Gallbladder and Gallstone

gallblader-gallstone

The purpose of this page is to give you an overview of gallstones and gallbladder surgery so that you are well-informed when you visit your LapSurgery Australia surgeon.

Keyhole gallbladder surgery or laparoscopic cholecystectomy is the “gold standard” treatment of symptomatic gallstones.

Why choose LapSurgery Australia for your gallbladder operation?

LapSurgery Australia surgeons have a major interest in the management of patients with gallbladder disease and have many years of experience performing this procedure.

With Private Health Insurance

If you have private health insurance there is no waiting list. If you wish, your operation can usually be performed within a week or two or planned at a time of your choosing. For most patients with full private health insurance there will be some extra costs not covered by Medicare or your health fund. The cover provided by your health fund will vary according to which fund and which level of cover you are on and in some cases you may have to pay an "excess". It is your responsibility to check with your health fund prior to surgery. Full financial details will be provided to you prior to surgery unless the surgery is done as an emergency. Occasionally other tests, procedures or specialist consultations may be necessary and some other costs incurred.

Without Private Health Insurance

Public hospital waiting lists may be very long. There is no choice of surgeon in the Public Hospital and your LapSurgery Australia surgeon cannot not be involved in your operation.

Hospitals used by LapSurgery Australia gallbladder surgery are:

  • Mulgrave Private Hospital - Mulgrave
  • Knox Private Hospital - Wantirna
  • Peninsula Private, Frankston
  • St John of God Berwick Hospital –Berwick.

All surgery involves some risk. Risks can be broken down into two groups, those related to surgery in general and those specific to the operation being performed. Risks of surgery in general include risks of anaesthetics, infections inside the abdomen and in the wound, lung problems, blood clots in the leg or lungs and even death. Death from routine gallbladder surgery is exceptionally rare but has happened. If you have other health problems such as heart or lung problems, diabetes, smoking or excess weight the general risks of surgery are increased.

The major risk specific to the laparoscopic cholecystectomy operation is damage to the main bile duct system. This is a very major complication with potentially serious long term problems. Other possible complications specific to the laparoscopic cholecystectomy include bile leakages, bleeding and infection forming under or around the liver. LapSurgery Australia surgeons are able to deal with such complications to ensure recovery is complete. Please note that all risks mentioned are not all inclusive and a thorough discussion with your surgeon will occur.

Acute cholecystitis (inflammation of the gallbladder)

Acute cholecystitis occurs when a gall stone gets stuck in the outlet of the gallbladder and does not release. This causes a build-up of bile in the gallbladder which causes a chemical reaction of the bile literally starting to digest the gallbladder causing inflammation and unremitting pain. Then bacteria, which naturally occurr in the gallbladder, can cause infection making the situation worse and possibly leading to gangrene of the gallbladder. Emergency surgery is usually recommended and keyhole surgery may not be possible.

Jaundice (yellow discolouration of the skin and eyes).

This occurs when a stone gets stuck in the main bile duct and blocks bile going from the liver to the bowel. There is a backup of bile into the liver which then cannot function properly. Bile is absorbed into the bloodstream and this stains the skin and other organs a yellow colour. Secondary infection of the bile ducts can occur (cholangitis) which can be life threatening. The stone(s) must be removed from the bile duct urgently by ERCP or surgery.

Pancreatitis.

A stone in the main bile duct can interfere with the pancreas and cause pancreatitis. This is potentially a life threatening illness and requires hospital treatment.

Cancer.

Although rare, cancer of the gallbladder can occur and may be fatal. Cancers usually occur when gallstones have been present for 20 years or more.

1. No further severe attacks of pain

2. Relief of after meal nausea and fullness

3. Preventing complications from Gallstones, eg. infection in the gall bladder, gangrene of gallbladder and cancer of gallbladder

4. Relatively quick recovery after surgery with little pain

5. Fewer dietary restrictions

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The team at LAPSurgery Australia are recognised for their exceptional and major contribution to the Government sponsored Bariatric Safety Registry (BSR). The BSR tracks surgical complications and provides an unbiased safety record for weight loss surgery.

