Image description. Better Health Channel logo End of image description.

Gallbladder - gallstones and surgery

Ima
ge
des
crip

Thegallbladderisasmallsacthatholdsbile,adigestivejuiceproducedbytheliverthatisusedin
thebreakdownofdietaryfats.Thegallbladderextractswaterfromitsstoreofbileuntiltheliquid
becomeshighlyconcentrated.Thepresenceoffattyfoodstriggersthegallbladdertosqueezeits
bileconcentrateintothesmallintestine.
Gallstones(biliarycalculi)aresmallstonesmadefromcholesterol,bilepigmentandcalciumsalts,
usuallyinamixturethatformsinthegallbladder.Theyareacommondisorderofthedigestive
system,andaffectaround15percentofpeopleaged50yearsandover.
Somethingsthatmaycausegallstonestoformincludethecrystallisationofexcesscholesterolin
bileandthefailureofthegallbladdertoemptycompletely.
Inmostcases,gallstonesdontcauseanyproblems.However,youmightneedprompttreatmentif
stonesblockductsandcausecomplicationssuchasinfectionsorinflammationofthepancreas
(pancreatitis).
Surgeonsmayremoveyourgallbladder(calledacholecystectomy)ifgallstones(orothertypesof
gallbladderdisease)arecausingproblems.Techniquesincludelaparoscopic(keyhole)
cholecystectomyoropensurgery.Thegallbladderisnotavitalorgan,soyourbodycancopequite
wellwithoutit.

Symptoms of gallstones
Inapproximately70percentofcases,gallstonescausenosymptoms.Thesymptomsofgallstones
mayinclude:

painintheabdomenandback.Painisgenerallyinfrequent,butsevere
increaseinabdominalpainaftereatingafattymeal
jaundice
feverandpain,ifthegallbladderorbileductbecomesinfected.

Types of gallstones
Therearethreemaintypesofgallstonesbeing:

mixedstonesthemostcommontype.Theyaremadeupofcholesterolandsalts.Mixed
stonestendtodevelopinbatches
cholesterolstonesmadeupmainlyofcholesterol,afat-likesubstancethatiscrucialto
manymetabolicprocesses.Cholesterolstonescangrowlargeenoughtoblockbileducts
pigmentstonesbileisgreenish-brownincolour,duetoparticularpigments.Gallstones
madefrombilepigmentareusuallysmall,butnumerous.

Causes and risk factors for gallstones

Gallstonesaremorecommoninwomenthaninmen.Theyarealsomorecommoninoverweight
peopleandpeoplewithafamilyhistoryofgallstones.
Thereisnosinglecauseofgallstones.Insomepeople,theliverproducestoomuchcholesterol.
Thiscanresultintheformationofcholesterolcrystalsinbilethatgrowintostones.Inother
people,gallstonesformbecauseofchangesinothercomponentsofbileorbecausethegallbladder
doesnotemptynormally.

Gallbladder-gallstonesandsurgery

Page1of4

Diagnosis of gallstones
Doctorsdiagnosegallstonesbyusinganumberoftests,including:

generaltestssuchasphysicalexaminationandx-rays
ultrasoundsoundwavesformapicturethatshowsthepresenceofgallstones
endoscopetestendoscopicretrogradecholangiopancreatography(ERCP).Athintubeis
passedthroughtheoesophagusandinjectsdyeintotheboweltoimprovethequalityofxraypictures
hepatobiliaryiminodiaceticacid(HIDA)scanaspecialtypeofnuclearscanthatassesses
howwellthegallbladderfunctions
magneticresonancecholangiopancreatography(MRCP)aformofthebody-imaging
techniquemagneticresonanceimaging(MRI).Thepersonsliver,biliaryandpancreatic
systemisimagedusinganMRIunit.TheimageissimilartoanERCPtest.

