Prof. Dr. Taner YİĞİT
General Surgeon
×
The gallbladder is an organ where bile, synthesized and secreted by the liver, is stored and concentrated before draining into the duodenum during fasting. The bile stored in the gallbladder is transferred first to the common bile duct and then to the duodenum as a result of the gallbladder contracting when needed.
Bile plays an important role in the digestion and absorption of fats and fat-soluble vitamins taken with food, helps regulate cholesterol levels in the body by excreting cholesterol into the bile fluid, and also ensures the excretion of the golden-yellow substance called bilirubin, which is formed as a result of blood destruction, from the body with feces. An adult synthesizes an average of 400-800 cc of bile per day.
Sometimes, gallstones can occur in the gallbladder, depending on the properties of the bile and the status of bile flow. These formed stones can irritate the gallbladder wall over time, causing cholecystitis, characterized by abdominal pain, nausea, vomiting, and fever.
Furthermore, gallstones, especially those of small size, can drop into the common bile duct, causing a decrease or cessation of bile flow to the intestine. In this case, a condition called obstructive jaundice occurs, characterized by yellowing of the skin and the whites of the eyes, itching, dark urine color, and light-colored feces. Some of the rare pathologies that can occur in the gallbladder are gallbladder polyps and gallbladder cancers.
In summary, certain pathologies that can occur in the gallbladder are:
Gallstones
Cholecystitis (gallbladder inflammation)
Obstructive jaundice
Gallbladder polyp
Gallbladder cancer
General signs and symptoms in gallbladder pathologies include:
Abdominal pain
More pronounced especially after meals
Mistaken for stomach ache
Under the right rib cage
More intense on the right side of the back
Nausea
Vomiting
Fever
Signs of obstructive jaundice
Itching
Yellowing of the skin
Yellowing of the eye whites
Darkening of the urine color
Lightening and whitening of the stool color (colorless stool, acholic stool)
Who is eligible for surgery?
Surgical treatment comes into question when one of the gallbladder diseases mentioned above occurs.
Gallstones may not always cause signs and symptoms, and can be diagnosed incidentally during an abdominal ultrasonography performed for another reason. Regardless of whether they cause signs and symptoms, gallstones should be treated with surgery from the moment they are diagnosed. The reason for this is the potential for gallstones to cause gallbladder inflammation and obstructive jaundice at any moment.
In gallbladder inflammations (cholecystitis), surgery should be planned as much as possible after the inflammation has been brought under control. If the inflammation cannot be controlled, surgical treatment may be considered under emergency conditions.
In gallbladder polyps, surgical treatment is planned in relation to the size and number of the polyp(s). Single polyps larger than 1 cm should be treated with surgery due to the high risk of cancer development.
Single polyps between 0.5-1 cm in size can be monitored under follow-up or treated with surgery, depending on many variables such as the surgeon’s experience, the patient’s general health status, and whether the patient can attend regular check-ups. Single polyps smaller than 0.5 cm should be monitored if there is no clinical or laboratory data suggesting cancer. Multiple polyps should be treated surgically regardless of their size.
In gallbladder cancers, surgical treatment planning should be done without delay.
In gallbladder surgeries, the entire gallbladder is removed, regardless of the underlying pathology. Procedures such as only removing the stone from the gallbladder or partial removal of the gallbladder are not performed during surgery.
Furthermore, unlike kidney stones, there is no treatment method involving stone fragmentation (lithotripsy) for gallstones. The reason for this is that fragmented and broken stones can drop from the gallbladder into the common bile duct and cause obstructive jaundice.
What preparations are required before surgery?
A good and complete patient evaluation before surgery is a prerequisite for a safe operation.
The first step planned for this purpose is a detailed patient-doctor consultation. After this consultation, your doctor will have:
Obtained your physical data (height, weight, BMI, etc.),
Learned your expectations from the surgery,
Learned the physical damage caused by your gallbladder complaints,
Understood what other co-morbidities you have besides the gallbladder disease,
Decided whether you can comply with certain rules and lifestyle changes that will be requested after the surgery,
Reached a position to make a comment about your general health status.
The next stage is to conduct a detailed pre-operative evaluation in the hospital.
At this stage:
Detailed blood tests,
Abdominal ultrasonography,
Gastric endoscopy (if needed),
Chest X-ray,
Pulmonary function tests (if needed),
Doppler ultrasonography of your vessels (if suspicion exists),
ECG, Echocardiography tests (if needed),
Cardiologist examination (if needed),
Internal medicine specialist examination,
Anesthesiologist evaluation is performed to assess whether you are suitable for a safe operation.
Our team will contact you shortly regarding your appointment details.
How is it done?
