Gall Bladder Surgery

Laparoscopic or keyhole removal of the gall bladder was one of the first procedures to utilize using the laparoscopic surgical technique. The procedure has been in use since 1993 in Australia, with many thousands of the procedures being performed. The advantage of this technique in terms of small incisions, diminished pain, short hospital stay and early return to normal activity were so obvious that it has quickly become the standard method of gall bladder removal.

What does the gall bladder do?

The gall bladder is a small pear-shaped organ attached to the side of the bile duct by a small secondary duct, the cystic duct. The bile duct is a tube that carries bile from the liver to the small intestine. When the patient is fasting, the lower end of the bile duct closes and bile back-flows into the gall bladder. There it is concentrated by the gall bladder, absorbing the water in the bile. When a patient eats a fatty meal, the gall bladder squeezes out the bile to help absorb the fats. If stones are present, at this point, they can cause the gall bladder to go into spasm and this causes severe pain. The only way to prevent this and the other problems that can occur with gall stones is to remove the gall bladder. Since the gall bladder is only one of the mechanisms of fat digestion, its removal does not cause any major interference with the patient’s digestive process. In many cases of patients with stones, the gall bladder is not functioning and so digestion of fats is not affected by its removal.

Should I have the gall bladder removed?

If the gall bladder is causing symptoms or if multiple small stones that can escape into the bile duct are present, then removal of the gall bladder is advised. If there is a solitary large stone causing no symptoms then it can be left, although these can cause problems later in life. The surgery, when performed, entails removal of the whole gall bladder with the stones inside. To remove only the stones could result in them reforming after several years and problems returning.

How is the surgery performed?

The laparoscopic removal of the gall bladder (cholecystectomy) is performed under general anaesthetic so that the patient must be in reasonable health. Four punctures are made in the abdominal wall. The first is in the umbilicus. After inflating the abdominal cavity with CO2, a telescope attached to a tiny video camera is introduced and the abdominal contents inspected. The gall bladder is readily located and is grasped with forceps. It is freed from attachments to the liver. A small tube, the cystic duct, connecting the gall bladder to the bile duct is dissected free of the fatty tissue that encases it and a catheter inserted into it. Dye is injected down this and an x-ray of the main bile duct, which takes bile from the liver to the intestine, is taken. This is to confirm that no gallstones have entered the bile duct where they could cause a blockage leading to obstructive jaundice. Once the Xray has been completed, the cystic duct and the little artery feeding the gall bladder are clipped with little metal clips and divided. The gallbladder is then dissected away from the liver and removed through the small incision beneath the umbilicus. It is like a small bag that passes through the little incision once the stones and bile have been emptied out of it.

Open operation, laparotomy, may have to be performed if there are difficulties experienced in identifying the anatomy and there is a danger of damaging vital structures such as the bile duct. This can occur if there has been chronic or acute infection in the gall bladder or where there is abnormal anatomy. Open surgery may also be necessary when the abdomen is full of adhesions due to previous surgery as these can prevent views of the abdominal cavity and of the gall bladder. Other reasons for open surgery include a history of bleeding disorders and with pregnancy.