Gallbladder (Biliary) Surgery  [return to the list of articles]

Part I
Most of us know of a relative or friend who has undergone gallbladder surgery. This type of surgery is one of the most common procedures performed.

The gallbladder is a sac-like organ located under the liver on the right-hand side of your body, just under the rib cage. The liver performs many tasks in the body, one of which is to produce bile. Bile is a yellow-green thick liquid which is stored in the gallbladder via a duct system. Bile assists in the digestion of fatty foods. After a high fat meal such as fried chicken, butter or ice cream, your body tells the gallbladder to contract and squeeze out bile through the ducts into our digestive tract.

"Cholelithiasis" or gallstones can sometimes form. It is estimated that 12 million Americans have stones in their gallbladder. A majority of people are not even aware that they have them, but 5-10% will manifest symptoms. Their symptoms can vary from very mild to severe - even life threatening.

"Biliary colic" is a term used to designate a mild early symptom. Pain occurs when the stones block the gallbladder's ductal system. One experiences a feeling of pain or pressure and sometimes nausea after eating, it tends to subside spontaneously. The pain occurs when the gallbladder contracts in response to a fatty meal ; pressure builds up secondary to the duct obstruction.
"Acute cholecystitis" is the next level of severity of gallbladder disease .this term describes symptoms of pain associated with fever and infection.

"Chronic cholecystitis" describes a condition of long term history of pain on the rt side of the abdomen and is due to recurrent bouts of biliary colic or acute cholecystitis with associated scarring of the gallbladder.

Each of these conditions are best treated by surgery called "cholecystectomy" which means removal of the gallbladder. The first cholecystectomy was performed over 100 years ago. For the past 10-15 years, laparoscopic surgery or removal of the gallbladder though a small incision, has been performed, shortening the recovery time significantly.

If you have a history of abdominal pain after eating, this may be due to gallbladder disease. However the pain may also be secondary to stomach ulcers, gastritis or even heart disease. You should see your family doctor and/or surgeon for an evaluation.

Biliary surgery-part ii

So far, we have discussed a number of diseases associated with the gallbladder. Those diseases were associated with gallstones and included biliary colic, acute cholecystitis, and chronic cholecystitis.

"Choledocholithiasis" is a term used to describe gallstones that pass from the gallbladder and enter the main bile duct system. This occurs in 10% of people with gallstones. Symptoms of pain and fever similar to those of gallstones can occur, but a classic sign is that of "jaundice". This is when the main bile duct system is blocked and causes a back-up of bile produced by the liver.

This manifests as a yellow appearance to the skin, the eyes and associated itching. In this instance, the stone needs to be removed along with the gallbladder, usually with the help of a gastroenterologist.

"Gallstone pancreatitis" is a condition when a bile duct stone described above irritates the pancreas whose ducts are connected to the bile duct system. These symptoms present as a more central pain, sometimes felt in the patient's back. Treatment is initially conservative until the pancreatitis is resolved, then the gallbladder can be removed.

"Cholangitis" is a condition in which a duct blockage due to a stone is associated with infection. The triad of symptoms are pain, fever, and jaundice. Treatment is antibiotics and intravenous fluids, but most importantly, but most importantly, removal of the stone and decompression of the bile duct system.

Each of these above conditions is listed in order of increasing severity. Early diagnosis and early treatment increases the chance of a healthy recovery. All of these conditions can be treated by laparoscopic techniques, but sometimes a conventional, open operation is needed.

If you manifest any of these symptoms, consult your family doctor for an evaluation.

-- Michael D. Bono, M.D.