Gallbladder anatomy and physiology
The gallbladder is a pear shaped organ which is situated on the undersurface of the liver. It is connected to the liver above and the intestine below by a system of ducts which transport bile between these organs. Fresh bile for digestion of food is produced by the liver continuously which flows down this duct and enters the gallbladder. This bile is stored here for a while and is concentrated by absorption of water and is released into the intestine upon ingestion of food. The bile then enters the intestine and mixes with the food and helps in the process of digestion.
How are gallbladder stones formed?
Gallstones are mostly formed of cholesterol and this condition occurs when the concentration of cholesterol in the bile increases. This can happen as a result of high fat diet, obesity, hormonal changes of pregnancy, prolonged fasting and rapid weight loss. Some stones are formed of pigment and they occur in patients having infection if the gallbladder or blood disorders which cause increased pigment production in the bile.
Symptoms of gallbladder stones
When stones form inside the gallbladder, the flow of bile from and into the gallbladder is blocked. This leads to symptoms of indigestion, bloating and intolerance of fatty foods. When the stones block the opening of gallbladder completely, the gallbladder swells up and the person experiences a severe pain which can radiate to the back or shoulder. This may be accompanied by vomiting or fever. If the stone slips back inside the gallbladder, the bile flow is restored and the swelling subsides. In case the blockage continues, the swelling increases and sometimes the gallbladder may get filled with mucous. If this mucous becomes infected, then pus can also form inside the gallbladder. In very severe cases, the wall of the gallbladder may develop a hole and then the infection can spread to other parts of the abdomen. In case the stone slips past the gallbladder into the main bile duct, the flow of bile from the liver can be blocked and the person can develop jaundice. In case the stone blocks the lower part of the duct, the opening of pancreas also gets blocked and there might be swelling of the pancreas.
Gallbladder stones diagnosis
The diagnosis of gallbladder stones is confirmed with the help of an ultrasound of the abdomen. The ultrasound can tell about the size, number and location of stones and whether there is any swelling in the gallbladder or the liver. The treatment of gallbladder stones requires surgical removal of gallbladder from the body. This can be done by open surgery or laparoscopy. The advantage of laparoscopy is that the same operation can be performed without any major cuts or scar marks. Removal of the stones alone is not recommended as they will form again in the gallbladder and can cause problems in the future.
Surgery for gallbladder stones
During this surgery, the duct going into the gallbladder is blocked by surgical clips and then the gallbladder is divided and extracted outside from the body. After the procedure, the bile formed in the liver goes directly into the intestine without taking the route via the gallbladder. This means that the digestion of food occurs normally and is not affected by this surgery. The surgery is carried out under general anaesthesia and normally is performed with 30-40 minutes. The patient is discharged the very next day and can do their routine activities within 2-3 days.
Gallbladder surgery diet
The patient is allowed a soft diet the day following the gallbladder surgery and this diet is continued for 3-4 days. They are asked to take plenty of fluids to maintain hydration and fibre to avoid constipation. They can take a normal diet subsequently but should avoid deep fried and spicy foods for the next 10-15 days. They should avoid heavy meals and take small frequent meals to allow the body to adapt to the new physiology in the first 2-3 months following the surgery.
Gallbladder surgery cost in India
The cost of this surgery varies between 40000-70000 INR depending upon the hospital and the operating surgeon. Most of the cases are operated by the laparoscopic approach but the open surgery may be done in cases of complications like gallbladder perforation and dense adhesions. The cost of the surgery may also increase in complicated cases.
Gallbladder stone surgery in Covid-19 era
Surgery can be safely performed in Covid-19 era by taking due precautions. All patients are tested for Covid-19 before the procedure and if their report is negative, they can proceed for surgery as planned. The surgeon and the operating team don PPE suits during the procedure and barrier nursing is done in the post operative period to avoid infection. The patient is advised to maintain social distancing during convalescence as a safety precaution.