Gallbladder removal

introduction

The gallbladder is used to store and thicken the bile secretion required for fat digestion, which is produced in the liver. If there are symptoms due to gallstones (thickened bile secretions) or inflammation of the gallbladder, it may be necessary to remove them. A distinction is made between an open operation through an abdominal incision and the often preferred removal of the gallbladder using the keyhole technique (Laparoscopy). The procedure is associated with a hospital stay of several days. After the gallbladder has been removed, no major permanent restrictions are to be expected, provided that no complications occur. As with all operations, these are possible, but comparatively rare. It is important to follow the doctor's instructions and to take some time off after the operation.

Indications for gallbladder removal

A gallbladder removal may be necessary if, for example, gallstones or a gallbladder inflammation cause symptoms such as pain in the right upper abdomen, feeling of fullness or nausea. The symptoms typically occur especially after eating high-fat foods.
Often, gallstones are discovered by chance during an ultrasound scan of the abdomen. However, if there are no associated symptoms (one also speaks of asymptomatic gallstones), an operation is not indicated.
Other indications for the removal of the gallbladder arise, for example, in the event of a rupture of the organ after an accident or in the event of another injury. In addition, surgical removal is necessary for the rather rare cancers of the biliary tract or the gall bladder. Another indication for a gallbladder removal is when there is a connection duct between the gallbladder and another organ (for example the intestine). One speaks of a biliary fistula, which has to be removed with the gallbladder.

The actual operation steps are similar in both procedures.
First, the gallbladder is sought out and something is dissected freely, i.e. brought into a clearly visible position from the surrounding tissue. The artery that supplies the organ with blood is closed with a clip. The bile duct, which connects the gallbladder with the other bile ducts, is also closed in order to prevent a bile leak into the abdomen. The gallbladder can then be detached from the liver. Then the organ must be retrieved. With open surgery, the gallbladder can be removed directly. With the keyhole technique, it is packed in a small recovery bag, which can then usually be pulled out through the small incision on the navel. The individual layers of the abdominal wall are then closed in layers using sutures. The patient usually comes to a recovery room after the operation and can then be transferred back to the ward.

Find out more about the process of a laparoscopic operation here.

preparation

If gallbladder removal is planned, there are a few things that are necessary or at least useful in preparation for the operation. As a rule, a preliminary examination is carried out in advance at the hospital where the procedure is to be carried out. The appointment for the operation is usually also agreed. In your personal environment, you should tell your family and your job that you have to go to hospital for a few days and that you will not be able to bear full stress for several weeks after that. If necessary, the care of children, other relatives or pets must be organized in advance. One week before the date of the operation at the latest, you should pay particular attention to eating healthy. Sufficient exercise is also useful, but without overloading yourself. If possible, you should also get enough sleep so that the body is as relaxed as possible and can process the procedure better. Contact with people who have a gastrointestinal infection or a cold should be avoided if possible. Should you still suffer such an infection, it is important to inform the doctor about it. He will decide whether the operation can still be carried out or whether it should be postponed. Another part of preparing for a gallbladder removal is to prepare for the multi-day hospital stay in good time. This particularly includes packing items of clothing and other utensils. In addition to hygiene items such as toothbrushes and shower gel, you should think of some cash and entertainment such as something to read. When it comes to clothing, wide and comfortable trousers are particularly recommended, as the stomach can still be bloated after the operation using the keyhole technique. In addition to these recommendations, the doctor will inform you about all the steps necessary to prepare. This includes, for example, that you are not allowed to eat in advance on the day the operation takes place and you are only allowed to drink water up to two hours beforehand.

Procedure of the operation

There are basically two different surgical procedures for removing the gallbladder. General anesthesia is necessary for both. In terms of the process, the operations differ primarily in the access routes. While open surgery involves making a larger incision through the skin of the abdominal wall and the layers below it, with keyhole techniques or laparoscopic surgery, only small incisions are made and inserted through these tubes. The required surgical instruments and a camera can now be advanced through these so-called trocars. In addition, the abdominal cavity is inflated with the gas carbon dioxide so that the abdominal vault is stretched and visibility is improved. In the open procedure, however, the operating area is exposed and the surgeon can operate "directly".

Aftercare

The care after a gallbladder removal essentially includes the usual measures after an operation. This includes a brief monitoring in the recovery room until the anesthesia has subsided. In the following days, blood will be drawn to check laboratory values, such as Control inflammation levels. If there are no complications, the patient can be discharged after a few days. Special follow-up treatment is usually not necessary. If the gallbladder is removed through a structural incision, it may be necessary to remove threads or staples after about two weeks. The attending doctor at the hospital will inform you if this becomes necessary. As a rule, the removal can then also be carried out by your family doctor. Otherwise, further checks are only necessary if complaints reappear.

Risks of gallbladder removal

Like any surgery, gallbladder removal is not without risk. The procedure can injure (neighboring) organs.
Blood loss, which in extreme cases can be life-threatening or requires the transfer of blood products, is also possible. In rare cases, this can lead to infection with a disease or an allergic reaction. However, relevant blood loss is extremely rare when the gallbladder is removed, and even if blood reserves have to be transferred, the risk of infection and a rejection reaction of the blood is minimal due to multiple controls.

Find out more about blood transfusion here.

In addition, inflammation of the peritoneum or the abdominal cavity and impaired wound healing can occur. The doctor in the hospital will explain the possible risks of the procedure in detail and answer questions from the patient. In addition, sufficient reflection time is given. Overall, gallbladder removal can be classified as relatively low-risk.

