Your liver is a solid organ that sits in the right side of your tummy underneath your ribs.
From the liver comes a tiny little tube called the bile duct that carries the bile from the
liver to your gut to help digest the food. The gallbladder is a little bag the size
of a pear that hangs of this bile tube and it stores a little bit of bile and every time
food arrives in your gut after being digested in the stomach, the gallbladder gives a little
squeeze and the gush of bile goes and mixes with the food. That’s the gall bladder’s
job. If your bile is particularly concentrated,
it can form a sediment in the gallbladder, and over a period of time, that can form stones
which are called gallstones. Now, in the majority of people, gallstones do not cause
any symptoms at all. They’re completely silent and picked up by chance. Such gallstones
can be left alone. You don’t have to have them removed surgically unless there are certain
extenuating circumstances. It is only when they start causing symptoms
that you have to worry about gallstones. The symptoms they can cause are, in milder situations,
pain, which doctors describe as biliary colic and typically this is pain that comes on after
a meal especially a fatty meal and often strikes you in the middle of the tummy in the upper
part and very often goes around towards the back, towards the right shoulder blade.
It is often associated with vomiting, can be quite severe, people land up in Accident
and Emergency with this sort of pain sometimes and end up having tests done to exclude a
heart attack. It’s often ascribed to acid reflux as well.
If the gallbladder gets completely blocked, the stone doesn't allow bile to come out of
the gallbladder and it’s full of stagnant bile and that can get infected and lead to
what is called acute cholecystitis or acute inflammation of the gallbladder. This can
be very painful. It almost always requires hospitalisation and more tests, antibiotics,
and surgery. That’s a nasty complication. Gallstones can also slip into the bile duct
and if they do that, then they can block the flow of bile and give you jaundice or they
may irritate the pancreas which also drains into the same duct just before it goes into
the gut and give you pancreatitis which is another nasty complication.
This is the acute scenario and occasionally, people get what’s called chronic cholecystitis
or chronic inflammation of the gall bladder where they keep getting pain usually after
eating, almost on a daily basis. That’s called chronic cholecystitis.
The test we do to identify gallstones is an ultrasound scan of the abdomen. It’s straightforward,
painless, doesn't involve any radiation and widely available. Only occasionally do we
need other scans like an MRI which is called an MRCP and very rarely, if you are suspected
to have stones in your bile duct, you might need what’s called an ERCP which is an endoscopy procedure.
If you do have gallstones that are causing
trouble, there isn’t any medical therapy that will really dissolve those stones for
you. Blasting the stones with shockwave lithotripsy, or soundwaves doesn't really
work because the sand will just go and clog the bile tube. Surgically removing only the
stones but leaving the gallbladder again doesn't make sense because they form again.
The only practical solution is to remove the gallbladder surgically. This operation is
called laparascopic cholecystectomy which means keyhole surgery to remove the gallbladder.
It’s always done under a general anaesthetic and involves three or four little cuts to
the abdomen and the gallbladder is removed by the keyhole approach.
Very occasionally, one might have to do an open operation where you get a longer cut
underneath the ribs on the right side and that removes the gallbladder. What’s done
inside is the same but you have a bigger flesh wound so the recovery period is longer.
The operation is done as a day case in most instances. You might go home the same evening
or the following morning after the keyhole operation. The recovery takes a variable period
of time in different people but most patients who are at desk jobs are back at work within
one to two weeks. If you have a more physical job, it might take a bit longer.
Interestingly, if you don’t have a gallbladder, it doesn't seem to make too much of a difference
to your digestive processes. There’s no particular diet or dietary restrictions that
you have to follow if you don’t have a gallbladder. Just eat and drink as normal.
The liver still makes the same amount of bile and that flows down drip, drip, drip into
the gut and the gut adapts to that. You don’t get a gush of bile going and mixing with the
food every time it comes along, but the bowel just adjusts to that.
The concerns are all to do with the immediate aftermath of the operation. One worries about
bleeding, infections, inadvertent damage to something else at the time of the operation
and all those risks are exceedingly low. By-and-large, it’s a very safe standard operation that’s
done very widely across the country in many hospitals by many surgeons. The overwhelming
majority of patients just get back to a normal life and forget that they ever had a problem
with their gallbladder.