Complications of gallstones
Ifgallstonescausenosymptoms,yourarelyneedanytreatment.
Complicationsthatmayrequirepromptmedicaltreatmentinclude:

biliarycolicagallstonecanmovefromthebodyofthegallbladderintoitsneck(cystic
duct),leadingtoobstruction.Symptomsincludeseverepainandfever
inflammationofthegallbladder(cholecystitis)agallstoneblocksthegallbladderduct,
leadingtoinfectionandinflammationofthegallbladder.Symptomsincludesevere
abdominalpain,nauseaandvomiting
jaundiceifagallstoneblocksabileductleadingtothebowel,trappedbileentersthe
personsbloodstreaminsteadofthedigestivesystem.Thebilepigmentscauseayellowing
ofthepersonsskinandeyes.Theirurinemayalsoturnorangeorbrown
pancreatitisinflammationofthepancreas,causedbyablockedbileductlowdownnear
thepancreas.Pancreaticenzymesirritateandburnthepancreasandleakoutintothe
abdominalcavity
cholangitisinflammationofthebileducts,whichoccurswhenabileductbecomes
blockedbyagallstoneandthebilebecomesinfected.Thiscausespain,fever,jaundiceand
rigors(shaking)
infectionoftheliver
cancerofthegallbladder(occursrarely).

Treatment for gallstones

Gallstonesthatcausenosymptoms,generallydontneedanymedicaltreatment.Incertaincases
(suchasabdominalsurgeryforotherconditions),doctorsmayremoveyourgallbladderifyouare
athighriskofcomplicationsofgallstones.
Treatmentdependsonthesizeandlocationofthegallstones,butmayinclude:

dietarymodificationssuchaslimitingoreliminatingfattyfoodsanddairyproducts
lithotripsyaspecialmachinegeneratessoundwavestoshatterthegallstones.This
treatmentisusedincertaincentresonly,fortheminorityofpeoplewithsmallandsoft
stones
medicationssomemedicationscandissolvegallstones,butthistreatmentisonlyrarely
given,duetosideeffectsandavariablesuccessrate
surgery.

Surgical removal of the gall bladder or gallstones

Around80percentofpeoplewithgallstonesymptomswillneedsurgery.Surgeonsmayremove
yourentiregallbladder(cholecystectomy),orjustthestonesfrombileducts.
Techniquestoremovethegallbladderinclude:

Gallbladder-gallstonesandsurgery

Page2of4

laparoscopiccholecystectomykeyholesurgery.Thesurgeonmakesanumberofsmall
incisions(cuts)throughtheskin,allowingaccessforarangeofinstruments.Thesurgeon
removesthegallbladderthroughoneoftheincisions
opensurgery(laparotomy)thesurgeonreachesthegallbladderthroughawider
abdominalincision.Youmightneedopensurgeryifyouhavescarringfromprioroperations
orableedingdisorder.

Medical factors to consider before cholecystectomy

Beforetheoperation,youneedtodiscusssomethingswithyourdoctororsurgeon,including:

yourmedicalhistory,sincesomepre-existingconditionsmayinfluencedecisionson
surgeryandanaesthetic
anymedicationsyoutakeonaregularbasis,includingover-the-counterpreparations
anybadreactionsorsideeffectsfromanymedications.

Laparoscopic cholecystectomy
Thegeneralprocedureincludes:

Thesurgeonmakesanumberofsmallincisionsintoyourabdomen,sothatslender
instrumentscanreachintotheabdominalcavity.
Atubeblowingagentlestreamofcarbondioxidegasisinserted.Thisseparatesthe
abdominalwallfromtheunderlyingorgans.
ThesurgeonviewsthegallbladderonaTVmonitorbyusingatinycameraattachedtothe
laparoscope.
Specialx-rays(cholangiograms)duringtheoperationcancheckforgallstoneswedgedin
thebileducts.
Theductsandarterythatservicethegallbladderareclippedshut.Theseclipsare
permanent.
Thegallbladderiscutfreeusingeitherlaserorelectrocautery
Thegallbladder,alongwithitsloadofgallstones,ispulledoutofthebodythroughoneof
theabdominalincisions.
Theinstrumentsandthecarbondioxidegasareremovedfromtheabdominalcavity.The
incisionsaresutured(closedup)andcoveredwithdressings.

