There are a myriad of diseases that could affect the gallbladder as well as the biliary tree such as gallbladder cancer, gallbladder stones, biliary strictures and stenosis, calcification within the gallbladder and biliary structures as well as congenital abnormalities associated with the gallbladder and the biliary tree such as biliary atresia.

The main goal of gallbladder surgery is the restoration of a normal anatomy and physiology of the body organ and removing any pathologies that may be causing the patient any clinical symptoms such as pain in the case of gallstones and incomplete digestion of fats in the case of stenosis of the ducts emptying the gallbladder.

Indications for cholecystectomy

• Those with the clinical signs and symptoms of gallstones (cholelithiasis).
• Gallbladder inflammation in the case of infections (cholecystitis) is an indication for cholecystectomy.
• If one is to undergo bariatric surgery in the case of obesity, cholecystectomy could also be done.
• Those suffering from congenital hemolytic anemia should also be strongly considered for the surgery as they are at increased risk for the complications associated with gallstones.

The major surgical operation is cholecystectomy which involves the removal of the gallbladder itself. A History of gallstones should be confirmed using radiological investigations such as the ultrasound and before surgery is indicated. In addition to this, since about 80% of the people with gallstones are asymptomatic, surgery is only strongly indicated to those who develop symptoms of the gallstones and or the associated complications.

Risks

Because the bile acids are used to breakdown fats in a way that can be easily absorbed by the body, the patient’s body will take a while to get accustomed to the new mode of fat digestion without involving the gallbladder production of bile salts. Drugs prescribed could assist this fat breakdown.

How you prepare for the surgery

The patient’s fitness for the surgical procedure is assessed first. The patient should be prepared for this. In the case of an acute attack of the symptoms associated with the gallstones, the cholecystectomy should be immediate with a duration of about 5 days for one to undergo the surgery, but if chronic the patient should wait for about 6-8 weeks for the inflammation to subside before they are booked for surgery.

• The patient should take prophylactic antibiotics before the surgery.
• Blood profile of the patient is done- this includes a full hemogram, liver function tests, and renal function tests.
• The ultrasound scans or other radiological investigations that have already been carried out should be brought to the surgeon in charge of the operation before the operation for analysis.
• Consent is mandatory before any procedure. The patient should be made aware of the risks and the benefits of cholecystectomy and left to decide then sign after they’ve fully understood everything.

Recovery after surgery

Surgery is usually done outpatient, and patients can go home the same day of surgery. The average healing time is about 6-8 weeks, where the patients can comfortably go back to their normal routine and work.

You can resume your normal diet immediately but adhere to the instructions given by the health practitioners regarding dieting. You should start with small frequent meals and scale up gradually. It should be a balanced diet but avoid taking fatty foods as your body is getting accustomed to the new way of digesting fat. Plenty of water intake should accompany the healthy diet.

Thromboprophylaxis is done using blood thinners during the recovery period. The patient is also advised to take brief walks frequently to prevent blood clot formation.

Outcomes after surgery

Post-cholecystectomy syndrome: Rarely, in about 15% of the patients, the clinical signs and symptoms that were the key indications for the cholecystectomy don’t go away. It could be a result of the presence of other unidentified stones in the biliary tree, surgical damage to the biliary tree or just a continuation of the symptoms and should be investigated further.