The gallbladder is a pear-shaped organ located below the liver on the right side of the abdomen which stores and stores the digestive juice known as bile fluid which is used to breakdown the dietary fats. The organ extracts water from its store of bile until the liquid becomes highly concentrated. The gallbladder is triggered to squeeze its bile concentrate into the small intestine via the common bile duct on the presence of fatty foods.
It is a misconception that bile is produced in the gall bladder. Bile is actually produced in the liver and then it is connected to the small intestine, duodenum by the common bile duct.
Gall bladder only stores a small amount of bile and connects to the common bile duct via a small tubular connection called the cystic duct.
Digestion can continue to be normal even in the absence of gall bladder and the bile duct can take over part of the function of the gall bladder.
Small, soft to hard, and stone-like substance made up of cholesterol, bile pigment and calcium salts in the gall bladder are known as gallstones also known as biliary calculi. It is condensation of the bile into tiny fragments which can come together and form stones. It is a common disease of the digestive or called the biliary system. The size of the gallstone can vary from a small grain of sand to a size of the golf ball. Gall stones can be seen at any age and are becoming more common.
Gall bladder stones can be because of multiple reasons. Gall bladder stones may be a result of condensation or crystallization of excess cholesterol in the bile, overproduction of cholesterol by the liver and failure of the gallbladder to empty completely are identified as the main cause of gall bladder stones.
Stones also form when the gall bladder wall is thick or diseased. The contractile capacity of the gall bladder wall reduces giving rise to stasis of bile and subsequent stone formation.
Another common cause seen in these times is due to weight loss after det, exercise or after newer medications for weight loss. Weight loss of any kind which could be intentional or after any illness may give rise to formation of gall stones.
There are 3 different types of gall bladder stone which are listed below
Who are more prone to get gall bladder stone ? :
Dr Shashank Shah at the Laparo Obeso Centre in the city extracted more than 1450 gall bladder stone
In some people, gall bladder stones may cause no signs and symptoms and the patient may be apparently asymptomatic. The symptoms may be vague like acidity, bloating, burning in chest, gaseous bloating or discomfort after meals and the person may not correlate them to gall stones. Patients with diabetes may not feel symptoms or the pain or symptoms may be masked due to diabetes. Hence, patients with diabetes are suggested to have gall bladder stones treated with laparoscopic cholecystectomy to prevent any emergency or complications.
In a case where gall bladder stone gets stuck in the cystic duct ( the duct or the small narrow tube which connects the gall bladder to the main biliary duct)and causes a blockage, it may cause blockage of the gall bladder leading to its distension, infection and the gall bladder may burst ( perforation) if not treated in time. If the stone gets stuck in the common or the main bile duct, bile can not pass into the intestine and hence jaundice develops. This type of jaundice is caused by obstruction to the flow of bile and hence it is called obstructive jaundice.
Common symptoms if the stone get stuck are:
Pain caused by the gall bladder stone may last several minutes to a few hours.
Patients experiencing symptoms from their gall bladder stones are recommended a gallbladder removal surgery.
The gall bladder with stones inside is known as a diseased gall bladder and hence removal of gall bladder with stones is recommended scientifically. Only removal of stones is not recommended because the diseased gall bladder would form stones again.
The procedure is safe, effective and standardised. The surgery clears stones in the gallbladder but the stones in the common bile duct are removed endoscopically . Endoscopic removal of stones in the common bile duct is called ERCP.
This surgery is also known as Cholecystectomy. It is performed to remove the gallbladder and gallstones by making multiple small incisions in the abdomen. Laparoscopic Cholecystectomy procedure is minimally invasive treatment option for removal of gall bladder stone and can be a day care procedure.
The procedure is performed under general anaesthesia and takes about 30 minutes or less in expert hands. The patient’s abdomen is inflated with carbon dioxide ( CO2 ) to get a clear view and expand the section.. Then, into the incision near the belly button, a lighted scope attached to a small video camera is inserted. Then the surgeon inserts surgical instruments through the other incisions to remove the gallbladder with the help of a video monitor guiding the surgeon.
Surgeons at Laparo Obeso Centre use disposable bladeless trocars and advanced coagulating devices like Harmonic scalpel to dissect the gall bladder. The gall bladder removal from the attachments of liver can also be dissected with a diathermy which burns the tissues with an electric current and seals the vessels. Use of diathermy or cautery may be economical but with a chance of some thermal injury. To avoid this and to perform surgery with minimal tissue injury, minimal blood loss and less time, the procedure is always performed with Harmonic scalpel at Laparo Obeso Centre.
