The Antidote Newsletter
Gallbladder surgery is a common operation that is usually performed effectively and without complication. However, there are known risks and complications which can be minimized or avoided. If you are considering gallbladder surgery or know someone else that is, it is important to review the risks carefully with your surgeon and anesthesiologist. (Information contained herein is for educational purposes only and should not be the basis for medical decisions. There is no substitute for competent medical advice.)
What is the Gall Bladder?
The gallbladder is a pouch-shaped organ which lies near the liver. It accepts bile from the liver, and stores it. Bile is a watery, greeny-yellowish fluid produced by the liver which aids in the digestion of fatty foods. It contains bile salts, bile pigments, cholesterol and phospholipids. In the gallbladder, the bile is concentrated by the reabsorption of water from it. When food is digested, the gallbladder releases bile into the small intestine where it is able to help dissolve fats. The most common disorder of the gall bladder is gallstones.
Gallstones are cholesterol crystals or pigment material that form in the gall bladder. Some bile components (such as cholesterol) are not very soluble. When there is too much of these bile components, they separate and form a solid. This process causes the formation of gallstones - also known as cholelithiasis.
Patients with symptomatic gallstones experience severe abdominal pain, and suffer further complications such as jaundice (yellowing of the skin and eyes), and inflammation of the gall bladder, bile ducts, liver or pancreas. However, about 80 per cent of people who have gallstones have no symptoms. These people are said to have so-called "silent" gallstones with no associated pain. Gas and indigestion are not symptoms of gall bladder or gallstone disease.
Variations in the anatomy of the gallbladder, the bile ducts, and the arteries that supply them and the liver are important to the surgeon, because failure to recognize them can cause iatrogenic injury to the biliary tract.
About the Surgery
The gallbladder operation, called a cholecystectomy, is performed in two ways. A laparoscopic cholecystectomy is a less invasive procedure and allows a much shortened recovery time. It involves the use of a laparoscope and other surgical instruments that are inserted through small holes that penetrate the abdomen, which has been inflated with CO2 (carbon dioxide). There is minimal surgical injury. A 1.5 cm needed insertion and a 3.05 trocar incision are required.
The other procedure, called the "open procedure," requires an opening of the abdomen by incision. The incision is usually 20 cms. and passes through the skin, muscle, and fascia.
Both procedures require the identification of the gallbladder, the cystic duct, the cystic artery, and the common bile duct. The cystic duct and cystic artery are clamped, and the diseased gallbladder is removed.
Complications may occur in both procedures. it is not appropriate to belive that because there is minimal invasion with the laparoscopic approach that there is minimal risk in this procedure.
Laparoscopic operations carry many of the same inherent risks as the traditional "open" procedure. Also, there are risks that are attributable to the laparoscopic method.
It is important to be aware of the potential complications and whether or not the risks in a particular case is increased because of a patient's condition.
There are many conditions that may precipitate complications in the laparoscopic procedure. These include:
Asking your surgeon questions, particularly about the number of operations which he has performed, and whether there are any conditions that he believes provide increased risk for you as a patient, are an important way to make the right choice on which surgery is best for you, and to reduce the risks inherent in that surgery. Recognized complications of laparoscopic surgery include: