Treatments and Surgical Options for Gallbladder Disease

Open Surgery 

With open surgery, your surgeon makes a long abdominal cut/incision to reach your gallbladder. The incision must be large enough for your surgeon to fit his or her hands and surgical instruments inside your body. The open incision allows doctors to see and touch your organs while operating. For most benign (non-cancer) gallbladder disease, open surgery is considered a rescue option that can be used to keep you safe if an emergency occurs.

Minimally Invasive Surgery 

The goal of minimally invasive surgery is to reduce your pain, hospital stay and recovery time. However, people who are obese or have a severe infection or inflammation in the gallbladder may not be candidates for minimally invasive surgery. 

• Traditional Laparoscopic Surgery: With laparoscopic surgery, your surgeon operates through a few small incisions. Long-handled instruments are inserted through the incisions. One of the instruments is a laparoscope – a thin, lighted tube with a tiny camera at the end. The camera takes images inside your body and sends them to a video monitor to guide doctors as they operate. 
• Robotic Surgery: Using the da Vinci® Surgical System, your surgeon makes a few small incisions – similar to traditional laparoscopy. The robotic surgical system translates your surgeon’s hand movements into smaller, more precise movements of tiny instruments inside your body. This tool is often beneficial for performing complex surgery. The robot has no autonomy and moves only as directed by your surgeon. 

While gallstones are often found during tests for other health conditions, some common tests for finding gallstones and gallbladder disease are: 

• Ultrasound: A technician glides a hand-held device over your stomach. The device sends sound waves to your gallbladder. The sound waves bounce off your gallbladder, liver, and other organs. The echoes make electrical impulses that create a picture of your gallbladder on a video monitor. If you have gallstones, the sound waves will also bounce off the stones and show their location. 
• Computerized tomography (CT) scan: An X-ray produces cross-section images of the abdomen. Your doctor reviews the images to gain a better understanding of your anatomy. This is typically less good at identifying gallstones, but offers an improved understanding of the surrounding anatomy. 
• Cholescintigraphy (HIDA scan): A radioactive chemical or tracer is injected into a vein in your arm. This tracer is taken up by your liver and excreted into your bile ducts, allowing a functional evaluation of your gallbladder (whether it fills and empties normally). 
• Endoscopic retrograde cholangiopancreatography (ERCP): During ERCP, a thin tube with a camera at the end is inserted down your throat and into the first part of your small intestine where your bile duct empties. This can be used for diagnostic purposes, but is most commonly used when stones are known to be stuck in the bile duct and require removal. 
• Blood tests: Blood tests may be performed to look for infection, obstruction, pancreatitis, or jaundice. 

Non-operative options for managing gallbladder disease typically focus on reducing the frequency and severity of attacks by avoiding triggers and sometimes by taking medications that will help your body slowly dissolve stones. If avoiding surgery is a priority for you, you may discuss these options in more detail with your surgeon. 

Main Causes 

Your gallbladder may cause symptoms if something blocks the flow of bile through your cystic duct. The most common cause of a blockage is a gallstone. Doctors believe stones form when bile has too much cholesterol or not enough bile salts. Stones can also form if the gallbladder does not empty correctly.  

Other Causes & Risk Factors 

There are other common causes for gallstones, including: 

• Gender: Women are twice as likely as men to have gallstones. Extra estrogen from pregnancy, hormone replacement therapy, or birth control pills may raise cholesterol levels in bile and decrease gallbladder movement. 
• Genetics: Gallstones often run in families. 
• Weight: Even being slightly overweight raises your risk for gallstones. Obesity is a major risk factor for gallstones. 
• Diet: A diet high in fat and cholesterol and low in fiber can cause gallstones to form. 
• Rapid weight loss: Rapid weight loss, fasting and “crash” dieting can cause your liver to release extra cholesterol, which can cause gallstones. 
• Age: People over age 60 are more likely to develop gallstones. 
• Ethnicity: Native Americans and Latino men have higher rates of gallstones. 
• Cholesterol-lowering drugs: Drugs that lower your cholesterol levels can increase the amount of cholesterol secreted into bile, which increases the risk of gallstones. 
• Diabetes: People with diabetes often have high levels of fatty acids called triglycerides. These fatty acids may increase the risk of gallstones. 

The cause of pigment gallstones is not fully understood. These stones tend to form in people who have liver cirrhosis (scarring of the liver), biliary tract infections, or hereditary blood disorders where the liver makes too much bilirubin (a waste product).

Signs and symptoms of gallbladder disease are often caused by gallstones that block your bile ducts.  

Gallbladder symptoms are sometimes called “gallbladder attacks” because they can occur without warning. Gallbladder attacks often happen at night or after a high-fat meal, as fats trigger contraction of the gallbladder. 

Common Symptoms 

• Sharp and cramping pain in the upper right side of your stomach 
• Pain increases quickly and generally lasts 30 minutes to several hours 
• Pain can be very intense 
• Pain can radiate to your back or right shoulder
• Nausea and vomiting are also common with gallbladder attacks

If your symptoms fail to resolve or include a fever, see a doctor immediately. An attack often goes away as the gallbladder decompresses, but your gallbladder can become infected and rupture if it remains completely blocked.  

Severe Symptoms 

See a doctor immediately if you have any of the following symptoms: 

• Pain that lasts more than 4 hours 
• Vomiting that prevents you from eating or drinking
• Chills or fever 
• Yellowish discoloration of the skin or whites of the eyes 
• Clay-colored stools 

Asymptomatic Stones 

Only about a third of people with gallstones have symptoms from them. If you have gallstones but no symptoms, these gallstones are called “asymptomatic stones”. They do not affect how your gallbladder, liver, or pancreas works.

Your gallbladder is a small pear-shaped organ under your liver. Your gallbladder acts as a storage tank for bile. Bile, also known as gall, is a fluid made by your liver to help digest fat. As your stomach and intestines digest food, your gallbladder releases bile through the common bile duct. The gallbladder, liver, and bile ducts together are referred to as the hepatobiliary system.  

You can live without your gallbladder. Bile will still be produced in your liver and delivered via bile ducts to your small intestine. Removal does reduce the amount of bile that you can deliver at one time, which means you may experience some increased difficulty digesting fats. Most people post-gallbladder removal do not experience enough difficulty that they need to change their diet.