Diseases of the gallbladder and bile ducts (“biliary diseases”) are among the most common surgical diseases, with frequent occurrence at young ages. By understanding the function of the bile and the problems that may arise when it is disturbed, you can understand the need for immediate treatment by the specialist surgeon, when necessary.
What is the Bile?
Bile is a liquid that helps digest food and is produced in the liver. Through very thin tubes (biliary system), bile is collected and stored in the gallbladder, a pear-like organ located on the lower surface of the liver.
After each meal, especially when it contains enough fat, the gallbladder contracts and distributes, through a tube to which it is connected and is called the bile duct, the bile in the small intestine to mix with the fluid produced by the pancreas and create the “juice” necessary for the digestion of food.
Gallstones
The most common gallbladder condition is gallstones. When bile settles inside the gallbladder and its composition changes (due to diet), stones may form. The oversaturation of bile with cholesterol is the most important factor in gallstone formation. The disease affects women four times more frequently, while taking hormones such as contraceptive pills – oestrogens and pregnancy further increase the frequency of the disease. Obesity and a diet rich in carbohydrates and fats and low in fibre are also factors that triple the risk of gallstones. The presence of stones in the gallbladder is responsible for several pathological conditions:
- Biliary colic. Acute pain in the right upper abdomen from a stone that is temporarily blocking the outflow of the gallbladder. It usually subsides spontaneously or with simple analgesics.
- Acute cholecystitis. Inflammation of the gallbladder, usually due to an impacted stone blocking the outflow of the gallbladder, which causes severe pain in the right upper abdomen and fever. Hospitalization and surgical treatment on an emergency basis (removal of the gallbladder) are required.
- Choledocholithiasis. Entry of stones from the gallbladder into the bile duct resulting in potentially dangerous complications:
- Obstructive jaundice. A stone passed from the gallbladder into the tube that carries bile to the intestine (bile duct), leading to jaundice-yellowish discolouration of the mucous membranes, urine and stool. Hospitalization is required until jaundice subsides, after which cholecystectomy must be performed. A special MRI scan (MRCP) of the area is always performed and if the jaundice does not subside, then the patient must undergo a special endoscopic test called ERCP to clear his extrahepatic ducts from stones. Surgery must follow soon after.
- Cholangitis. Inflammation in the biliary ducts resulting in jaundice, pain and high fever. Immediate hospitalization and possibly endoscopic biliary decongestion (ERCP) are required.
- Pancreatitis. The pancreatic duct is blocked by a gallstone and inflammation of the pancreas is caused, initially manifested by severe pain and vomiting. It is a condition that can be very mild to very serious, requiring hospitalization and sometimes intensive care monitoring and management.
Symptoms of Gallstones
Very often, the condition is asymptomatic and the patient incidentally discovers its existence, usually after an abdominal ultrasound, for another reason. Occasionally, various symptoms that we usually do not pay attention to, such as indigestion, pain in the stomach area or back pain, may be due to the presence of stones in the gallbladder.
The symptoms, therefore, that gallstones can cause to a patient and should lead him immediately to the doctor are the following:
- Pain in the upper abdomen
- Nausea or vomiting
- Recurrent episodes of indigestion
and in more severe cases
- Fever
- Jaundice
It is very important, when the patient presents any of the above symptoms, to consult his doctor, so that early diagnosis and treatment can be made to prevent the progression of the condition and the development of complications.
Management of gallstones
The size of gallstones does not predict the course of the disease, as large stones can more easily obstruct the gallbladder and cause infection, while smaller stones can enter the bile ducts and cause a series of complications. A low-fat diet may reduce the likelihood of symptoms for some time, but success rates are limited and short-term. The symptoms will eventually return unless a definitive treatment is performed, which is none other than the removal of the gallbladder.
Laparoscopic Cholecystectomy
Laparoscopic cholecystectomy is a completely safe operation, depending of course on the experience and expertise of the general surgeon who undertakes it. The laparoscopic technique is completely safe and applicable even in severe inflammation of the gallbladder. During the operation the surgeon will make a cut near the umbilicus and will introduce a camera in the abdominal cavity which will be inflated with gas. Another one cut will be made in the central upper part of the abdomen (epigastrium) and one or two small cuts will be made on the right upper side. The gallbladder will be released from any attachments to nearby tissues and the cystic duct and the cystic artery will be clipped and then cut. Finally, the surgeon will separate the gallbladder from the liver.
Laparoscopic cholecystectomy is a safe procedure which is associated by:
- Minimal surgical trauma
- Minimal blood loss
- Short hospital stay.
- Fast recovery
- Rapid return to everyday life
- Minimal pain
- Minimal risk of infectious complications from the surgical wound