The gallbladder is a small organ just beneath the liver. Its function is to collect bile (a digestive liquid) that has been produced by the liver, and to release the bile into the small intestine when it is needed for digestion. Small tubes called bile ducts connect the gallbladder to the liver and to the small intestine through which the bile travels.

The most common gallbladder problem is gallstones, which are small hard formations of cholesterol in the gallbladder or in a bile duct. It is not known why some people form gallstones, and there is no way to prevent this. It has been noted that certain people are more prone to developing gallstones. Risk factors for forming gallstones include rapid weight loss, obesity, pregnancy, high cholesterol, and certain medical conditions (such as sickle cell anemia). Formation of gallstones can also be caused by nonfunctioning gallbladders. They also occur at a higher rate in women than in men, and in certain ethnic groups.

Many people have gallstones and never know it, because they can exist in the gallbladder symptom-free for many years. It is currently not recommended that the gallbladder be removed unless you have symptoms, such as abdominal pain or discomfort, especially in the right upper abdomen, problems with eating certain foods, particularly fatty foods, and sometimes back pain.

Gallstones can cause the gallbladder to become inflamed, infected (cholecystitis), or even rupture. Gallstones can move out of the gallbladder, get caught in the bile duct, and cause a dangerous infection called cholangitis. All of these conditions are extremely painful, causing vomiting and indigestion and sometimes fever, and will require more urgent, even emergent, surgery to remove the gallbladder and any stones that are blocking the ducts.

Some people do not have gallstones, but for some reason the gallbladder does not function properly. If you continue to have symptoms similar to symptoms of gallstones, you may require surgery for a nonfunctioning gallbladder.

Ultrasound is the most common procedure to find gallstones. This is done in the radiology department and is a very simple procedure in which the technician runs a probe, or scanner, over your abdomen, to look at your gallbladder and record what is seen for the radiologist to view.

If you have symptoms of gallbladder disease but do not show gallstones on an ultrasound, you may be sent for a HIDA scan. This is a nuclear test in which dye is injected and picked up by the liver. The dye is then detected by a nuclear scan, and measures the function of the gallbladder, or demonstrates cholecystitis (inflammation), or even a blockage of the ducts.

Gallstones will not go away on their own. You can be made more comfortable with drugs and by avoiding certain foods (such as fried or fatty foods), but these measures will not make gallstones go away. The only way to get rid of gallstones is to either have them removed or destroyed. If you have symptoms and gallstones, but you are not a good surgical candidate, there are other methods that can be used. These methods, such as medications and lithotripsy, are not very effective, and do not remove the gallbladder, which can always reform stones. Surgical removal is still the safest and most effective solution in most cases.

DO I ALWAYS NEED TO HAVE SURGERY IF I HAVE GALLSTONES?

• Prior to the operation, you should refrain from eating or drinking after midnight on the night before your operation.
• You should shower the night before or the morning of your operation.
• Some preoperative testing may be required depending on your medical condition.
• If you take medication on a daily basis, discuss this with your surgeon. If you take aspirin, blood thinners, or arthritis medication, you need to discuss with your surgeon the proper timing of discontinuing these medications before your operation.

HOW IS LAPAROSCOPIC GALLBLADDER REMOVAL PERFORMED?

• Under general anesthesia, so the patient is asleep throughout the procedure.
• Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen in the region of the navel.
• A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs on a television screen.
• Other cannulas are inserted which allow your surgeon to delicately separate the gallbladder from its attachments and then remove it through one of the openings.
• Many surgeons perform an X-ray, called a cholangiogram, during surgery, to identify stones that may be located in the bile ducts or to insure that structures have been properly identified.
• If the surgeon finds one or more stones in the common bile duct, he may remove them with a special scope, may choose to have them removed later through a second minimally invasive procedure, or may convert to an open operation in order to remove all the stones during the operation.
• After the surgeon removes the gallbladder, the small incisions are closed with a stitch or two or with surgical tape.
  

WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED BY THE LAPAROSCOPIC METHOD?
In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. This is most often the case when there has been previous abdominal surgery, or when the gallbladder is infected or too inflamed from infection. Often the surgeon will have an idea of this situation before he schedules your operation, and you will be advised to have an open procedure. However, sometimes a laparoscopic procedure is tried and the surgeon feels that an open procedure would be better for you.

When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, it is not a complication. It is sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety. If you should need to have an open procedure, you should know that in recent years pain management advances and early mobilization after surgery has allowed patients to recover much more quickly and with less discomfort than previously.
HOW LONG WILL YOU BE IN THE HOSPITAL?
Most Laparoscopic Cholecystectomy patients go home the day after surgery. Some may even go home the same day the operation is performed. This compares with a five-day stay following the traditional procedure.
WHEN CAN YOU GO BACK TO WORK?
Most patients can return to work within seven days following the laparoscopic procedure. Of course, this depends on the nature of your job. Patients with administrative or desk jobs usually return in a few days while those involved in manual labor or heavy lifting may require a bit more time. This compares to patients undergoing the open procedure who usually cannot resume normal activities for four to six weeks.
WILL YOU HAVE A LARGE SCAR?
No. By using laparoscopic techniques, the surgeon can avoid a large incision, leaving the patient with only four small marks.
IS LAPAROSCOPIC GALLBLADDER SURGERY SAFE?
Numerous medical studies show that the complication rate for laparoscopic gallbladder surgery is comparable to the complication rate for traditional gallbladder surgery when performed by a properly trained surgeon.
WHAT ARE THE RISKS OF LAPAROSCOPIC GALLBLADDER SURGERY?
While there are risks associated with any kind of operation, the vast majority of laparoscopic gallbladder patients experience few or no complications and quickly return to normal activities. The risks of laparoscopic cholecystectomy are less than the risks of leaving the condition untreated. Complications of Laparoscopic Cholecystectomy are infrequent, but include bleeding, infection, pneumonia, blood clots, or heart problems. Unintended injury to an adjacent structure such as the common bile duct or duodenum may occur and may require another surgical procedure to repair it. Bile leakage into the abdomen from tubular channels leading from the liver to the gallbladder has been described, and is usually easily treated with a drain.

• Gallbladder removal is a major abdominal operation and a certain amount of postoperative pain occurs. Nausea and vomiting are not uncommon.
• Once you are able to handle liquids or soft foods, you may leave the hospital. Usually this is the same day or a day after the laparoscopic gallbladder surgery.
• You will not notice a difference in your eating habits without the gallbladder. Although a small percentage of patients will, for a short time, have diarrhea after eating fatty foods.
• Activity is dependent on how you feel. Walking is encouraged. You can remove your dressings and shower the day after the operation.
• You will probably be able to get back to normal activities within a week's time, including driving, walking up stairs, light lifting and work.
• You should make an appointment with your surgeon within 2 weeks following your operation, even if your post-operative course has been uneventful.
  

WHAT SHOULD YOU WATCH FOR AFTER SURGERY?
The onset of fever, yellow skin or eyes, worsening abdominal pain, distention, persistent nausea or vomiting, or drainage from the incision are indications that a complication may have occurred. Your surgeon should be contacted in these instances.
IS LAPAROSCOPIC GALLBLADDER REMOVAL RIGHT FOR YOU?
Although there are many advantages to laparoscopy, the procedure may not be appropriate for some patients who have had previous upper abdominal surgery or who have some pre-existing medical conditions. Your surgeon will do a thorough medical evaluation and can determine if laparoscopic gallbladder removal is an appropriate procedure for you.