Open gallbladder surgery

Thegeneralprocedureisthesameasforlaparoscopicsurgery,exceptthatthesurgeonreaches
thegallbladderthroughalarge,singleincisionintheabdominalwall.Sometimes,anoperationthat
startsoutasalaparoscopiccholecystectomyturnsintoopensurgeryifthesurgeonencounters
unexpecteddifficulties,suchasnotbeingabletoseethegallbladderproperly.

Immediately after gallbladder surgery

Afteragallbladderoperation,youcanexpectto:

feelmildpaininyourshoulderfromthecarbondioxidegas
receivepain-relievingmedications
beencouragedtocoughregularlytoclearyourlungsfromthegeneralanaesthetic
beencouragedtowalkaroundassoonasyoufeelable
stayovernightinhospital,ifyouhadalaparoscopiccholecystectomy
stayuptoeightdaysinhospital,ifyouhadopensurgery.

Complications after gallbladder surgery

Allsurgerycarriessomedegreeofrisk.Possiblecomplicationsofcholecystectomyinclude:

internalbleeding
infection
injurytonearbydigestiveorgans
injurytothebileduct

Gallbladder-gallstonesandsurgery

Page3of4

leakageofbileintotheabdominalcavity
injurytobloodvessels.

Self-care after gallbladder surgery

Beguidedbyyourdoctor,butgeneralself-caresuggestionsinclude:

Restasmuchasyoucanforaroundthreetofivedays.
Avoidheavyliftingandphysicalexertion.
Expectyourdigestivesystemtotakeafewdaystosettledown.Commonshort-term
problemsincludebloating,abdominalpainsandchangestotoilethabits.

Mostpeoplerecoverwithinoneweekoflaparoscopicsurgery.

Long-term outlook after gall bladder surgery

Youwillneedtoseeyourdoctorbetweensevenand10daysaftersurgerytomakesurealliswell.
Somerarecomplicationsmayhavetobefollowedupwithanotheroperation.

Where to get help

Yourdoctor
Gastroenterologist
NURSE-ON-CALLTel.1300606024forexperthealthinformationandadvice(24hours,
7days)

Things to remember

Gallstonesaresmallstonesmadefromcholesterol,bilepigmentandcalciumsalts,which
forminapersonsgallbladder.
Medicaltreatmentisntnecessaryunlessthegallstonescausesymptoms.
Treatmentoptionsincludesurgeryandshatteringthestoneswithsoundwaves.

This page has been produced in consultation with, and approved by:

CanberraHospital-GastroenterologyUnit
Contentonthiswebsiteisprovidedforeducationandinformationpurposesonly.Information
aboutatherapy,service,productortreatmentdoesnotimplyendorsementandisnotintendedto
replaceadvicefromyourdoctororotherregisteredhealthprofessional.Contenthasbeen
preparedforVictorianresidentsandwiderAustralianaudiences,andwasaccurateatthetimeof
publication.Readersshouldnotethat,overtime,currencyandcompletenessoftheinformation
maychange.Allusersareurgedtoalwaysseekadvicefromaregisteredhealthcareprofessional
fordiagnosisandanswerstotheirmedicalquestions.
Forthelatestupdatesandmoreinformation,visitwww.betterhealth.vic.gov.au
Copyight 1999/2013StateofVictoria.ReproducedfromtheBetterHealthChannel
(www.betterhealth.vic.gov.au)atnocostwithpermissionoftheVictorianMinisterforHealth.
Unauthorisedreproductionandotherusescomprisedinthecopyrightareprohibitedwithout
permission.

Gallbladder-gallstonesandsurgery

Page4of4