Diseases of the gall bladder
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These are diseases involving the gall bladder, a reservoir of bile located under the liver.
The most frequent of these is cholelithiasis, more commonly known as gallstones. In France, 15% of adults are affected, one-third of these without any symptoms. In 80% of cases, these gallstones are made up of cholesterol.
The other diseases of the gall bladder are rarer: polyps and cancer of the gall bladder, the latter being extremely rare in the western world.
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Gallstones may remain asymptomatic or lead to bouts of biliary colic. These attacks cause pain, typically following a meal, the onset of pain being sudden, sometimes at night, and located around the right hypochondrium (below the ribs, on the right) and sometimes in the middle of the abdomen. Often, pain is felt between the shoulders. This pain hinders breathing, increases for about an hour, then fades over a period of from 1 to 6 hours. Pain may be accompanied by vomiting. Diagnosis is made by ultrasound which will highlight the gallstones and any complications.
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• Cholecystitis : an infection of the gall bladder related with the gallsones. This cause fever, in addition to pain. It often requires the patient to be hospitalised, put on a strict diet and a course of antibiotics.
• Gallstone migration : when stones are small, they may migrate into the bile duct and obstruct it, leading to jaundice as well as pain. In this case, the gallstone obstructing the bile duct must be removed by endoscopy, and, later, the gall bladder.
• Acute pancreatitis : although rarer, this is a serious complication. When a small gall stone migrates in the bile duct it may also obstruct the pancreatic duct, leading to pancreatitis. In this case too, the gallstone must be removed by endoscopy. This complication may require a long stay in intensive care.
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The operation involves removing the gall bladder and the gall stones inside it. This is a very frequent operation, rarely causing complications.
It is today carried out using laparoscopy (keyhole surgery) via 4 small incisions..
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The day before the operation :
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No special examination is required, unless your state of health makes it necessary..
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The day of the operation :
- The patient takes a shower with antiseptic and his/her abdomen is coated with antiseptic
- Anti-thrombosis stockings are provided
- An anticoagulant is injected to prevent the risk of phlebitis, on the morning of the operation..
- Premedication.
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The operation is carried out under general anaesthetic. It takes from 30 minutes to 1 hour. In most cases, the operation is performed by laparoscopy via four 5 to 10 mm holes.
The advantage of this technique is that the patient returns to his/her normal way of life more quickly. The surgeon may, however, decide to make a conventional incision if he encounters difficulties during the operation.
The operation involves removing the gall stones and the gall bladder.
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The purpose of this phase is to make sure there are no complications so the patient can return to his/her normal way of life. This phase begins in the recovery room, continues on the hospital ward and finally through a period of convalescence at home..
Recovery phase:
When the operation is over, you are moved to the recovery room for at least 2 hours. Your state of consciousness, your pulse, your oxygen saturation, your breathing and any drainage tubes are all monitored. In exceptional circumstances, you may also have a nasogastric tube: a pipe going through the nose into the stomach to keep it clear. You may also have drainage tubes: pipes which vacuum away any secretions which might build up in the stomach.
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In the evening or on the day following the operation you will be got out of bed.
Any tubes or drains will be progressively removed over the following days. You generally leave hospital on the following day .
You begin eating again progressively, generally the evening after the operation, starting with drinks and then solid food little by little.
Dressings are removed at home, either on your own, or with the help of a nurse.
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During your convalescence, you will be able to eat normally. There is no need for a special diet.
Progressively, you can get back into your usual routine: after 3 weeks if you have been operated on by laparoscopy.
In the now unlikely event of your having been operated on using laparatomy, i.e. with a conventional incision, you will have to wear an abdominal belt and you will need an average of 4 to 6 weeks before you can return to normal routine with physical effort.
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Consequences and complications |
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Removal of the gall bladder (known as cholecystectomy) has no impact on your digestion. A passing phase of diarrhoea may be observed.
Complications arising during the operation :
These are the same as with any form of surgery. Phlebitis, pulmonary embolism, haemorrhage and infection may occur. During the operation, it may, in exceptional circumstances, be necessary to open the abdomen to control haemorrhaging, for example.
Of complications specific to gall bladder surgery, the following may be encountered:
- Injury to the bile duct: this complication has become exceptional as techniques have improved. It may require a second operation afterwards.
- njury to the vessels: this is generally detected and repaired during the initial operation.
- Stomach wall abscess: sometimes suppuration of a trocard orifice may be observed, especially if the gall bladder was infected This is treated by dressings on the wall.
Taken together these complications may appear dramatic, but remain exceptional for trained staff.
Long-term surveillance
No particular surveillance is necessary following a simple cholecystectomy.
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