What is The Gallbladder?
Bile is a secretion produced in the liver and poured into the duodenum. Through this secretion, some substances are eliminated from the body. It also ensures that some fat-soluble vitamins and fats are absorbed in the body. An average of 600 ml of bile is produced daily.
The gallbladder is pear-shaped. It is attached to the lower surface of the liver. It is connected to the main bile ducts by a duct called the cystic duct.
The Role of The Gallbladder
It is to store and concentrate some of the bile produced by the liver, especially during fasting periods, and to be secreted back into the intestine during digestion. The gallbladder has a volume of about 50 ml. It can concentrate bile up to 10 times. Following the arrival of food in the stomach, it contracts and empties more than half of its contents into the intestine within half an hour. The liver can also send some of the bile it produces directly to the intestine without the need for the gallbladder. In the absence of a gallbladder, all of the bile can be delivered to the intestine through the common bile duct. Therefore, the gallbladder is not an indispensable organ for life. When it needs to be removed in case of inflammation, it does not create a vital defect in functioning.
Why Do Gallbladder Stones Happen?
Some of the bile produced by the liver is stored in the gallbladder, especially during starvation. The main components of bile are cholesterol, lecithin, bilirubin and calcium. Under normal conditions, there is a balance between these substances that make up the bile.
In case of disruption of this balance, gallstones and sludge are formed. The solubility in the medium decreases and the liquid content becomes extremely dense. Some substances that need to be discarded crystallize and precipitate and form sediment. Precipitated cholesterol crystals or calcium particles combine with the gelatinous substance secreted from the gallbladder wall to form biliary sludge.
Long periods of fasting increase the formation of bile sludge. The deterioration of the contraction and relaxation function of the gallbladder and the secretion function from the inner wall of the wall prepares the ground for the stone. Over time, a harder core forms and becomes a gallstone. There may be a familial predisposition for gallstones.
Gallstones are more common in overweight, forties, women, and those who have given birth multiple times. In order for gallstones to cause discomfort to the person and cause complaints, they must be obstructed in the mouth of the canal or reach a size that will cause damage to the inner wall.
There are also factors that accelerate the formation of gallstones. Some of these are: patients who have undergone gastric surgery, patients who have undergone bypass surgery due to obesity, morbid obesity.
Gallbladder Inflammation (Cholecystitis)
Gallbladder inflammation can occur in two forms, acute and chronic. In both, gallbladder inflammation usually develops as a result of obstruction of the gallbladder duct. The stone or sludge formed in the bladder sits in the mouth of the gallbladder duct. It does not allow the bile inside to drain. The gallbladder swells, stretches. Edema develops in the wall of the sac.
The most important symptom of gallbladder inflammation is pain in the abdomen, especially in the upper right side. It usually happens after meals. It is typical for the pain to hit the back and shoulder. Pain may often be accompanied by complaints such as nausea, bloating, indigestion, burning, heartburn.
Who Needs Gallbladder Surgery?
In case of detection of stones, sludge or inflammation in the gallbladder in ultrasonography, closed gallbladder surgery should be performed.
Gallbladder surgery is performed in patients with stony gallbladder who have had an attack of acute or chronic cholecystitis (inflammation of the gallbladder).
Surgery is performed in patients with multiple small gallstones who have had acute pancreatitis (inflammation of the pancreas), swelling in the gallbladder without stones or sludge in the gallbladder, and patients with biliary inflammation (acalculous cholecystitis).
What to Do for Gallbladder Polyps?
Gallbladder polyps are milimetric soft formations that grow into the inner layer of the gallbladder wall, usually stalked, and sometimes several together and resemble a bunch of grapes.
A polyp is seen in one out of every 20 patients undergoing gallbladder ultrasound. One-third of patients with polyps also have more than one polyp.
Conditions that increase the risk of developing cancer in gallbladder polyps;
- In our patients over 60 years of age
- Polyps found with gallstones,
- In rapidly growing polyps
- Polyps larger than 10 mm in diameter
In patients with gallbladder polyps, if there are gallbladder complaints, surgery is performed regardless of the size of the polyp. If the size of the bile polyp is over 10 mm, surgery is performed regardless of the complaint. And if a growth is detected in the gallbladder polyp, surgery is performed again. If there are polyps and stones in the gallbladder, the operation is performed again.
What Happens If I Don’t Have Surgery or After?
Most patients with gallbladder stones and no complaints can live for years without any problems. Surgery is not recommended, especially for patients without complaints.
Periodic control is sufficient for stones that are detected by chance in the gallbladder and do not cause any complaints. However, complaints occur in 5% of these patients every year.
If there is concomitant diabetes, it is necessary to stay closer to the option of surgery in general in these patients. Because gallbladder inflammation in diabetics can progress rapidly and easily lead to decay and perforation.
Surgery is recommended for patients with stones smaller than 2-3 millimeters in size, such as sand and mud, even if the complaints are mild. Because such stones are more prone to blockage by passing into the bile ducts. As a result of the blockage, dangerous secondary problems such as jaundice and pancreatitis may develop.
