FACTS AND MYTHS ABOUT GALL BLADDER SURGERY

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Gall bladder diseases are very common these days. These diseases range from innocuous gall stones to cancer of gall bladder which has very dismal prognosis. As a GASTROINTESTINAL SURGEON with HEPATOBILIARY experience we daily see cases from one extreme to another. Majority are simple gall stones and are managed at periphery , however what we receive are one that are either left to be referred to higher level or are complicated ones. Many a times we also deal with cases that are operated elsewhere and become complicated and are then referred to us.

So today in this blog I would like to discuss about gall bladder diseases with special focus on stone diseases. Most commonly asked questions in patient’s mind are

1. How are stones formed?

Bile is juice produce by liver and stored in gall bladder and released when food reaches small intestine. It is composed of bile salts, pigments and they are kept in solution form by mixing with cholesterol. So any change that disturbs this proportion of each component required to keep these in solution form can result in formation of stones. For example diet rich in fats can result in high cholesterol component and can result in stones formation.

2. How can we prevent formation of gall stones?

Gall stones are usually formed by mismatch in concentration of cholesterol and bile salts in bile. So a balanced diet that is low in fats can help in decreasing chances of gall stone formation.

3. What are risks associated with gall stones?

Gall stones can cause pain by themselves. They can result in jaundice if a stone slips into bile duct. It can cause pancreatitis which can be mild or life threatening. Gall bladder neck can be blocked by stone resulting in huge distension of gall bladder thus causing pain and can result in pus formation in gall bladder. Large stones in gall bladder are risk factors for cancer of gall bladder.

4. If they are not causing any trouble, should I undergo surgery?

These are called asymptomatic stones. Asymptomatic stones usually do not require surgery unless
a. Patient is having low immunity
b. Patient is living in a place where medical facilities are meager.
c. Patient is undergoing surgery of abdomen for some other reason
Relative indications are
i. Multiple small stones
ii. Diabetic patient
iii. Large stone

5. Can we just remove stones and leave gall bladder behind?

We have to remove gall bladder as its functionally abnormal and stones would reform. Moreover cut on gall bladder heal very poorly.

6. Will removal of gall bladder affect my digestion?

There is no effect on digestion if gall bladder is removed. Body adapts to removal of gall bladder very well and digestion is not affected at all.

7. What are dietary restrictions after gall bladder surgery?

There is no dietary restriction and patient can have normal diet as before. Digestive system adapts well to removal of gall bladder and there is no effect on digestion of food.

8. Is it major surgery?

Gall bladder removal surgery is performed by laparoscopy. It is successful in more than 99% of cases. Occasionally it is done by open surgery is anatomy is difficult or there is risk of injury to important structures. But as the experience of surgeon increases chances of conversion to open procedure decreases.

9. Is it very painful?

Laparoscopy surgery is done through small cuts made on your tummy ranging from 0.5-1 cm. these are small cuts and pain is minimum.

10. Should we undergo open or laparoscopic surgery?

That is to be decided by surgeon operating upon you. As mentioned above large majority of procedures can be done by laparoscopy and needs open surgery only if surgery is difficult or in the presence of gall bladder cancer.

11. How long does it take to remove gall bladder?

Surgery is never about time. It is better to finish the procedure safely than quickly. It may take from 10 mintues to an hour depending upon anatomy.

12. What are risks of surgery?

Apart from anaesthesia risk that depends upon general condition of patient gall bladder surgery carries minimum risk. Still there is small but real risk of bleeding, injury to bile duct or injury to bowel.

13. How long does it take to recover and get back to normal life?

Gall bladder surgery is usually done as day care surgery and patient is send home same evening of surgery. Patient is up and about Few hours after surgery and start his normal routine within few days of surgery.

14. How does experience of surgeon matter in gall bladder surgery?

Experienced surgeon has fewer conversion rate and chances of complication are less. Surgeon experienced in hepatobiliary or gastrointestinal surgery can handle majority of complications on table and can provide better outcome in difficult cases.

15. Why some people are unsatisfied after gall bladder surgery?

Gallstones can cause abdominal pain, bloating or discomfort after food intake and the complications listed above. Symptoms such as indigestion, heartburn, constipation and increased frequency of stools are very common in the general population and are not related to gallstones. Mostly when the patients / treating doctors try to correlate these symptoms with gallstones it leads to unhappiness as these symptoms may not get relieved by a removal of gall bladder. So proper patient selection and counseling can help avoid unsatisfied patient.

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