Hey, what’s up you guys? My name is Buck Parker. I’m a board-certified general surgeon.
In this video, we’re gonna talk about gallbladder surgery, also called cholecystectomy or laparoscopic cholecystectomy. In my other videos, I went over why we get gallbladder disease and the symptoms and the pain and all those things. In this video, I wanna talk about specifically the surgery and, well basically, the treatment.
There’s a couple of different reasons that we do gallbladder surgery. One I’ll talk about is…Just list a couple here. And I’ll say recurrent or symptomatic biliary colic. That’s just when- That’s when you have gallstones. We got gallstones in this little gallbladder here. They get stuck in the neck of the gallbladder, the gallbladder can’t get them out or then it gets kicked out and your pain completely goes away or completely resolves. But if you get that over and over, then it could lead to other bad things such as acute cholecystitis, gangrenous cholecystitis, gangrenous pancreatitis, which I haven’t talked about yet, but we’ll talk about that later.
Recurrent or symptomatic, we’ll call it symptomatic. And there’s a reason I say symptomatic. Biliary colic. Chronic cholecystitis. Biliary colic, chronic cholecystitis is similar, but you may have some evidence of chronic cholecystitis on an ultrasound or a CAT scan or something like that. Third is acute cholecystitis, and this is an infection of the gallbladder. There’s other ones called gangrenous of course. Gangrenous real bad. Sometimes we don’t know. We can just say…Beforehand, we’ll say acute cholecystitis and then we’ll go in and say, “Oh, the gallbladder’s dead. Hello. Hello, dead gallbladder.” Cystitis.
So for these reasons, your surgeon slash doctor will recommend you have your gallbladder out. There are a couple different ways we can do gallbladder surgery. The most common one right now is called laparoscopic cholecystectomy. That means what we do…I’m gonna draw another- I’m gonna take all these, and I’m gonna put them…I’ll move them over here, actually. This is better. And I’m gonna use this.
That means what we do is. This is my little famous drawing here. This is the belly button. This is the ribcage. This is the groin crease. We make an incision, which is about 12 millimeters right here. We make another one about five millimeters. Let’s say I make it 12 millimeters, five millimeters, five millimeters, and five millimeters here. We’ll put a camera in like this. I say that because some people do a 12 here and a five here and a five here and a five here. That’s a little bit different. Different people, it’s fine. So put in a camera right here. We put small instruments in this way, the gallbladder lives about right there and we go in and we take the gallbladder out.
We see, obviously, we have a TV screen over here, which is showing us the picture of what’s inside and what we end up doing…Let’s move over to this little drawing here. We come in and we get- This is called the cystic duct right here, and we clamp or clip…Actually put a couple of clips there. Going there. And then we’ll cut the cystic duct right here, and we’ll take this, which is the gallbladder, and then put it in a little baggie. We’ll do a little baggie. We’ll pretend this is a baggie. We’ll put it in the baggie and pull it out through the incision in your belly button.
There is also an artery there. It’s called the cystic artery. Clip that as well. The gallbladder’s actually attached to the liver, so we peel the gallbladder off the liver using some electrocautery and then put it in the baggie and pull it out through your belly button.
That takes, I would say on average – because some of them are really quick like 16 minutes – and then some of them take longer, a couple of hours. On average, it’s an hour surgery. For non-complicated gallbladder disease. You have some biliary colic here and there. It’s not that inflamed, it’s not a big deal. It’ll be maybe a half an hour surgery. If it’s recurrent and it’s really bad, and it’s been 10 years. You’ve had this pain for 10 years and it’s really scarred in, it could be longer. If it’s acute, it’s infected, it’s bleeding, all that stuff, it could be longer, a couple of hours. Two, three hours. Typically, they’re not two to three hours. On average, one hour. Could be plus or minus.
The other things I’d like to talk about are potential risks of the surgery and the options, if you wanna say options, of not doing surgery. What I think you could do, and you can break them up into categories of non-infected and then infected or acute cholecystitis.
Non-infected…What are your alternatives if it’s not infected? Well, you can just do nothing essentially, and you can improve your diet. So we’ll say no surgery and it would not require antibiotics. No…I write antibiotics like that. And then diet modification. Diet modification would include things that do not stimulate the gallbladder too much, which would be fat. So dairy, fried foods, hamburger, all the fun stuff to eat, you can’t eat any of that or you’d have to minimize that. Because when you eat that stuff, then the gallbladder is stimulated to squeeze. If there’s stones in there, which I’m assuming…If it’s not infected, you have colon lithiasis, which means you have gallstones and you start eating dairy, fried foods, hamburgers, cheese, all that good stuff. And that squeezes the gallbladder, squeezes- kicks the stone out. You’re gonna have the pain. So that’s why I say this is the alternative to surgery.
