Gallstones and Other Gallbladder Disorders

The gallbladder functions as a storage bag for the bile made by the liver. Bile is secreted by the liver and aids in the digestion of fat in the foods we eat. Some of this bile is stored in the gallbladder, but some also flows directly into the intestine. When fat is eaten, hormones stimulate the gallbladder to contract and release bile through the ducts to the intestine, where it helps break down food. Not only does the gallbladder store bile, but concentrates it by removing the water from it. This process also can cause the bile to form crystals, which may play a part in the formation of gallstones. Once the gallbladder is removed, the liver will continue to make bile to aid in digestion.

Gallstones

Gallstones are the most common disorder of the biliary tract (gallbladder and bile ducts). It isn’t completely understood how or why gallstones form, but some researchers think that the gallbladder malfunctions and removes too much water from the bile so that it crystallizes. Gallstones occur more frequently in developed countries, and therefore, some researchers think it’s associated with eating a high-fat, low-fiber diet. Heredity and age also may play a part.

About 10 to 20 percent of Americans over the age of 40 have gallstones. Although some patients may be unaware of the gallstones, most will develop symptoms at some time. These symptoms vary but most often include pain (biliary colic). Besides pain, complications that can develop from gallstones include cholecystitis (inflammation of the gallbladder), choledocholithiasis (gallstones in the common bile duct), cholangitis (infection of the bile ducts) and pancreatitis.

Biliary Colic

Pain is often the first symptom of a gallbladder problem. Often, attacks of pain occur after eating or in the evening. A gallstone becomes stuck in either the junction of the gallbladder and the bile duct or in the bile duct itself. The muscles in the walls of these vessels squeeze and try to push the stone out, causing pain. Often the pain is under the ribs on the right-hand side of the abdomen, but the location can vary. Sometimes the patient has nausea, vomiting and bloating. Usually, after a while, the stone drops back into the gallbladder and the pain subsides. However, in some cases, it may become lodged in the neck of the gallbladder. Often, these episodes of pain recur.

Acute Cholecystitis

Twenty percent of patients who develop gallbladder symptoms suffer from acute inflammation of the gallbladder. This occurs when a stone gets stuck and blocks the exit of bile from the gallbladder. The gallbladder becomes tense and inflamed, and the trapped bile may become infected. The pain in acute cholecystitis becomes constant and quite severe. It often is felt across the center and right parts of the upper abdomen and under the right shoulder. The patient usually vomits and is ill and feverish. Jaundice can occur if the bile duct becomes swollen and the bile cannot drain into the intestines.

Treatment

When gallstone symptoms occur, most physicians agree that removing the gallbladder is the best approach. The “gold standard” procedure to remove the gallbladder is a laparoscopic cholecystectomy. A conventional open cholecystectomy is major surgery and involves a large open incision and a longer hospital stay and recovery, as well as more discomfort. Laparoscopic cholecystectomy usually results in a speedier recovery with less pain and fewer complications.

Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is performed through several small puncture incisions using hollow tubes called ports. These ports allow instruments to be moved in and out and allow the doctor to manipulate the gallbladder. A long scope with a camera attachment also is placed through one of these ports. This allows the doctors to work while watching a video screen. Once the attachments of the gallbladder have been disconnected, the surgeon removes the gallbladder through one of the small incisions. The surgery may take one to two hours and usually requires a very brief hospital stay. Once your gallbladder is removed, you should be able to eat normally and quickly return to a normal, active lifestyle.

Open Cholecystectomy

In some situations, your doctor may feel it is not safe to continue removing your gallbladder laparoscopically once the surgery has begun. If so, your gallbladder would be removed at that time through a larger incision on your abdomen. If this is necessary, your hospital stay and recuperation will be longer.

Washington University in St. Louis minimally invasive surgeons who treat gallbladder disorders:

Michael M. Awad, MD
L. Michael Brunt, MD
J. Christopher Eagon, MD