Thanks to modern surgical methods, these operations are now routinely performed with laparoscopic surgery. In laparoscopic surgery, your abdomen is not opened to reach the operation site. Your abdomen is inflated with $\text{CO}_2$ gas, and 4-6 tubes called trocars of various diameters (5mm, 10mm, 12mm, and 15mm, varying according to the type of surgery and the surgeon’s preference) are placed into your abdominal wall. Surgical instruments are passed through these to reach the organs where the operation will be performed, and your surgery is carried out.
Although laparoscopy is the most frequently used method as a routine procedure today, robotic surgery is also an alternative surgical method.
Rarely, these operations may be performed with open surgery. Open surgery is generally a method that can be applied after any problems that may arise during laparoscopy or robotic surgery. It should be kept in mind that every closed method (Laparoscopic or Robotic) has a certain potential to be converted to open surgery.
What preparations are required before hospital admission?
Since your surgery is a surgical procedure to be performed on the digestive system;
Generally, it is useful to start consuming liquid food 1 day before the surgery, so that your intestines are empty during the operation and your need to use the toilet is delayed and easier afterward.
If you are using blood-thinning medications, you must warn your doctor about this and give your doctor time to stop these medications and start alternative ones instead.
It is safe to continue using the routine medications you must take, except for blood thinners, until the night before the surgery. Blood pressure medication and heart medication can be taken on the morning of the surgery with a small amount of water, at least 2 hours before the operation, with your doctor’s knowledge.
If you smoke, it is absolutely necessary to quit smoking at least 1 week before the surgery or reduce it to the lowest possible level. This is a situation that will directly affect your lung performance after the surgery.
Generally, you should stop all solid or liquid food intake around 10-11 PM the night before the surgery, and you should be ready with at least 6 hours of fasting on the morning of the surgery.
Take a bath at home before being admitted to the hospital for the surgery. Remember that you will not have the opportunity to bathe for at least 2 or 3 days.
Do not wear nylon underwear when coming to the hospital. Nylon underwear can interact with some electrical devices used during surgery and cause skin burns.
It is useful to bring slippers, personal hygiene supplies (toothbrush, toothpaste, shaving kit, etc.), and sufficient underwear when coming to the hospital.
How long will I stay in the hospital?
Although your hospital stay is affected by many factors such as whether you were admitted the night before the surgery or on the morning of the surgery, how long your surgeon makes it a principle to keep the patient in the hospital after the surgery, and whether a surgical problem has developed after the surgery, it is generally about 1-2 nights.
What will happen during my stay in the hospital?
If you were admitted to the hospital the night before the surgery, you should use a protective blood thinner in the hospital. If you are admitted on the morning of the surgery, you should use it at home. This treatment will be planned and administered by your doctor. Be sure to use the toilet before going down to the operating room on the morning of the surgery. The time between being taken from your bed for the surgery and returning to your bed will generally be a time frame of about 2-3 hours, although this varies depending on the surgery to be performed.
This entire period is not the time spent on the surgery; the pre-operative preparation period in the operating room, your surgery, and your awakening procedure after the surgery are included in this process. You will mostly be taken back to your bed on the floor after the surgery, and generally, intensive care is not needed after the surgery. The process in the days following the surgery is as follows:
Day of Surgery: Approximately 4-5 hours after returning to your bed, you are encouraged to get up for your first walk and take a small walk inside the room. All your treatments on the day of surgery are administered intravenously, and food intake is not permitted.
1st Day After Surgery: This is the day you start drinking water sip by sip, seedless soups, and fruit juices. We encourage you to increase the amount of walking during the day and have a more active day. If you do not have a surgical complication by the end of this day and your surgery was performed laparoscopically, your discharge may be planned according to your surgeon’s preference.
2nd Day After Surgery: If you were not discharged on the 1st day after surgery, today you will be asked to increase the quantity and variety of your food intake to a certain extent and spend the day more actively. If it is believed that you do not have a surgical problem by the end of the day, you are usually discharged from the hospital towards the end of this day.
When can I start my normal life?
Your return to normal life is highly dependent on the job you do. If you work a desk job, you will be able to perform your job for short periods 2-3 days after being discharged from the hospital. However, the standard rest period for this job group is about 7 days. If you work a job that requires physical labor, you can rest for a period of 10-12 days and then return to work.
What will my control and follow-up process be like?
After being discharged from the hospital, you will be advised to follow a diet program that can be called a gallbladder diet for a certain period, and then transition to normal nutrition. The content and duration of this post-operative diet will be conveyed to you in detail by our expert dietitians. In non-cancerous gallbladder surgeries, you do not need periodic control examinations unless you have complaints after the surgery.
Our team will contact you shortly regarding your appointment details.