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FAQ

The gallbladder lies underneath the liver which is situated in the upper part of the abdomen on the right side protected by the ribs.

The liver secretes bile which travels down the bile ducts to the sphincter which is normally closed. Bile then flows into the gallbladder, which absorbs water from the bile, making the bile more concentrated. When food moves from the stomach into the duodenum a hormone (cholecystokinin or CCK) is released which causes the gallbladder to contract, the sphincter to open and the concentrated bile to flow into the duodenum. This allows digestion of fat, even very large amounts of fat which, in hunter/gatherer times was a very important part of the diet because of it's very high caloric value.

Gallstones are formed in the gallbladder and vary in size, shape and colour. Some stones contain a large amount of cholesterol and these stones tend to be yellowish in colour. Others are dark green or black in colour and these are pigment-type Gall stones.

The liver manufactures bile which travels down the bile duct. Some of the bile is then directed into the gallbladder and concentrated. In susceptible people, the concentration of bile triggers the formation of crystals that slowly grow to form Gallstones. This process usually occurs over a number of years, but can occasionally occur quite suddenly such as during rapid weight loss.

Gallstone prevalence increases with age so by the time we reach our later years, approximately 15% of the population will have developed gallstones. Females are more prone to developing gallstones than males. During pregnancy the function of the gallbladder is diminished which appears to make stone formation more likely. Excess weight is another factor that increases gallstone formation and this relates to increased cholesterol content in the bile. Gallstones sometimes run in families.

When you eat a meal, especially a fatty meal, a hormone is released which causes the gallbladder to contract and squeeze concentrated bile into the intestine. Bile is necessary for the digestion of fat which is essential to health. Sometimes a stone jams in the outlet of the gallbladder and blocks the bile from getting out of the gallbladder. The gallbladder continues to contract against the stone and this is what causes the pain of a gallbladder attack. In many cases the gallstone will release spontaneously and symptoms disappear. Episodic attacks of pain ranging from mild to very severe are the most common symptoms of gallstones. The pain often occurs during the night or after a fatty meal.

The pain is usually situated in the upper part of the abdomen and under the right ribs. The pain often radiates around and into the back on the right side. Occasionally the pain is felt in the lower chest and the symptoms can be confused with a heart attack. If the gallstone fails to release, the gallbladder may become acutely inflamed and this condition is known as acute cholecystitis. In some cases, this may lead to a serious infection with gangrene of the gallbladder.

Ultrasound of the abdomen is the standard way of diagnosing gallstones. This is a painless examination that allows the stones within the gallbladder to be seen in the majority of cases. Blood tests to measure the function of the liver and the pancreas may also be used to determine the likelihood of stone migration from the gallbladder into the bile duct. More complicated, tests including imaging of the main bile ducts, may be necessary involving CT or MRI scans. Occasionally ERCP is necessary to diagnose and remove stones from the bile ducts.

Sometimes gallstones are diagnosed during tests for other conditions, but there have been no symptoms of gallbladder disease. In general, we don't recommend removal of the gallbladder in this situation, but each person and situation is different. If, for example, you had gallstones without symptoms and planned to spend a year in the outback, Antarctica or travelling the world there may be a place for removing the gallbladder even though you have no symptoms. We recommend careful discussion with your LapSurgery Australia surgeon before embarking on gallbladder removal in the absence of symptoms.

It is recognised that a few people can have gallstone type symptoms without gallstones being found. This condition is challenging for both patient and doctor and requires very careful consideration and multiple diagnostic tests before going ahead with surgery. In the absence of gallstones no guarantee can be given about relief of symptoms by surgery to remove the gallbladder. LapSurgery Australia surgeons have the necessary experience to advise you in this situation.

Providing you have significant symptoms related to gallstones, in almost every case we will recommend keyhole (laparoscopic) surgery to remove the gallbladder.

No. There are no satisfactory means of treating gallstones other than surgery. Both ultrasound disintegration and chemical dissolving of gallstones with tablets have been tried. In only a very few patients is the treatment successful, but even in these cases the stones almost always recur within months or a year or two.

