

Obese patients:

Larger incisions can be avoided reducing the risk of post-operative complications like wound infections and hernias.

Severe cholecystitis:

This can be done safely using keyhole techniques but there is significant swelling of the tissues and is more difficult and more likely to need exploration of the duct or an associated ERCP.

Previous surgery:

Adhesions can often be dealt with successfully with laparoscopy reducing risk of more adhesions from open surgery.

Pregnancy:

It is not uncommon to develop gallstones during pregnancy. The second trimester is the preferred and safest time if it is essential to remove the gallbladder during pregnancy. Physical space to perform laparoscopic surgery may not be there during the later stages of pregnancy.

Risks & complications of gallbladder Surgery

Laparoscopic Cholecystectomy is one of the most commonly performed operations. Complications are rare but can include:

  • Bleeding and infection
  • Blood clots: minimised if you move around soon after surgery and with blood-thinning injections (Heparin) and Thrombo Embolic Deterrent (TED) stockings
  • Retained stone: this can happen if a stone has passed into the bile duct. Experienced surgeons routinely use x-rays with a special dye injected into your bile duct to look for stones. A skilled surgeon can often remove these using keyhole surgery. However, sometimes an ERCP is required
  • Bile leak: very rarely (1 in 200 cases) there can be leakage of bile from the duct or liver. If this occurs a further procedure for drainage or an ERCP may be needed
  • Bile duct injury: rare (1 in 350 cases) this is usually only a risk when severe inflammation causes the gallbladder to stick to the bile ducts making them difficult to separate or when there is abnormal anatomy of the ducts. This often requires further surgeries and or ERCP and drains but may require complex surgery to remedy
  • Bile duct transection: extremely rare (1 in 1500 cases) as mentioned above this is usually only a risk when severe inflammation causes the gallbladder to stick to the bile ducts making them difficult to separate or when there is abnormal anatomy of the ducts this usually requires major procedures to try and remedy.
"On rare occasions, your surgeon may need to switch to an open procedure if the gallbladder cannot be safely removed by keyhole surgery. Our experienced team very rarely need to do this. However, a severe attack of cholecystitis, recurrent attacks or if surgery is delayed can increase the risk."
Mr Sanjeeva Kariyawasam
Gallbladder specialist Perth

Recovery from gallbladder surgery

Most keyhole gallbladder surgeries are carried out as overnight stay procedures. That means you generally can go home the day after your surgery. Recovery time is around two weeks. If you require open surgery, you will spend three to five days in hospital. Recovery time with open surgery takes longer, typically 4-6 weeks.

" Typically, you should be back at work within 10 days to two weeks with laparoscopic surgery. If you do require open surgery, you will need a few more weeks off work. The amount of time you need off work will also depend on your job.

If your job involves lifting heavy objects or being on your feet for a long time, you will need more time off. You should not drive while you are taking strong painkillers. You also need to ensure you can drive safely without pain and impairment, including wearing a seatbelt."

Mr Matt Henderson
Gallbladder specialist Perth

Upper GI West and Gallbladder surgery

Our surgeons have additional training over and above standard general surgery training in both open and laparoscopic gallbladder surgery. We have advanced laparoscopic skills and can explore suitable bile ducts laparoscopically. We can remove gallstones from the ducts laparoscopically as well as stent ducts laparoscopically if needed.

Members of our team perform ERCPs as well, therefore additional procedures or pre surgery procedures can be performed in house. We have access to theatres and endoscopy lists daily to offer optimal, timely and unbiased skilled treatment for your gallstone symptoms.

If you have symptoms of a gallstone attack, speak to our friendly team about your concerns. We will help you decide the best course of treatment for you.