GALLBLADDER SURGERY

The gallbladder is an organ located in the R upper abdomen and under the liver. Its main function is to concentrate bile that is made by the liver. It is not an essential organ and we can remove it without causing any issues to the patient. Removing the gallbladder will not make you loose or gain weight and after the surgery is done you can eat any type of food. Before surgery we recommend a low fat diet to prevent attacks. This is due to the fact that a fatty meal strongly stimulates the gallbladder to empty.
The symptoms of gallbladder disease classically are those of R upper abdominal pain that may travel to the back or along the R side and around the ribs.
These symptoms may be caused by gallstones or by an abormally contracting gallbladder, a condition known as biliary diskinesia.
The gallbladder is removed now a days through small cuts in the abdomen and that is called the laparoscopic approach.
For some reason people call it the laser approach which is the wrong name.
In the past this was done using a large R upper abdomen incision and althoug the vast majority of surgeries are completed via the above mentioned approach, at times we are forced to make the larger incision.
The times this usually happens is when we encounter an infected gallbladder or a gallbladder that is hard to remove due to anatomical variants or large stones.

The most common reason for a gallbladder removal is due to gallstones. These gallstones at times can get lodged in the gallbladder duct and cause gallbladder infection or at other times can migrate outside the gallbladder and block the main bile duct causing the bile to back up, leading to jaundice and liver irritation. This would require the removal of the stone through the opening of the bile duct in the duodenum. This would complicate the condition and require another rocedure known as and ERCP. This is an endoscopic procedure (camera scope though the mouth) and then use of baloon catheters to remove the stone. If not removed then we would have to operate and open the bile duct to remove the stone. This is a more complicated surgery. For these reasons and many more we can discuss in person we remvoe the gallbladder when it is causing symptoms due to stones. The main symptoms is upper abdominal pain after eating and it is mainly due to the stones blocking the flow of bile from the gallbladder.

There is a condition known as biliary diskinesia. This is a controversial condition that is a diagnosis by exclusion. This means that we give the diagnosis after we have discarded every other possible diagnosis. In this condition the patient ahs pain in the upper abdomen, but there are no gallstones. We diagnose this condition using a nuclear medicine study called a HIDA scan. This measures the emptying of the gallbladder. When the emptying of the gallbladder is measured at less than 35%, we recommend removing the gallbladder if it seems to be the cause of the pain and symptoms.

There are also patients that present with non classical smptoms and these are very hard to pinpoint. These patients are may have indigestion, vbloating and non specific symptoms. If really asked to remember, they may have had one pain attack. We opt to remove the gallblder then there is question and stones are found in ultrasound.

Having gallstones by itself is not an indication for automatic removal of the gallbladder. Asymptomatic gallstones can be observed. The disease is usually progressive and as time passes teh symptoms are more and more frequent.
Many people ask, why not remove the gallstones and leave the gallbladder? That has been tried and invariably the gallstones will form again. For that reason this approacehd was abandoned. Also the scar or seam left in the gallbladder wall would cause issues too.

The operation for removal of the gallbladder carries risks as any other operation. Some of these are


RISKS

  • Bleeding - as in any operation this is a possible issue and we try to control all bleeding while we are there, but it is always possible that in certain occasions bleeding starts later, in which case we would have to go back to stop it.

  • Infection - This can happen in the skin incisions or inside the abdomen. Both situations are usually controlled with oral or intravenous antibiotics.

  • Bile leak - We clip the duct that goes to the gallbladder and this clip could come loose and cause a leak of bile. When the patient experiences this, they have increase pain, difficulty breathing and constipation after surgery. If this happened, we would have to go back through the mouth and place a stent to stop the leak and in a small number of cases operate again if this procedure does not control the leak.

  • Bile duct injury - An infrequent complication is the injury of the main bile ducts. When this occurs, it is usually due to a difficult anatomy, chronic and severe inflammation or infection. If this were to happen, it is a bad problem and requires a major operation to correct the issue.

  • Retained bile duct stone - At times, during the mobilization of the gallbladder a stone might become dislodged from the gallbladder and go into the main bile ducts and get trapped there. This would be evident when the patient comes back with similar symptoms. If this is the case then we can remove the gallstone fromt he bile duct using an endoscope and through the mouth. In extreme cases we may have to reoperate.

Lugo Surgical Group

150 Pine Forest Dr,,

Shenandoah, TX 77384

Phone. 832-377-5846

Email. lugosurgicalgroup@gmail.com