Good question! Firstly, removing just the stones from the gallbladder is extremely difficult and much more dangerous than taking out the gall bladder. More importantly, even if you could just have the stones removed safely, they would almost certainly form again in the coming months or years and it would be back to square one!

Quite well actually! The function of the gallbladder is to concentrate and store bile. When you eat a meal, particularly a fatty meal, a large amount of concentrated bile is released into the duodenum. This enables a very large amount of fat to be digested at once. With the gallbladder removed, bile is released in small amounts continually into the duodenum. This is adequate for all normal eating situations. However if, after removal of the gallbladder, you were to eat a large amount of fat at one sitting the fat may not be digested but will pass through the bowel and cause diarrhoea.

For keyhole surgery four tiny (0.5 to 1.5 cm) cuts are made in the approximate positions shown on the diagram. If open (non-keyhole) surgery is required the cut is about 15-20 cm long under the right ribs.

Unfortunately not always. At least 95% of gallbladder operations can be performed safely using keyhole surgery.

Occasionally anatomic issues will make it risky to proceed with the keyhole approach so an incision will be made under the ribs on the right side to safely complete the procedure. If you do wake up after the operation with a large incision instead of keyhole surgery you should be reassured that your surgeon placed your safety and long term health before the convenience of a keyhole operation.

This section is not and is not intended to be a comprehensive account of possible complications. Possible complications must be discussed with your surgeon prior to operation.

All surgery involves some risk. Risks can be broken down into two groups, those related to surgery in general and those specific to the operation being performed. Risks of surgery in general include risks of anaesthetics, infections inside the abdomen and in the wound, lung problems, blood clots in the leg or lungs and even death. Death from routine gallbladder surgery is exceptionally rare but has happened. If you have other health problems such as heart or lung problems, diabetes, smoking or excess weight the general risks of surgery are increased.

The major risk specific to the laparoscopic cholecystectomy operation is damage to the main bile duct system. This is a very major complication with potentially serious long term problems. In the event of accidental damage to the main bile ducts you may experience a bile leak. Other possible complications specific to the laparoscopic cholecystectomy along with a bile leakage are infection forming under or around the liver and bleeding.

Please note that these risks mentioned are not all inclusive and a thorough discussion with your surgeon is needed before your surgery.

Stones can escape from the gallbladder into the bile ducts which carry bile from the liver and gallbladder to the bowel (duodenum). Sometimes these stones can pass harmlessly through the bile ducts and into the duodenum causing either no symptoms or some short lived pain rather like a gallbladder attack. If we suspect gallstones in the main bile ducts we may arrange an MRI test before operation to confirm this or will perform an X-Ray of the bile ducts during the gallbladder surgery. Depending on individual circumstances we may recommend pre-operative ERCP to remove the stones. Alternatives are removal of the stones at operation (either keyhole or through a larger incision) or ERCP after the surgery. If we find bile duct stones unexpectedly at operation we will usually leave these and arrange ERCP in the early postoperative recovery period. LapSurgery Australia surgeons will decide which of these options is best for each individual and to undertake the best and most appropriate treatment.

The standard ultrasound test is very accurate for diagnosing stones in the gallbladder, but is a very poor test for stones in the main bile ducts. An X-Ray of the bile ducts taken during surgery is very accurate. If stones are present these may either be removed at the time through the key hole approach or afterwards through a separate procedure called an ERCP.

Where the operation is completed laparoscopically (keyhole surgery) more than 90% of patients will be able to go home on the day after surgery. Return to normal activities (other than very heavy occupations) is usually possible in 7-10 days. If you needed the open operation (large incision) then hospital stay would be around 4-5 days and return to normal activities in 3-4 weeks.

Ask your family doctor for a referral to one of our surgeons. Under Medicare legislation and medical ethics, we cannot see you without a valid referral. Consultations are available in Boronia, Mulgrave, Frankston, Berwick, Cranbourne and Warragul. Please note that not all of our surgeons consult at all of these locations. Please call (03) 9760 2777 for any enquiries or see our contact page.

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