Gallbladder surgery (cholecystectomy) is the most common method of removing gallstones.  It is actually one of the most common surgeries performed in the United States, with over half a million people undergoing the procedure each year.   Most gallstones cause no symptoms at all, and some may even pass by themselves without being detected.  However, gallstones that cause severe pain and anguish need to be treated immediately.

Before anyone undergoes a major gallbladder operation they should understand what the gallbladder is and what it is for. Located on the right side of the abdomen just below the liver, the gallbladder is a small digestive organ which stores and secretes bile. The gallbladder serves as a reservoir for bile before it is secreted to the intestines to break down fats.

Most diseases and disorders of the gallbladder results from gallstones. A gallstone is a by-product of solid material collected in the gallbladder. There are two types of gallstones: pigment and cholesterol. A pigment gallstone forms when there is an excess of bilirubin in the bile. A cholesterol gallstone occurs when the liver secretes too much cholesterol, and the cholesterol is transferred to the bile. Even though gallstones typically form in the gallbladder, they can also form in the various ducts that bile can be found. Stones in the gallbladder can also transfer to and block the bile duct, causing excruciating pain. The following are those who are most at risk for gallstones:

• women over 20 years of age
• men over 60 years of age
• obese men and women
• people who fast or lose a lot of weight suddenly and quickly
• women who are pregnant, and
  
• women on birth control pills or hormone replacement therapy

The majority of gallstones do not cause symptoms or other serious problems. However, with symptoms become apparent, then a gallbladder treatment becomes necessary.

The decision of having gallbladder removal surgery depends on your personal feelings and the severity of gallbladder attack. If you are having mild, infrequent gallbladder attacks, you may want to consider the alternatives to gallbladder surgery. One way to treat gallstones is by performing a liver cleanse. This is the most natural way to get rid of gallstones, passing the stones through your urine.

You may also discuss medical non-surgical methods with your doctor. One possibility is use of bile acids. Bile acids is a medication that works to slowly dissolve gallstones made of cholesterol and is generally used for people in which surgery could be too risky. Lithotripsy is a procedure in which small, non-calcified gallstones are broken down by ultrasound shock waves. Endoscopic sphincterotomy is used to remove gallstones blocking the common bile duct. This is a procedure in which a doctor places an endoscope(flexible viewing tube) down the esophogus into the small intestine. Then the opening between the common bile duct and small intestine is widened, and the stones are removed with a small basket. Endoscopic sphincterotomy has a high success rate, but this technique cannot remove gallstones in the gallbladder.

It is important to note that gallstones return in 30%-50% of people who used nonsurgical treatment, and some people often remove the gallbladder at a later date.

Before Surgery

If you opt to have gallbladder surgery, there are a few ways to prepare before the day of the procedure. Your doctor will instruct you when to stop taking ibuprofen and aspirin (usually a week before). Your doctor may also decide to draw and test your blood. Just before surgery, your doctor will instruct you when to stop consuming food and liquids. The night before the procedure, the doctor may suggest taking a sleeping pill.

On the day of surgery the doctor may perform a series of tests before operating. This includes taking your vital signs (i.e. temperature, blood pressure, breathing rate) blood tests, and chest x-rays.

During Surgery

There are two ways to perform gallstone surgery: by Open Cholecystectomy and Laparoscopic Cholecystectomy. An Open Cholecystectomy is a method in which a large incision is made under the right rib cage. This surgery can take 1-2 hours, and the patient stays in the hospital for two days to a week. The Laparoscopic Cholecystectomy , also known as the "band-aid surgery", makes four small incisions: one below the navel, two in the abdomen, and one just below the center of the rib cage. A laparascope (small lighted camera) is inserted through one incision, while surgical tools are placed in the remaining incisions to remove the stones. This procedure can also take 1-2 hours, but the hospital stay can be less than a day.

General anesthesia is used to keep the patient completely unconscious during the operation. The heart rate, pulse, and level of liquids is closely monitored as well.

After Surgery

Immediately after the operation, a thin rubber tube may be attached to the side of the abdomen to drain the bile. You may also have a catheter inserted into the bladder to drain urine. The incisions will be bandaged to keep the area(s) clean and prevent infection. Your doctor will also monitor your need for oxygen. You will be able to eat once your doctor can hear bowel sounds through a stethoscope. Usually you will start with liquids and soft food.

Some medications given include:

• Pain medication - via IV, shot, or orally
• Antibiotics - to prevent bacterial infection
• Stool softeners - help make bowel movements softer
• Anti-nausea medicine - helps to calm the stomach and control vomiting.

You should be able to resume your normal lifestyle within a few days to a few weeks after the surgery.

There is always a risk of gallbladder surgery complications that can occur during or after surgery. Complications during surgery can include:

• Internal bleeding and/or infection
• Blood clotting
• Bile leakage from the liver or duct
• Injury to the common bile duct or nearby organs.
• Risk of general anesthesia.

Complications after surgery may include:

• Redness, swelling, and pain that gets worse
  
• Dizziness
• Chest pain
• Nausea and vomiting
• Shortness of breath
• Jaundice

If you experience any of the above, contact your doctor immediately.

You can help lower the risk of complications after surgery by taking your medication as directed, resting, cleaning the incisions with soap and water, use a heating pad over the incisions, and following a diet the doctor recommends.

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