Hey, my name is Buck Parker. I am a board certified general surgeon.
In this little video, I wanna talk about the gallbladder. The problems that the gallbladder causes. Don’t mind the unmade bed back there. This is just a call room somebody slept in last night.
Anyway, so a lot of patients have gallbladder disease. And they need gallbladder surgery, but they don’t know what exactly that means, what the gallbladder does, why they need surgery, why they have a problem, all that stuff. So I wanna go over that in this video.
So a little anatomy lesson first, okay? So let me get a little closer. Here we go. Now, not to scale. This is the liver, the esophagus, stomach, first part of the small bowel. This is the gallbladder, and these are what we call the bile tubes or the bile ducts, okay? So liver makes bile all the time, and it trickles down these tubes here. There’s actually a little valve right there before it goes into the small bowel. That valve is closed most of the time or when you’re not eating, okay? And then the valve…The bile will back up into these- the tubes. And it will drop into the gallbladder, okay? The gallbladder then stores and concentrates the bile for when you do eat. It squeezes a little muscular bag. Squeezes out. Squeezes the bile out. The valve opens. The bile goes into the small bowel. It mixes with the food. It rests in your stomach, and it helps you digest your food. Mostly the fatty portions of the foods, okay? The pancreas, now, lives right here. This is the little pancreatic duct, which sometimes meets with the bile duct. And every once in a while, you can have the gall stones, which I’ll show you in a little bit, can cause pancreatitis or inflammation of the pancreas, okay?
So I’m gonna draw the little gall stones in here, and…
So what happens is the gallbladder concentrates the bile, okay? Sometimes it concentrates it so much that it becomes a solid, and the solids turn into stones. And then you have these little stones here. Now what happens is when the gallbladder then squeezes, it shoots the stone out. And then it can get stuck, okay?
Then they get stuck anywhere along this little thing here.
They can get stuck here, which we call the gallbladder neck. The common bile duct and the main bile duct. Here anywhere along the main bile duct, and they often get stuck at the little valve. The little sphincter there. It gets stuck right there. Okay, so when they get stuck in there, then the gallbladder squeezes to try and shoot the stone out. And that’s when you have pain, okay? So people get- They say, “Oh my God.” They get a lot of pain right up in here, and they go, “Oh my God. I’m having a lot of pain.” It’s maybe sometimes right under the breast bone there. Mostly in the right upper quadrant, we call. And then sometimes it radiates around to the back. Okay, so that’s (indistinct).
So what we do for that, okay? Is we just take this gallbladder out.
So this, all this portion, we take the whole thing out. And how we do that is, most of the time, just laparoscopically. And these days, you’re gonna see this little thing here. There’s the belly button, the ribcage, and the groin crease, okay?
What we do is make a little incision, which is about 1.5 millimeters or 1.5 centimeters, sorry. I’m gonna show you this in a second.
So we make an incision here, okay? 1.5 centimeters. Five millimeters here, five millimeters here, and five millimeters here. This is the right side, this is the left side, okay? And this is the belly button. Right above the belly button. We put a camera in here, okay? And the gallbladder lives up here somewhere. Gallbladder lives up there, and then we put small instruments in, okay? This is my…These are my awesome drawing for small instruments like this.
We get the gallbladder. We remove it, okay? Put it in a little baggie and take it out through your belly button.
So that’s the…That’s what’s called the laparoscopic cholecystectomy, and that’s what you’ll get if you have a gallbladder problem with the stones.
Now there’s lots of different problems that can happen with the gallbladder. Some of them are- include infection, and some of them do not include infection. So there’s a continuum, okay? One side, you have, basically, the stones. They- You form the stones, and they get stuck every once in a while. You have some pain, but then this completely goes away. That’s called biliary colic, and that can cause you problems. Can cause you a lot of pain or can cause you a minor amount of pain. Some people actually think it’s gas pain, and it comes back again and again. That’s pretty common, and that can cause…That can just go away on its own.
About 20% of the population in the United States have gall stones, and only about 20% of those patients that have gall stones need a gallbladder surgery. So not everybody…Just because you have gall stones doesn’t mean you have to have laparoscopic cholecystectomy.
Now on the way through to the continuum, over here is some pain every once in a while. Stone gets stuck, but then it goes away. And we have over here where stone gets stuck. It stays stuck. You have lots of pain. The gallbladder swells up so bad because the stone is stuck, and you get an infection. And you have sepsis and all that good stuff. In the middle, there’s most of you. So a lot of people just have biliary colic. They have a little bit of pain. They may come to the hospital for that pain. The pain goes away. Usually, if it’s severe enough, we recommend you have your gallbladder out. Most of the time you should probably have it out because once it happens one time, it’s probably gonna happen again. And you can have complications from that, which is pancreatitis, which is normal. Can be a serious complication.
