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Gallbladder Surgery: Dealing with the Pain of Gall Stones

Gallbladder surgery or cholecystectomy is standard treatment for inflammation of the gall bladder; biliary colic (pain caused by small stones blocking bile ducts); pancreatitis (gallstones in the common duct inflaming the pancreas), and in some cases, gall bladder cancer.

Gall bladder surgery involves the removal of the organ, which is located in the upper right quadrant of the trunk of the body; underneath the liver. The gall bladder is part of the biliary system of the body, and serves as a reservoir for bile on its way to the small intestine for digestion. Humans can live very well without a gallbladder, usually with minimal aftereffects although in some cases the removal of the organ causes chronic diarrhea, for reasons not entirely understood.

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Gallstone surgery, as cholecystectomy is often familiarly called becomes necessary when gall “stones” form as crystals inside the gallbladder and grow to a size that irritates the organ and blocks biliary ducts. Most often these stones are comprised of cholesterol and they can grow to a substantial size increasing the likelihood of the gall bladder becoming inflamed.

Some individuals have what are called “silent stones” that may be seen on x-rays and other imaging technology, but which do not present with any symptoms. Surgery may still be an option for these patients to avoid the risk of pancreatitis and biliary colic, but is not considered an emergent condition.

Just a few years ago, gallstone surgery was a major, invasive procedure that required a large incision which cut through abdominal muscles and required substantial recovery time. The operation also carried a not insignificant risk of infection due to the open nature of the incision wound.

In recent years this so called “open” procedure has largely been replaced by laparoscopic gall bladder surgery, although the former operation is still used in some cases that do not lend themselves to the less invasive technique.

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Laparoscopic surgery uses small incisions into which tubes are inserted. These tubes become ports containing surgical implements and a video camera. The surgeon uses the video camera to guide the procedure; the camera magnifies the view of the gall bladder enabling him to safely remove the organ through one of the ports.

Laparoscopic gallstone surgery yields a much quicker recovery time with substantially lower risk for infection and other complications such as tissue adhesion. Unlike the open procedure, the laparoscopic version requires no cuts into abdominal muscles, which means that postoperative pain is greatly reduced.

The surgeon must be careful not to cause inadvertent damage to the common duct; which is the primary complication risk in this form of the operation. The gall bladder itself must not be perforated, as bile leakage can lead to peritonitis. Complications of this nature are relatively rare, estimated at 0.25% of all cases.

The laparoscopic form of the surgery may require as many as four small incisions, although a recent refinement to the procedure has utilized one small incision in the umbilicus. This revised procedure hides the incision scar within the navel yielding better cosmetic results than the three to four incision methods.

The surgeon performing laparoscopic gallstone surgery must be very exacting and meticulous. In order to be certified to perform the procedure, the surgeon must meet stringent requirements in experience and training. The National Institutes of Health issued strict guidelines in training, competence testing and ongoing monitoring. The NIH has also determined the laparoscopic cholecystectomy be used only for patients who have symptomatic gall stones.

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Cholecystectomy is not to be confused with bladder surgery which refers to the organ in the pelvic region that collects urine processed by the kidneys.

In the United States it has been estimated that over 600,000 patients undergo gall bladder surgery each year; making cholecystectomy one of the most common surgeries in the nation.