Complications

The removal of the gallbladder is a very frequently performed operation, which nowadays seldom leads to complications due to routine and standardized steps. Nevertheless, problems arise in some cases, either during the procedure itself or during the healing phase. During the operation, organs such as the liver can be damaged. In addition to internal bleeding, in some cases inflammation of the peritoneum due to leaking bile secretions can occur. In the worst possible case, these complications can lead to death, which is extremely rare in the context of a gallbladder removal. Even with an initially uncomplicated course, problems can still arise if one does not take care of oneself appropriately after the procedure or if one expects too much too soon. Patients who lift heavy weights or otherwise put too much physical strain on themselves in the first four weeks after the gallbladder removal may suffer a hernia, which may have to be treated with another operation. But even with good rest, complications in the further course cannot be ruled out. A doctor should be consulted as soon as possible if the condition deteriorates significantly or if the pain recurs or increases. The family doctor can help with minor complaints. If the symptoms are pronounced, however, it is advisable to return to the hospital straight away. The two surgical methods - open through an abdominal incision and minimally invasive using a keyhole technique - do not differ significantly in terms of the frequency of possible complications.

Please also read: Pain after gallbladder surgery

What are the consequences?

As with almost any abdominal surgery, the immediate consequences of a gallbladder removal are. At first you are physically weak and you have to recover from the procedure and the anesthesia. If the course is uncomplicated, you can leave the hospital after a few days, but you should also take it easy at home for a period specified by the doctor. In particular, heavy lifting or other activities that put stress on the abdominal wall should be avoided in the initial phase in order to avoid the occurrence of a hernia. Depending on the job you are doing, it may be necessary to take it off for a while. When it comes to nutrition, you should pay attention to a low-fat diet, especially in the initial phase. In most cases, there are no long-term consequences after removal of the gallbladder. It is most likely that fatty foods are less well tolerated than at the time before the operation. In addition, small, inconspicuous scars usually remain on the abdomen. While a slightly larger scar remains in the area of ​​the abdominal incision after an open procedure, the scars after an operation with the keyhole technique are usually very small and often only noticeable on closer inspection. In addition, as after any surgical procedure, adhesions can also occur after the gallbladder has been removed. These can possibly cause pain and in some cases have to be resolved by a new operation. However, this is a rather rare consequence of gallbladder surgery.

Read more about postoperative complications in general here.

How long have you been sick?

How long you will be sick after a gallbladder removal depends on various factors. If the course is uncomplicated, you are no longer dependent on pain medication after a few days. However, you should first take it easy on your body. After about three days you can go for a walk and after two weeks light endurance sports are possible again. However, you should avoid lifting weights over seven kilograms and doing abdominal muscle training for at least four weeks. If complications arise as part of the gallbladder removal, the time one is sick can be much longer. How long you should be on sick leave also depends individually on the type of work performed and your personal well-being. Those who work in an office are more likely to return to work earlier than people who do physically strenuous work or, for example, have to lift heavily.

How long are you in the hospital?

How long you are in the hospital for a gallbladder removal depends on the one hand on the selected surgical method and on the other hand on whether there are complications or not. The hospital stay is usually shorter for an operation that is performed using the keyhole technique. Usually you are in the hospital between two and four days. If the gallbladder is removed openly, however, a stay of between six and eight days can be expected. The prerequisite for the aforementioned periods is a complication-free course, which occurs in most cases. However, if complications arise, you may be in the hospital for between ten days and two weeks. In extremely rare cases, there are more serious complications that require an even longer stay in hospital.

Can the gallbladder be removed on an outpatient basis?

A gallbladder removal can generally be performed on an outpatient basis. However, this is only offered in a very few hospitals. Both the open surgical method and the minimally invasive procedure are only possible under general anesthesia and therefore the procedure should, if possible, be combined with an inpatient hospital stay for at least two days. Even if complications rarely occur, adequate monitoring of the patient is not possible in outpatient settings. In addition, it can be very agonizing when you come home on the day of the operation and are not given good medical care.

Pain after the operation

After a gallbladder removal, there is usually temporary pain in the surgical area and around the wounds. After a minimally invasive procedure, the shoulders can also be painful, as the expansion of the abdomen during the operation can put pressure on a nerve that conveys pain from the shoulder area. Already during the operation and afterwards, the patient is given painkillers through the vein so that often no pain is felt at all. However, if you still suffer from pain after the operation and the resources administered are insufficient, you should inform one of the doctors or the nursing staff in good time. It is not advisable to try to endure the pain instead. In addition, if pain treatment begins in good time, the total dose required is rather lower. Recovery and recovery are also better and faster by relieving the pain.

Read more about pain after biliary surgery and postoperative pain therapy in general.

What restrictions do I have in my diet after the gallbladder removal?

After removing the gall bladder and recovering from two to four weeks, there are no major restrictions.The bile secretion required for fat digestion is further produced by the liver and released directly into the intestine. After the gallbladder has been removed, the only thing missing is the function of storing and thickening the secretion. It is therefore possible that very fatty food is less well tolerated than before the operation. Patients who have had their gallbladder removed occasionally complain of epigastric pain, bloating, or diarrhea after high-fat meals. It is therefore advisable to pay attention to a low-fat diet, especially in the first time after the operation. In addition, digestion can be made easier by increasing the fiber content. Distributing the food intake over several smaller meals also helps the intestine to utilize the components better.

You might also be interested in: Wholesome nutrition.