GALL BLADDER AND GALL BLADDER SURGERY
Gall bladder is a small sac situated under the liver on the right side of the rib cage. It stores bile, produced by the liver and releases the bile into the intestine from time to time for digestion of fat. The bile drains into the intestine via tube called bile duct.
Is gall bladder essential for life:
No. One can live a normal life without the gall bladder. The only difference is that bile instead of going into the intestine only when fat is eaten; is released continuously as it is produced.
Why does gall bladder need to be removed:
- When it gets infected, it causes severe pain on the right side of belly particularly on eating fried and fatty food,
- When there are stones in the gall bladder, it is no use and causes pain and complications
- Rarely can have cancer of the gall bladder
Nearly 1: 5 ladies and 1:3 men develop gallstones before the age of 75 years.
Some people have a single large stone, while others can have multiple small ones. I have removed 210 stones in one patient.Concentration of cholesterol in the bile results in formation of stones.
- These stones cause inflammation of gall bladder (cholecystitis)
- Small stone can slips down the bile duct and cause blockage to flow of bile, which results in jaundice
- The stone can go into the small intestine and cause blockage of the intestine (gall stone ileus)
Any form of complications add on to the problems, which need to be sorted before the gall bladder is removed e.g if the stones blocks the bile duct and causes, it needs to be removed by a procedure called ercp which involves a telescope being passed via the gullet into the small intestine, cutting the lower end of bile duct (sphincterotomy)to make it wider and allow the stone to come out. Unfortunately every surgical procedure carries a risk of some complications.
How to know if you have gall stones:
Symptoms of pain in the right side of the belly, which may be associated with nausea, vomiting, radiation to the right shoulder and or back and indigestion usually force you to seek help either in the hospital or through your gp.
The best test to diagnosed gall stones is an ultrasound scan.
What should i do if i have gall stones:
- Some doctors would suggest that if you do not have any symptoms relating to your gallstones, why bother doing anything.
- I would agree with this opinion only if the patient is very elderly or the risk of anaesthesia is significantly higher than the benefit of the operation.
I believe it is safer to have the gall bladder with the stones removed by a key hole surgery, rather than wait till one of the complications makes it an emergency problem/ operation which not only prolongs the recovery but also increases the chances of post-operative problems.
However there are surgeons who advise that gallstones, which are not causing any problem, could be left alone. My argument is if they are not causing, why did a patient have an ultrasound scan. This could have been done for some other problem. If the other problem when treated can sort the pain out, it is reasonable to assume that was the cause of the pain, but if it does not, there is no way to prove that gall stones are not the cause of the symptoms. Considering the complications, although uncommon, i would rather have my gall bladder with stones removed before any complication sets in rather than wait for the problem to get worse , as no one can tell who is likely to get the complication and when.
If left alone the gall stones can cause repeated attacks of pain (cholecystitis) usually needing urgent hospitalisation, or jaundice due to a slipped stone which goes and blocks the bile duct (necessitating ercp and sphinterotomy, with its possible complications ) or a stone gets into the intestine because of a fusion of the gall bladder with the small intestine and perforating through the gall bladder wall (fistula). This leads to a condition called gallstone ileus, which forces an emergency operation with a rather large cut in the belly.