Bladeless disposable trocars induce minimal tissue injury with less pain and reduced chances of development of hernia at the site of puncture.After the surgical procedure is performed bile starts flowing from the liver where it is produced, through the common bile duct and into the small intestine. After the gallbladder is removed, the bile produced in the liver flows normally into the intestines. This has minor or no effect on digestion in most of the patients. Most patients need a stay at the hospital for only 1 or 2 days after the procedure and can return to their normal routine in a day or twoThere are no diet restrictions after discharge from the hospital.
Small stones or sand, often called as sludge on ultrasound have more risk of slippage into the bile duct causing obstruction. Small stones have a tendency to pass into the opening duct of gall bladder and tend to get stuck there, blocking the bile passage of gall bladder.
Generally, the symptoms may not be obvious to a patient. The symptoms could be vague like acidity, gases, indigestion, bloating or upper abdominal discomfort or backache.
On the other hand, large stones are equally risky and in the long run, they can induce ulcerations to the inner lining or mucosa of the gall bladder and in some, they may cause gall bladder cancer.
The key hole surgery of gall bladder known as laparoscopic cholecystectomy can be performed using advanced technology and infrastructure and the patient can recover in a day.
At LOC , we use advanced Endo vision/ laparoscopy systems with use of ICG ( when required)which can delineate the anatomy of gall bladder very clear and can make the procedure of laparoscopic cholecystectomy very precise. Every operating room should have ICG or enhanced fluorescence imaging for laparoscopic biliary like cholecystectomy.
The laparoscopic cholecystectomy can also be performed through a single incision inside the naval. Tiny scar inside the naval becomes invisible over time and hence called No Scar surgery.
Generally four tiny, 5mm to 10mm incisions are used.At LOC, special needle instruments are used for surgery so that the number of punctures or incisions are reduced making it almost painless, scarless and day care procedure.
Standard scientifically approved treatment for gall bladder stones is cholecystectomy. Unlike kidney and kidney stones, gall bladder has minimal role in digestion when diseased. Attempts at only removal of stones have failed and resulted in recurrence. Keeping gall stones is keeping a risk. Being a simple laparoscopic procedure, we recommend laparoscopic cholecystectomy as a treatment option.
Bile is secreted from liver and carried to the intestine through the common bile duct. This secretion continues normally even after gall bladder and aids normal digestion. In most cases, normal digestion remains unaffected even after laparoscopic removal of gall bladder stones. In fact, with symptomatic gall stones, a fat free diet is advised to avoid stimulation of gall bladder and possible attack. However, after laparoscopic cholecystectomy, a normal diet can be resumed.
Yes, diet can be normal after laparoscopic gall bladder surgery.
Once gall stones are formed, they generally remain for life time. It is also because the causes like gall bladder dysfunction or reduced contractility remain as it is. Only sludge in the initial stage can be treated with ursodeoxycholic acid with a surveillance on ultrasound.
The symptoms of gall bladder stones most often are non-specific. However, if a person has diabetes, severe obesity or medical risks, the gall bladder surgery should be performed electively to avoid any emergency. Gall stones may slowly grow and the number and cause obstruction to biliary tree in future. If the gall bladder wall is thick, it suggests that the gall bladder is diseases with multiple attacks of inflammation even though the patient has no symptoms.
1. Acute cholecystitis: it means acute severe infection in the gall bladder, most often because of stones. Patient needs to be admitted and investigated.
2. Chronic cholecystitis: chronic infection of the gall bladder . Sonography may show thickened gall bladder wall. Laparoscopic removal of gall bladder is the treatment of choice.
3. Empyema of gall bladder: Pus and infection in the gall bladder with signs of infection in the body like pain in abdomen, fever, vomiting, etc. Emergency laparoscopic cholecystectomy is usually advised.
4. Mucocele of the gall bladder: It means that the opening duct of the gall bladder called the cystic duct is blocked due to a stone giving rise to distension of the gall bladder. The gall bladder contains white bile with mucous. Chances of gall bladder getting burst are high, perforation of the gall bladder. This is known as an emergency requiring surgery of the gall bladder
5. Gall stone pancreatitis: This is the most concerning and life- threatening complication of gall bladder stones. This happens when a stone from the gall bladder passes into the common bile duct and gets stuck at the narrow opening of the duct into the intestines. The duct draining pancreatic juice also opens with the bile duct and hence the passage of pancreatic juice can get blocked. This blockage of pancreatic duct can give rise to inflammation of pancreas giving rise to pancreatitis. Pancreatitis can be severe and may be serios. Such patients may need an investigation called MRCP and stone is removed endoscopically. Laparoscopic removal of gall bladder is necessary after this procedure.
