Gall Bladder Surgery

The gallbladder lies on the underside of the liver in the main liver fissure at the junction of the right and left lobes of the liver. The relationship of the gall bladder to the liver varies between being embedded within the liver substance to suspended by a mesentery.      The gall bladder is a reservoir for bile.   Bile is an emulsifier, breaks down fats.     During fasting, resistance to flow through the sphincter is high, and bile excreted by the liver isdiverted to the gall bladder. After feeding, the resistance to flowthrough the sphincter of Oddi is reduced, the gall bladder contracts,and the bile enters the duodenum.   These motor responses of the biliary tract are in part effected by the hormone CCK.  The second main function of the gall bladder is concentrationof bile by active absorption of water, sodium chloride and bicarbonate by the mucous membrane of the gall bladder.   The hepatic bile that enters  the gall bladder becomes concentrated 5–10 times, with a corresponding increase in the proportion of bile salts, bile pigments, cholesterol and calcium.The third function of the gall bladder is the secretion of mucus– approximately 20 ml is produced per day. With total obstructionof the cystic duct in a healthy gall bladder, a mucocele develops on account of this function of the mucosa of the gall bladder.

Gallstones can be divided into three main types: cholesterol,pigment (brown/black) or mixed stones. In the USA and Europe, 80% are cholesterol or mixed stones, whereas in Asia, 80% are pigment stones.   Cholesterol or mixed stones contain 51–99%pure cholesterol plus an admixture of calcium salts, bile acids, bile pigments and phospholipids.

HOW GALLSTONES DEVELOP

If the concentration of cholesterol or pigment in the gall-bladder becomes high, crystals may begin to form. Like pearls growing in an oyster, these specks will slowly enlarge as they accumulate layer after layer of solid material.  Gallstones may be round or oval either a smooth oran uneven surface.  Their size may range from 1/20th of an inch to a full inch across. There may be only one stone, or there may be many, they may cause stomach pain or may be silent.

There are three main types of gallstones, depending on what they are made of:

  • By far the most common gallstones are made of cholesterol, which can harden into stone-like lumps.
  • Other gallstones are made from the pigment that gives color to red blood cells.
  • Others are a combination of the two, or may contain other substances resembling chalk.

SEVERAL FACTORS THAT INCREASE THE LIKELIHOOD OF GALLSTONES

Family History and Race

Many people inherit the tendency to develop gallstones.   For some reason, Native Americans have a higher incidence of gallstones than whites, and whites show a higher incidence than African Americans.

Age

The risk increases as you grow older Ten to twenty percent of those 55 and older have gallstones, although  they may have no symptoms.

Gender

Women are more likely than men to have gallstones, and are especially likely to have them after pregnancy.

Obesity

Overweight people have a greater risk of developing gallstones.

Rapid Weight loss

Crash dieting can increase the risk of gallstones.

HOW GALLSTONES CAUSE TROUBLE:

Although most people with gallstones have no ill effects, when symptoms do occur they are sometimes severe.

Stones can cause trouble and produce symptoms as pain in several ways:

  • Gallstones may Irritate the gallbladder. If stones are partially obstructing the flow of bile, it can become highly concentrated and irritate the gallbladder walls. This in turn can lead to inflammation and possibly an infection inside the gallbladder, which is  called cholecystitis.
  • A stone may get caught in the duct leading out of the gallbladder .When the gallbladder squeezes its digestive juices out , it may force a stone into the cystic duct. As the gallbladder continues to contract against this blocked exit,  the result can be acute pain. This condition is called biliary colic.
  • Less often, stones may pass into the common bile duct, where they can block the flow of vital substances from the liver This blockage may cause jaundice which is yellow discoloration of the skin and eyes.
  • In some cases, gallstones are associated with inflammation of the pancreas. This can cause severe pain in the upper abdomen, with nausea and vomiting.  Gallstones are usually found in the gallbladder itself, but they may occasionally migrate to other sites, where they can cause problems:
  • Stones may get stuck in mcystic duct, which connects the neck of the gallbladder to the common hepatic duct to form the common bile duct (CBD).  This condition is treated with Cholecystectomy
  • Stones may occasionally pass even further and block the common bile duct. This condition is treated with ERCP (EndoscopicRetrogradCholagioPancreatograph) performed by the Gastroenterologist (GI) followed by Cholecystectomy

Cholecystectomy is usually done laparoscopically.  This is usually done with 4 small incisions, one at umbilicus and 3 under the right rib cage.  Uncomplicated procedures are usually outpatient.    If technically difficult, the procudure is performed by open method, with a 6-8 inch incision under the right rib cage.   The patient stays in the hospital 2-3 days.