Gallbladder is a small vesicle placed under the liver in the right upper quadrant of the abdomen. Its main function is to store and thicken bile that flows in from the liver through the bile duct system. Shortly after eating, the gallbladder receives a signal to release certain amount of bile into the duodenum, according to fat contained in the food. In the duodenum the bile mingles with the ingested food and simplifies fat digestion. Gallbladder diseases, especially the long-lasting, may result in the need of surgical treatment.
Indications for Gallbladder Surgery
Indication means certain condition or circumstance that leads to the choice of a specific diagnostic or therapeutic procedure. In the case of gallbladder surgery, indications comprise gallbladder diseases that cannot be treated differently. Among these diseases there are recurrent gallstones, recurrent gallbladder inflammations or conditions that might lead to development of cancer, such as gallbladder polyps. The indication for gallbladder surgery may also be newly arisen fistulas, fissures or accumulation of pus.
Contraindications for Gallbladder Surgery
Contraindication on the contrary means such circumstance that prevents the use of certain therapeutic or diagnostic procedure, in this case gallbladder surgery. There are contraindications so-called relative and absolute.
Relative contraindications make the surgery more risky, but under certain circumstances it still can be performed. In the group of relative contraindications for gallbladder surgery there are tumours in the abdominal cavity, obesity, acute biliary colic, and multiple previous operations in the upper abdomen.
If there is any absolute contraindication in the patient, the surgery cannot be performed. In the case of a gallbladder surgery, among absolute contraindications there are abdominal infections, pregnancy, bleeding disorders, portal hypertension and gallbladder carcinoma.
Technique of Gallbladder Surgery
In gallbladder diseases, the most commonly performed surgery is removal of the gallbladder, called cholecystectomy. In humans, the gallbladder is not vital. After its surgical removal, the bile flows continuously directly into the intestine, which allows satisfactory digestion. Earlier, the operation had a quite high complication rate. Nowadays, when laparoscopic methods are widely used, the cholecystectomy has become routine. Laparoscopy is a method that uses special instruments and several small incisions to enter the abdominal cavity, which significantly reduces the risk of the operation. To enable good visualization of the inside of the abdomen, the abdominal cavity is filled with gas, namely carbon dioxide. In the case of laparoscopic gallbladder surgery, the patient is under general anesthesia. The removal is performed laparoscopically; the gallbladder is than pulled out of the abdominal cavity through one bigger incision. The average operation time is 90 minutes; the stay in hospital is usually about 2 days. Laparoscopic operation can be carried out also in elderly people or in obese patients, without significant increase in the incidence of complications.
Complications of Gallbladder Surgery
Although the complication rate in laparoscopic operations is the lowest possible, still the surgery is not absolutely complication free. Sometimes, an accidental perforation or damage to surrounding organs by operating instruments may appear. In case of a surgery complication, it is usually necessary to convert the surgery from laparoscopy to classical operation. In most hospitals this necessity does not exceed 5%. The most common complication of gallbladder surgery is perforation of gallbladder itself and consequent leakage of bile and gallstones into the abdominal cavity. The most serious complication, however, is an injury to the biliary system itself, especially when not soon recognized. Some patients suffer after removal of the gallbladder from so-called postcholecystectomy syndrome. It manifests by indigestion and abdominal pain; the problems are usually only temporary, however.
Advantages of Gallbladder Surgery
Strictly conservative treatment, i.e. non-surgical, is not recommended in the above-mentioned gallbladder diseases. Even strict following of a special diet and appropriate medication is usually not effective enough to guarantee permanent therapeutic effect. Patient's problems and digestion usually improve only after surgical treatment. Yet, even after surgery it is necessary to follow certain principles of healthy eating, especially avoiding larger amounts of fatty foods in one meal. When the bile cannot be stored in the gallbladder due to his surgical removal, there is not enough bile in the digestive system to properly digest bigger amounts of fat at once.