GALLBLADDER & PANCREAS

The gallbladder and gallstones

The gallbladder is a small, pouch-like organ located in the upper right part of the abdomen. It stores bile, a fluid produced by the liver that helps break down fatty foods. Stones may develop within the gallbladder, usually made up of cholesterol. More than 1 in 10 people in the UK have gallstones, although the vast majority will cause no symptoms at all.

Causes of gallstones

Gallstones commonly develop because of an imbalance in the concentration of the various components that make up bile. The risk factors for developing gallstones include being female, being overweight, having high cholesterol, having a family history, following weight-loss surgery and having certain blood-related disorders. The risk of developing gallstones also increases with age. 

Symptoms of gallstones 

About 20% of people with gallstones develop symptom, which include recurrent upper or right-sided abdominal pain, particularly after eating fatty foods, nausea and vomiting. This is known as billiary colic. 

Complications of gallstones 

• Acute or chronic cholecystitis - infection within the gallbladder 
• Ascending cholangitis  - infection within the bile ducts 
• Obstructive jaundice - blockage of the main bile duct which may be from a stone or an inflamed gallbladder pressing on it 
• Acute pancreatitis - inflammation of the neighbouring pancreas which is sometimes related to a gallstone 

Treatments 

The definitive, gold-standard treatment for all of these conditions is removal of the gallbladder. The gallbladder is not an essential organ so it may be removed safely with no harm to you. The procedure is called a cholecystectomy and it is commonly performed laparoscopically (keyhole) through four tiny incisions in the abdomen. In the largest of the incisions, which is about a centimeter, a thin camera (laparoscope) is inserted to view the inside of your abdomen. Instruments are then inserted through the other incisions to manipulate and remove the gallbladder. The incisions are closed with stitches that dissolve. 

This operation will be performed under general anaesthesia and usually takes 60 - 90 minutes. 

If there is suspicion of gallstones in the bile duct, an X-ray test called a cholangiogram is undertaken during the operation. If stones are found they may be removed during the operation, or following the operation through an endoscopic procedure known as an endoscopic retrograde cholangiopancreatogram (ERCP). An ERCP is usually performed in the same admission under sedation. A long thin tube is passed through your mouth into the first part of the small intestine where the stone is extracted. This procedure is painless but mildly uncomfortable.  

Gallbladder surgery recovery time

You can usually go home the same day of the procedure. You are expected to be up and about on the same day and you are encouraged to stay mobile. However, heavy-lifting and carrying should be avoided for a minimum of 6 weeks to prevent wound-related complications. There are no dietary restrictions following the surgery. 

I offer the following benign biliary surgical treatments:

• Emergency 'hot' laparoscopic cholecystectomy
• Elective laparoscopic cholecystectomy 
• Perioperative cholangiography 
• Open cholecystectomy