The gallbladder is an organ of the digestive tract located in close contact with the liver, and is located a few centimeters from the confluence of the hepatic ducts that carry bile from the liver to the duodenum. It is communicated with this duct through the cystic duct, and from there, the common hepatic duct becomes known as the common bile duct.
What are its functions?
To store and concentrate the bile secreted by the liver until it is required for digestion. At that moment it produces the contraction of the wall, being more marked when the alimentary bolus is composed of fats.
Bile is a greenish-brown liquid that is in charge of emulsifying fats, in order to facilitate their digestion and absorption. On the other hand, bile collaborates in the excretion of products of hemoglobin metabolism (bilirubin), or excess cholesterol, among others.
When is it necessary to remove the gallbladder?
Normally when the bile excretion function of the gallbladder is altered, or when the bile itself is altered due to an alteration of the liver metabolism (lithogenic bile), lithiasis or stones are formed.
These can appear in the gallbladder, but also in the bile ducts. When cholelithiasis (gallstones in the gallbladder) is diagnosed, it is sometimes due to imaging scans for other reasons (asymptomatic lithiasis), and sometimes due to secondary symptoms. In the first case it is a relative indication to remove the gallbladder (cholecystectomy), in order to prevent complications. However, the absolute indications to perform it are when they originate symptoms or for subsequent complications.
Warning symptoms
Symptomatology may be poorly defined; digestive, upper abdominal floor, or florid (“biliary colic”), with acute pain in the right upper quadrant of the abdomen, which may be accompanied by nausea or vomiting. Although not always, they usually occur after ingestion, especially if the meal has been copious and with a component of animal fats.
In second place would be the complications derived from cholelithiasis. Among them, acute cholecystitis, which consists of inflammation of the gallbladder, in which pain is usually associated with febrile symptoms. In this case, the situation is urgent and, apart from antibiotic treatment, unless contraindicated, the gallbladder must be removed. When the stones are present in the bile ducts, mainly in the common bile duct, it is recommended that they be extracted by means of an endoscopic procedure called endoscopic retrograde cholangiopancreatography (ERCP), prior to cholecystectomy. Other times the stones can be one of the causes of acute pancreatitis (inflammation of the pancreas), which must initially be resolved before cholecystectomy.
Other reasons for which cholecystectomy is performed are the appearance of polyps inside the gallbladder that grow or are initially large (greater than 1 cm); suspicion of malignancy; porcelain gallbladder (calcification of the wall of the gallbladder).
How is cholecystectomy performed?
Nowadays the intervention has to be performed by means of a minimally invasive procedure, that is to say, by laparoscopy. The gallbladder is removed through small incisions in the abdominal wall under general anesthesia, after ligation of the cystic artery and duct. In very few exceptions, such as an important adherent component due to previous surgery, or the impossibility of adequately identifying the anatomical structures, it must be converted into an open procedure, but always starting from the beginning with a laparoscopic approach.
Risks of cholecystectomy
Although infrequent, like any surgical procedure, it is not free of risks. However, as long as the surgery is indicated in a timely manner, these risks will be considerably reduced. These include bleeding, collections in the excised gallbladder bed, and less commonly, bile duct lesions. With conservative non-invasive management some of them can be solved, being necessary in other occasions drainage, endoscopy or reinterventions. It is also necessary to consider those intrinsic to any abdominal surgical procedure with general anesthesia, such as infections or hernia at the wound level, pneumonias, etc.