Surgery is also recommended for stones larger than 2 cm in diameter. Large stones can damage the biliary tract by compressing the surrounding tissues. Patients with large stones have an increased risk of developing gallbladder cancer in the long term.
The difficulty of the operation to be performed and the problem that may arise after the operation increase as recurrent inflammatory attacks are experienced in patients who postpone the operation even though it is necessary. Recurrent attacks of inflammation cause the organs to stick together and the gallbladder wall to thicken and deteriorate. In this case, the chance of closing the surgery (laparoscopic) decreases. During surgery, such patients may develop life-threatening complications.
What are The Preoperative Preparations?
All patients to be operated should be examined by an anesthesiologist.
If the patient has a disease, this should be stated and a consultation should be made from the relevant department and their recommendations should be followed.
The patient should fast for 12 hours before the operation, without eating or drinking anything by mouth. The surgery should sound like fasting. It is recommended that they take a bath in the morning on the day of surgery, do their personal care and brush their teeth. It is recommended that they come with wide comfortable clothes that will not cause problems in wearing after the surgery.
If the patient smokes and drinks alcohol, he should definitely quit.
How is Closed Gallbladder Surgery Performed?
Today, almost all gallbladder surgery is performed with a closed (laparoscopic) technique. The surgery is performed with thin instruments inserted through tiny incisions made in the anterior abdominal wall. The surgery is usually performed under general anesthesia, with the patient completely asleep. The gallbladder is completely removed by cutting its connections from the liver and with the main bile ducts.
First, a 0.5 cm incision is made from the navel, and gas (CO2) is introduced into the abdomen through the 5 mm trocar, which is entered here. A thin rod-shaped camera is inserted into the abdomen through this thin tube. The image of this camera is projected onto a screen. In this way, by seeing the inside of the abdomen, other instruments are also entered into the abdomen through 0.5 cm and 1 cm incisions.
The camera enlarges the image 10 times. Since it can reflect from the desired angle, the surgeon’s vision is better than open surgeries. Before the operation, the intra-abdominal organs are reviewed.
Checking if there is a problem. Then, the area where the gallbladder connects to the bile duct and the vessel feeding the gallbladder are separated from the surrounding structures. It is made visible. They are then clipped and cut with titanium clips.
Then the gallbladder separates from the place where it is attached to the liver. It is made free. The gallbladder is taken out through the holes. Before completing the procedure, we review the area where we removed the gallbladder and the entire abdomen for one last time. Then we discharge the gas in the abdomen. The surgery is completed with small incisions and hidden stitches.
The operation time usually varies between 30-50 minutes if there is no extra problem.
What are The Results of the Gallbladder Surgery?
Closed gallbladder surgery is a well-established surgery that has been widely practiced all over the world for over thirty years. With a correct diagnosis, the result is close to perfect, especially when performed by surgeons with extensive experience in laparoscopic surgery.
In patients with gallbladder removal, problems related to gallbladder stones and inflammation are solved to a large extent. Since the gallbladder is completely removed, there is no re-formation of stones and sludge. The operation process is very comfortable for the patient. Almost all of the complaints disappear after the operation. In order not to miss the problems that may occur in the gallbladder other than inflammation, all gallbladders removed during the surgery are sent for pathological examination. The gallbladder is not a vital organ for bodily functions. It can be sacrificed when the risks it creates increase. No significant change in general health conditions is expected.
How is it After The Operation in The Hospital?
Patients with closed gallbladder surgery recover completely and can walk a few hours after the operation. After three to four hours, he can start taking food by mouth. It is sufficient to give painkillers a few times to prevent complaints such as mild abdominal pain and back pain that may occur on the night of the surgery.
Especially with long-acting local anesthesia drugs applied to these incision areas during surgery, this wound pain can be reduced well. A drain is rarely required during surgery.
This is a plastic tube with a diameter of 4-5 mm extending outward from the abdomen. In the early postoperative period, it is needed to remove possible leaks from the operating area. It is usually removed the next morning.
In cases where there is no mishap, one day of hospitalization is sufficient. Almost all of the patients can be discharged the next morning after staying in the hospital the night of the surgery day. On discharge, a pain reliever pill is prescribed to be used several times a day for a few days. Wound inflammation rate is very low, antibiotics are often not needed. Medication can be given to facilitate digestion.
After 48 hours from the operation, if there is no problem in the surgical wounds, the wounds can be left open. Bath can be done. No re-dressing is required. Self-dissolving hidden sutures are used for wounds. The patient should not eat heavy and fatty foods in the week after the surgery. Juicy soft foods should be consumed. A few titanium staples used in the surgical field in the abdomen remain in place for life.
These are seen in later abdominal films. However, they do not cause any problems. Removal of the gallbladder does not cause a significant problem in terms of daily life, eating and drinking patterns. If there is no mishap, one week of rest is sufficient for the patients to return to their social environments and work life. According to current medical information, removal of the gallbladder does not cause any physical deficiency. It does not require medication or vitamin supplements. After the first 10 days of follow-up, there is no need for long-term follow-up and controls.