Problems after Gallbladder Removal (cholecystectomy)

What is gallbladder removal surgery? 


Gallbladder removal surgery, medically known as cholecystectomy, is a surgical procedure performed when the gallbladder does not function properly or if the presence of gallstones causes health problems [1].


The Gallbladder

The gallbladder is a small pear-like organ located at the lower right part of the liver. It serves as a storage organ for bile, a substance produced by the liver that aids in the breakdown of fats in food. Upon ingestion of a fatty food, the gallbladder squeezes bile into the small intestine via small ducts. [2]



 Picture 1: Location of the gallbladder

Image source: stfranciscare.org

Gallstone Formation


Formation of gallstones is considered as one of the most common problems affecting the digestive system. It affects around 15% of people aged 50 and above.

These hard crystal-like substances are formed whenever there is excessive cholesterol present in the bile, or when the gallbladder fails to completely empty its contents. These gallstones may block the bile ducts, which may lead to the following complications: [1, 3]
  1. Nausea and vomiting
  2. Cholecystitis or inflammation of the gallbladder
  3. Jaundice
  4. Pancreatitis or inflammation of the pancreas
  5. Liver infections
  6. Cancer of the gallbladder (rare)


When these complications occur, it is necessary to remove the gallbladder. The gallbladder is not a vital organ; hence, the body can still function well even without it.

Once the gallbladder is removed, the bile flows through the common bile duct directly from the liver to the small intestine. There are non-surgical methods to remove gallstones, but the success rate of such procedures is low.

Gallbladder Removal Surgery Procedure

The gallbladder removal surgery can be performed in two ways: open cholecystectomy and laparoscopic cholecystectomy.



Picture 2: Laparoscopic Cholecystectomy vs. Open Cholecystectomy

Image source: drugline.org

 

Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the most common method used to remove the gallbladder.

In this procedure, the surgeon makes four small slits in the abdomen. In one slit, a nozzle which produces carbon dioxide is inserted. Carbon dioxide inflates the abdomen to allow the surgeon to easily see the gallbladder. In another slit, the laparoscope, or a small telescope with light and video camera, is injected.

Cholangiogram can be used during laparoscopic cholecystectomy. Surgical instruments, used to remove the gallbladder, such as lasers or electrocautery, are introduced in the other two slits.

After the gallbladder is removed, the slits are closed using sutures and staples. This procedure takes 1 to 2 hours to finish [4]. Recovery period, which usually takes 7 to 10 days, is shorter than in an open surgery. The patient can immediately go home after the surgery. However, the patients may feel sore for about a week [5].

 

Open Cholecystectomy

This procedure involves the removal of the gallbladder through an open cut on the abdomen. Before the surgery, a general anesthesia is first administered.

After the patient falls asleep, the surgeon starts the procedure by making a 6-inch cut in the upper right side of the abdomen. The gallbladder is then directly removed through the incision. The ducts connected to the gallbladder are clamped off. A temporary drain is then placed from the inside to the outside of the body, and the incision is closed afterwards. The whole procedure usually takes about 1-2 hours. [4]

A special x-ray called cholangiogram is sometimes used during the surgery. A special dye is applied to the common bile duct, which aids in locating the gallbladder area. It also helps in finding gallstones outside the gallbladder which can also be removed using a special medical instrument. [1]

Open gallbladder removal is only done when laparoscopic cholecystectomy cannot be performed. It is necessary during the following conditions:
  • Swollen bile duct or gallbladder
  • Peritonitis or inflammation in the lining of the abdomen
  • Hepatic hypertension or hypertension in the liver
  • Third trimester pregnancy
  • Severe bleeding
  • Scars from previous surgeries in the abdomen
  • Anatomical abnormalities in the abdomen


In some cases, laparoscopic surgeries need to be switched to an open surgery, which may be due to an unexpected inflammation, scar tissue, injury, or bleeding. [3]

The recovery time in an open surgery is longer than in a laparoscopic procedure. It involves a hospital confinement that lasts for 2 to 4 days. Patients who have undergone the surgery need to rest for 4 to 6 weeks before resuming to their normal activities. [3]

Problems after Gallbladder Removal 

 

Liver Problems after Gallbladder Removal

Even when the gallbladder is already removed, the liver still continues to produce bile. Without a storage organ, bile may accumulate which may weaken the liver and affect its functions in the long run. When the liver becomes weak, it cannot replenish the worn-out red blood cells, resulting in anemia. This causes further health problems.

Excessive bile may also leak into the bloodstream, causing skin rashes and itchy skin. It may also crystallize, leading to formation of gallstones in the liver.

 

Bile Duct Problems after Gallbladder Removal

The bile duct may be injured during a gallbladder removal surgery [2]. Gallstones may also form again and build up in the bile ducts, causing pain and indigestion [7].

Gallbladder removal can also cause the sphincter of Oddi, the regulatory valve between the duodenum, bile duct, and pancreatic duct, to become dysfunctional. It becomes spasmodic, preventing the bile from properly flowing in between ducts. When this happens, the bile duct can become inflamed [8].

 

Pancreas Problems after Gallbladder Removal

A dysfunctional sphincter of Oddi can also cause bile to build up in the pancreatic duct and pancreas, which leads to severe inflammation of the pancreas or pancreatitis [8].

 

Stomach problems after gallbladder removal

Patients who had their gallbladders removed may feel bloating, constipation, or diarrhea. These are caused by the difficulty of digesting fats. Patients also cannot tolerate several kinds of food anymore, such as milk and fatty or oily foods. Some patients may experience these problems chronically. [9] Bile reflux can also erode the stomach lining, causing nausea, vomiting, ulcers and severe heartburn [7]. Dietary modification is necessary when this happens.


References:
  1. http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Gall_bladder_removal
  2. http://www.sages.org/publications/patient-information/patient-information-for-laparoscopic-gallbladder-removal-cholecystectomy-from-sages/
  3. http://www.webmd.com/digestive-disorders/open-gallbladder-surgery-for-gallstones
  4. http://www.facs.org/public_info/operation/cholesys.pdf
  5. http://www.webmd.com/digestive-disorders/laparoscopic-gallbladder-surgery-for-gallstones
  6. http://www.ehow.com/about_5449794_liver-problems-after-cholecystectomy.html
  7. http://www.gallbladderattack.com/gallbladdersurgery.shtml
  8. http://www.biotherapy-clinic.com/gallbladder_removal_surgery.html

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