Gallbladder Surgery

What is the most common elective surgical procedure done in the western countries? Well, Susan knows the answer. Here is her story.

During the Christmas holidays, Susan has to rush to the Emergency Department as she develops severe pain in the right upper area of the abdomen where the liver and gall bladder reside. Pain is associated with vomiting.

After history and a physical examination, the emergency physician makes a provisional diagnoses of biliary colic i.e. pain due to gallstone. Susan gets a painkiller and gravol. She settles down and is discharged home for further investigations.

The first line of investigation is ultrasound of the abdomen. This test will check for problems in the liver, gall bladder, pancreas, aorta and kidneys. It may pick up problems in the stomach. The test is not 100 percent full proof but it is a good, non-invasive, and cost effective first line of investigation. For gallstones, quite often this is the only test required.

The ultrasound confirms Susan has gallstones. She is referred to a general surgeon. For most symptomatic gallstones, the best curative treatment is surgical removal of the gall bladder – cholecystectomy.

Each year, in Medicine Hat Regional Hospital, approximately 250 gall bladders are removed. About 95 percent of them laparoscopically- through four buttonholes. Patients are admitted to the hospital on the same day. Most patients are discharged within 24 hours of surgery with minimal complications. Most patients return to work within 7 days of surgery.

Compare this to the olden days when a patient would be admitted the day before surgery, have a long scar, stay about 5 to 7 days in the hospital and have 6 weeks of recuperation. A major life disruption when you think that this is the most common elective procedure done in western countries. And gall bladders have been removed for the past 116 years!

Observations of human gallstones go back to an Egyptian priestess at Thebes, around 1500 BC. Her mummy, when given to the Royal College of Surgeons Museum in London, was seen to contain a well-preserved gall bladder with 30 stones; unfortunately it was destroyed during the German bombing of World War II, says Dr. Knut Haeger in The Illustrated History of Surgery.

There are two types of gallstones: cholesterol stones (80 percent) and pigment stones (20 percent). Most cholesterol stones are mixed in nature. They are formed when bile becomes supersaturated with cholesterol and there is precipitation of cholesterol micro-crystals. This is a simple explanation of a complicated event in cholesterol gallstone formation.

Incidental finding of gallstones require no treatment if they do not cause any symptoms. Most symptoms are related to blockage of the gall bladder or one of its ducts by a gallstone. Cholecystectomy has minimal complications rate during and after surgery. But every procedure has some risk involved and should be undertaken after careful deliberation with the surgeon.

Susan is on the waiting list to have her gall bladder removed. She does not want to experience the pain of biliary colic again. Let us wish her good luck and speedy recovery!

This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems. They believe in ELMOS!

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