The gallbladder is a pear-shaped organ located in the lower part of the liver.
We can answer the question of what is the function of the gallbladder, as the bile produced by the liver flows to the duodenum through the bile ducts after the meal and helps the digestion process.
The main task of bile fluid is to ensure the absorption of fats and some vitamins in the intestine. Daily produced 0.5 – 1 lt. Most of the bile is stored in the gallbladder for later use. The water content of the bile in the pouch is absorbed and waits in a condensed form.
The amount of components that make up the bile and its fluidity are changed over time, accumulations in the form of bile becomes sludge and then gallstones.
In some cases, the possibility of stone formation in the gallbladder is high;
Since the bile secretion is stimulated by the intake of fatty foods, the nutrients taken in the diet are important.
Complaints such as pain in the upper right side of the abdomen, indigestion, bloating, heartburn and burning, and sometimes back and shoulder pain are seen in those with stones in the gallbladder, especially after fatty meals (gallstone colic).
As long as there is no inflammation, these complaints usually go away after 4-5 hours.
However, in cases where there is inflammation in the gallbladder (acute cholecystitis), the general condition of the patient begins to deteriorate. Weakness, chills, fever and severe pain on the right side of the abdomen to the back are added to the picture. Often, in this case, an emergency room visit is made.
Sometimes there are small stones in the gallbladder and these can be poured into the ducts during contractions of the gallbladder and cause obstruction.
In this case, the patient’s complaints increased much more. Abdominal pain, nausea, vomiting are much more pronounced. In cases of inflammation that spreads to the bile ducts, high fever and jaundice are added to the event and it becomes a serious situation that requires hospitalization.
In such cases, where the liver is also affected, a picture called cholangitis occurs and if not intervened early, it can have serious consequences.
Frequently, the patient’s complaints direct us about gallstones. Ultrasound and some blood tests performed after at least 6 hours of fasting are useful for understanding the gallstones in the gallbladder and its effects.
However, in some cases, when it is necessary to evaluate the condition of the liver and bile ducts, the imaging method called MRCP is used. In this way, the liver, biliary tract, gall bladder, pancreas and pancreatic duct are displayed.
Usually, when gallstones are diagnosed, the patient also has complaints. For long-standing bloating, indigestion, stomach pain and nausea, most patients suffer from stomach ulcers or gastritis.
For this reason, surgery is recommended for people with symptoms that we call symptomatic. Especially in those with very small stones called millimetric, surgery planning should be done as soon as possible because of the possibility of spilling into the biliary tract.
In diabetic patients, early surgery is recommended when gallstones are detected, since inflammation of a bladder may progress rapidly.
In cases of cholecystitis accompanied by inflammation in the gallbladder, we have two options.
In the first option, the patient is operated urgently within 24-48 hours. In this way, the gallbladder, which is the source of the inflammation, is eliminated and the progression of the inflammation to the bile ducts and other intra-abdominal areas is prevented. The most important disadvantage of this method is that sometimes there are adhesions due to inflammation and the risk of returning to open surgery because of insufficient vision for laparoscopic (closed) surgery.
The other option is to hospitalize the patient with serum and antibiotics, restrict his diet, and follow up until his general condition recovers. After the patient recovers, the planned operation time is 4 weeks later. The disadvantage of this option is that the patient may relapse during this expected 4-week period.
ERCP (Endoscopic Retrograde Cholangiopancreaticography) is the procedure to be performed if stones are detected in the bile ducts without inflammation. It is the removal of stones in the biliary tract by entering through the mouth of the bile duct in the duodenum through the mouth endoscopically. After cleaning the bile duct with this method, the patient can have gallbladder surgery.
It is removed together with the stones in the gallbladder. However, in the absence of the gallbladder, the body’s need for bile is met by the liver.
The operation is performed with the laparoscopic method (closed) through four holes opened in the abdomen. The duration is approximately 45 – 60 minutes. The hospital stay after the operation is one day.
The most feared surgery complication is the possibility of conversion to open surgery. However, although this condition is very rare, it is mostly seen in patients who have had a large number of painful attacks and inflammation.
The high probability of injury to other intra-abdominal organs due to recurrent adhesions after each attack and the troublesome laparoscopic vision are the reasons for conversion to open surgery.
In open surgery, the wound site is larger, the operation time, hospital stay and postoperative recovery period are longer.