The gallbladder is an organ located in the upper right abdomen, just below the liver.
The primary function of the gallbladder is to store and concentrate bile produced in the liver, and then release it into the bile duct to contribute to digestion. In digestion, it aids in the digestion of fats.
Approximately 1 liter of bile is produced by the liver daily. This bile is generated in the liver, stored, and concentrated in the gallbladder. The purpose of bile is to support digestion, particularly in the digestion of fats and the absorption of vitamins.
After the consumption of fatty foods, the concentrated bile in the gallbladder is released into the duodenum through the bile duct. This initiates the digestion of fats. Therefore, individuals with gallbladder disease may experience an increase in symptoms, especially after consuming fatty meals.
Gallbladder sludge and subsequently gallstones occur due to issues with gallbladder emptying and a reduction in the fluidity of bile. Gallstones are more common in women than in men. The number and sizes of gallstones can vary from person to person. Excessive cholesterol in bile, an excess of bilirubin in bile, and problems with gallbladder emptying can lead to the formation of gallstones.
Gallbladder stones may initially show no symptoms and often progress silently, being detected incidentally. Symptoms arise when the stones within the gallbladder block the exit, preventing the gallbladder from emptying.
Patients with gallbladder stones typically present to the emergency department with severe abdominal pain 2-4 hours after consuming a fatty meal (usually dinner). Nausea and vomiting may also occur. On examination, there is pain and tenderness in the right upper quadrant. The pain can be mistaken for conditions such as gas pain, a heart attack, or stomach pain. While the pain is commonly felt in the right upper quadrant, it can also be experienced in the middle of the abdomen, the right shoulder, and the right side of the abdomen.
If gallstones are small enough to pass through the gallbladder duct, they can cause more troublesome conditions such as obstructive jaundice. Symptoms may include fever, pain, jaundice, brown urine, nausea, and vomiting. This is a significantly distressing condition.
When a stone blocks the duct, gallbladder inflammation (cholecystitis) can occur within a few hours. If infection is added to this condition, it can lead to serious problems. Stones that fall into the main bile duct can also affect the pancreas along with the gallbladder. This can postpone the surgery. Pancreatic involvement can cause serious health problems.
When a stone blocks the bile duct, patients may experience sudden, rapidly onset abdominal pain that does not respond well to painkillers. This pain can radiate to the back and shoulders. Accompanying symptoms may include nausea, vomiting, darkening of urine color, light-colored stools, diarrhea, or excessive gas and digestive problems.
Gallbladder stones, by constantly irritating the inner wall of the gallbladder, can lead to chronic inflammation, eventually turning into gallbladder cancer in the long term. Gallstones are often associated with gallbladder inflammation, obstruction of the common bile duct, blockage of the pancreatic duct, and in advanced stages, the formation of gallbladder cancer.
Gallstones are more frequently observed in women, especially those over the age of 40. The risk factors for gallstones include being overweight, a sedentary lifestyle, pregnancy, a diet high in fat and low in fiber, a family history of gallstones, a family history of gallbladder stones, diabetes, rapid weight loss, use of birth control pills, liver diseases, and blood disorders.
The diagnosis of the patient is established through traditional examination findings, blood and urine tests, and ultrasound (USG). Occasionally, a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be required. For stones within the bile duct, magnetic resonance cholangiopancreatography (MRCP) or, if necessary, endoscopic retrograde cholangiopancreatography (ERCP) is performed.
The initial diagnostic test for gallbladder stones is ultrasound. Through this examination, gallstones, wall thickness, and surrounding fluid are detected, enabling the diagnosis of infection. In such cases, patients should initially be provided relief through medical treatment, and if possible, surgery should be planned within the first 24-48 hours. If this timeframe is surpassed, the operation should be scheduled for 6-8 weeks later. The aim is to perform surgery on the patient using a closed method (laparoscopically). Conducting an operation outside of these timeframes may result in patients undergoing open surgery.
Gallbladder surgery (cholecystectomy) involves the complete removal of the gallbladder. It can be performed using open or closed (laparoscopic) methods. While the closed (laparoscopic) method is always preferred, open surgery may be required due to anatomical differences or patient-specific reasons, such as previous surgeries.
Gallbladder surgery (cholecystectomy),whether open or closed (laparoscopic),always begins with a consultation and examination by a doctor. Before the surgery, information about the patient's general health status, medications, and past surgeries is gathered. After providing necessary information to the patient, blood tests are requested, and a consultation with an anesthesiologist is arranged. This way, the patient is informed about the surgery process.
The doctor informs the patient about how long they need to fast before the surgery, when to stop taking blood-thinning medications, and whether they should continue taking their current medications. If the patient has another condition that may affect the surgery, they are referred to the relevant department for consultation. The patient is then prepared for surgery.
Gallbladder surgery (cholecystectomy) is performed under general anesthesia (where the patient is put to sleep). If the closed (laparoscopic) method is chosen, the patient's abdomen is inflated with gas to a certain pressure to create a clear view and allow for the surgery.
Small incisions are made in the abdominal area, and round, small tubes called trocars are inserted through these incisions. These trocars allow the insertion and removal of instruments used in laparoscopic surgery. A camera is inserted through one of these small openings, and the surgery is completed by viewing the procedure on a screen. Compared to open surgery, this method results in a shorter hospital stay, faster recovery, and quicker return to daily activities.
Open surgery is chosen if the patient is not suitable for the laparoscopic method. Usually, a 10 cm incision is made under the right rib cage for the open gallbladder surgery. With this method, the patient’s hospital stay is longer, and recovery and return to work take more time.
After laparoscopic gallbladder surgery, the patient is brought to their room, and they can eat and start walking within 4-5 hours. Typically, the patient is discharged the next day. Before discharge, the patient consults with a dietitian, and a diet plan is arranged. This process is slightly longer for open surgery.
After being discharged, the patient may feel pain or discomfort at the site of the small incisions in the abdomen, which can increase with movement for a few days. These complaints can be alleviated with simple pain relievers. Afterward, the patient can return to normal activities. The patient is advised to avoid activities such as exercise and heavy lifting for a certain period. Following the diet recommendations provided by the dietitian is also important for a smooth recovery after surgery.
By attending follow-up appointments with their doctor, the patient ensures that the recovery process is completed in a healthy manner.
Gallbladder surgery (cholecystectomy) is generally a safe procedure, and the patient usually recovers quickly. However, as with any surgery, there are some risks and complications. These risks and complications must be explained to the patient. When performed by experienced doctors, these risks and complications can be minimized.
We are committed to being with you during your treatment process for general surgery diseases with accurate diagnosis and effective treatment methods. Here, you can read the real experiences of my patients who share their health journey with me. Their sincere comments can be a guide for you as well.
Prof. Dr. Sezai AydınGeneral Surgery Turkey
PROF. DR. SEZAI AYDIN
