The liver produces a green liquid, called bile, which aids in the digestion of fat. The gallbladder stores the bile and transports it to the small intestine, through the common bile duct. The gallbladder can become diseased if bile is inadequately released or if gallstones, hardened lumps of bile, accumulate in the organ. A diseased gallbladder requires surgical removal, a very common procedure.
Surgical Preparation
Gallbladder surgery preparation includes preliminary blood work, to assess the health of organs such as the liver and kidneys, and an EKG and a chest X-ray, to assess heart and lung function and structure. On the day of the surgery, the patient will discuss what to expect during and following the procedure with the surgeon and anesthesiologist. The patient is required to avoid ingesting aspirin, vitamin E or other blood thinning agents one week before surgery; these substances can cause excessive bleeding during and following surgery.
Laparoscopic Surgery
The gallbladder is typically removed laparoscopically. Laparoscopic surgery involves the insertion of thin instruments into the abdominal cavity through four to five small incisions in the abdominal wall. The patient is under general anesthetic, so she is fully asleep. Gas is pumped into the abdomen to distend the cavity and make more room for the surgeon to work. A surgeon cuts the bile ducts and blood vessels and removes the gallbladder through a small incision. The procedure ends with a special X-ray, called a cholangiogram, in which dye is injected into the common bile duct, in conjunction with an X-ray, to assess for gallstones outside of the gallbladder.
Open Surgery
An open surgical method is recommended for patients with a history of previous abdominal surgeries, patients who are experiencing acute gallbladder infection and inflammation, and patients over the age of 80. A 5- to 7-inch incision is made through the upper right abdominal wall to extract the organ; this is an open surgical method called a cholecystectomy. Under general anesthetic, the surgeon reaches in through the large incision, cuts the common bile duct and blood vessels and removes the gallbladder. A cholangiogram X-ray is administered to assess for gallstones outside of the gallbladder, then the incision is sutured closed. This surgical method takes one hour, says the University of Maryland Medical Center.
Complications
Surgeons may miss the presence of small gallstones outside the gallbladder. The stone could become infected and require further surgery. Infection or excessive bleeding is higher with open surgical methods as opposed to laparoscopic methods, since the abdominal wall must be cut more extensively. Either method can also cause damage to the common bile duct and small intestine, inhibiting the flow of bile from the liver to the small intestine and possibly causing liver damage, notes the University of Maryland Medical Center.
Recovery
Following the procedure, a liquid diet is necessary until solid foods are tolerated. Most patients return home the same day, or a day after surgery. Complications such as excessive bleeding, pain or infection may keep a patient in the hospital longer. Patients typically recover quickly. With an open surgical method, a drainage tube maybe placed in the wound to help clear the area of excessive fluid; the incision is covered by a dressing. The NYU Medical Center recommends that patients check the abdominal tissue daily and change the dressing frequently, to monitor and help prevent infection.