The other complication from just gall stones is having infections, so that’s where we start putting you along the continuum. So if we have…the gall stone gets stuck long enough, then you can develop an infection in the gallbladder. And then you have what we call acute cholecystitis. We have biliary colic and acute cholecystitis. The biliary colic actually can happen over and over over a lot of years. Maybe a little infection here and there. It’s not that big of a deal. It goes away on its own. That will…Some we call chronic cholecystitis, so it’s not really infected with the bacteria. And you have fevers and chills and all that good stuff. But it’s over and over. You have this chronic process going on, so we have biliary colic, chronic cholecystitis, and then acute cholecystitis. And you got acute cholecystitis, then you need antibiotics to take care of the infection. And then you’ll need the gallbladder out as soon as possible.
And then if you keep going on that continuum, we have what we call gangrenous cholecystitis, which is where the gallbladder starts to die, okay? And you can imagine if any of your organs start to die, that’s bad news. So that’s when you’re really sick, your gallbladder starts to die. You need infection, and you need emergent surgery for that. So that’s our continuum of gallbladder disease.
So the post-operative course for a routine laparoscopic cholecystectomy or a laparoscopic removal of the gallbladder would be, generally, you stay in the hospital. Actually, some folks do it as outpatient basis. You come in the morning, you have a surgery, then you go home in the afternoon. That would be for a biliary colic or maybe a chronic cholecystitis such that it’s not actively causing you problems.
The acute cholecystitis, generally, we see patients come in. They have some pain. Maybe their white blood count is up, which is a measure of infection. They have fevers. We give them antibiotics. We do the operations as soon as we can. And, generally, those folks stay in the hospital for about 24 to 48 hours, depending on their pain and all that. Or their post-op. Of course, some patients need a little bit more time because of the anesthesia causing some nausea and vomiting. Sometimes the pain is a little bit more in those folks, so they may stay a little bit longer.
But, generally, I would say on the average, about 24 hours in the hospital.
After the surgery, or when you can go back to work or school and all that good stuff. It depends with the person and the surgery and the disease, so biliary colic, you probably can go back to work. Maybe get it done on a Friday, and then go back to work on a Monday. And acute cholecystitis, you may not be able to do that. You may have to wait maybe five days or a week even, depending on how you feel.
So that’s the general…give you a good idea of your post-op recovery.
With the incisions that you get, you shouldn’t lift anything more than about 20 pounds for around two to four weeks, depending on who you are and what you do. If you are a smoker or you have what we call maybe some poor nutrition, then you don’t heal as well. And you should probably wait a little longer, about four weeks. If you are somebody that works lifting heavy objects all day everyday, you shouldn’t do that. You shouldn’t go back to work even if you’re in good health. You shouldn’t be lifting those things for about four weeks.
Now if it’s just you lift your kids every once in a while, maybe 20 pounds or something like that, then you can start doing that in a few…maybe a week or so after the surgery.
So I hope that’s cleared some things up for you. A lot of people ask me about…Well, a lot of people end up getting their gallbladder out or having somebody tell them they have their- they need their gallbladder out. But they don’t know what it is and why they’re getting it out, what the gallbladder does and all that.
One other thing a lot of people ask is what…”Does this change my diet? Do I have any- Do I do anything different after this and that?” The answer is, “No, not really.”
Most people have some diarrhea after surgery, but that generally clears up in about a week or two weeks. Very rarely, it can last longer. As in months, six months or something like that. It doesn’t happen very often, but it does happen every once in a while.
But as far as changing your diet after, you really don’t have to change your diet.
Now the reason most people get this in the United States is because of their diet in the first place. In the United States, it’s mostly due to cholesterol. The stones in the gallbladder are cholesterol stones, and that’s because we eat pizza and french fries and hamburgers and all the good stuff. And those cause imbalance in the bile. There’s more cholesterol in the bile, not necessarily the blood. So if you have normal cholesterol in the blood and you have gall stones, then that can happen. But the cholesterol in the bile itself ends up being more…The concentration in the bile or the cholesterol is higher than it should be. That’s why you have the stone.
So most of the time, in the United States, it’s because we like pizza too much. So if you want to avoid that, maybe you’ll avoid the pizza. But people really don’t like avoiding pizza.
Anyway, that’s my spiel on the gallbladder. I hope that helps you out a little bit, explains some things.
You know where to find me. Www.drbuckparker.com. I’ll see you later.
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