If you’re infected, you could – I don’t recommend – you could just do antibiotics. That would require in-hospital antibiotics. In through the IV and wait. But the problem with this is that you still have the stones. Once the infection clears, you risk again for those stones to block the neck of the gallbladder. In fact, it may stay blocked and then you may have more problems after.
The other thing that people ask is can I have some kind of ultrasound and break up the stones. You can, but the problem is that your body makes these stones and it’s gonna continue making these stones. You break these stones up and then they’re gonna- you’re gonna make more stones. And then you’re gonna have this problem again. That’s why we usually recommend that it comes out. It’s a pretty safe operation. It’s one of the most common operations we do, especially in general surgery- Well, general surgeons. So most people do very, very well with that.
So that is, basically, your alternative to that.
The other thing I’d like to talk about is the risk of surgery ’cause everybody should know the risk with surgery. Always, there’s risk with any surgery. The number one risk with surgery are bleeding and infection. Number one and two I mean. These are probably less than 1%. Infection depends on if you have an infection already. If you don’t have an infection already, you’re less than 1%. If you do have an infection, as in you have acute cholecystitis, you’re gonna be higher. You’re gonna be, like, five to 10…Even to 20% depending on the risk of infection.
The third one is bowel injury. You can just lump that into injuring something else besides what we’re in there for. Because we’re going in there. Sometimes everything is stuck together. We have to peel things apart or whatever, and you can always injure the small bowel. The, not really the esophagus, the stomach, the small bowel, even possibly the pancreas, although unlikely. The liver and the bile ducts.
The final one we like to talk about because it’s very specific to the surgery is the bile duct injury. This is, specifically, the CBD or the common bile duct. Which is this main bile duct here. If you have that injury to that as…It’s all scarred down and you can’t tell what’s what, and it’s all stuck together and you peel the gallbladder off the stuff and all of a sudden, there’s lots of bile everywhere and the common bile duct is injured.
In all gallbladder surgeries across the United States, it is 0.05% the chance of having a bile duct injury. Of all surgeries. That means all the easy ones and all the really, really hard ones. So if you have a really bad infection or it’s been 10 years or 20 years and you’ve been having this pain, then you’re at a higher risk if you have…It’s only been a couple months, and it’s not inflamed. It’s not infected or something like that, then you’re much lower risk even than this 0.5%.
The other thing is with the bile duct injury, what ends up happening is you can no longer do this laparoscopically. You have to do it, what we call, open. Essentially – I showed you the other incisions, they were here, here, and here – we end up connecting the dots, make an incision bigger, so we go and hand sew these things back together.
That’s the biggest risk, I think, as far as altering everything else with a regular laparoscopic surgery. You’re in the hospital maybe for 24 hours or something. And this one, you’re gonna be three to five days. It could even be more. And down the road you could have other problems related to this common bile duct injury.
That’s the big one. Nobody wants to talk about that, but I definitely make sure that I let everybody know about that before their surgery. This is one of those things where you always say, “If you’re gonna play football, you’re gonna get tackled.” You’re gonna do surgery, things are gonna happen. They’re gonna be unfortunate, they’re gonna be…Complications are gonna happen. Unfortunately, they do happen. Obviously, we try our best not to do that, but that does happen sometimes.
The last thing I wanna talk about after surgery, or about the surgery, is after surgery. The recovery. What’s the deal with the recovery? Everybody wants to know when can I go home and stuff.
Recovery from cholecystectomy, laparoscopic…Let’s see, laparoscopic, is going to be 24-48 hours in the hospital. Now this is if it’s infected. If you come in, you’re sick, you’re infected. So let’s say acute. This is acute. And then you can have it done outpatient. Which means you come in the morning, you go home in the afternoon. And this is if you just have colon lithiasis. Why did I say…This is just if you have colon lithiasis and there’s no infection, things like that. So you can go home the same day.
In recovery at home, I usually tell people to stay home for a couple of days, take some pain pills, you’re probably gonna be a little bit sore. But in two to three days, you should be getting up…In two to three days, you should be feeling pretty normal. You can do things around the house. You can watch movies, you can read. You may even be able to go to the grocery store within that first two to three days, but you just gotta take it easy.
After about a week, you feel really good. You forget you had surgery until you twist the wrong way and usually that belly button incision lets you know that.
I tell people no lifting over 20 pounds for four weeks. That’s the average I tell people. So if you’re younger and you’re healthy, maybe two weeks. If you are older and you’ve had…You’re a smoke and you’ve had other complications, then maybe I might say six weeks. It depends on the patient.
The last thing is the diet. There’s no change in diet post-operatively. Diet, no change. Nobody wants to change their diet. They always wanna know, “Do I have to eat something different?” You don’t have to eat anything different.
The reason you have the gallstones is usually because you’re having too many hamburgers and stuff like that, but you’re not gonna get gallstones anymore.
Finally, people always ask me, “How do I live without my gallbladder? Can I live without my gallbladder?”
The answer is, “Yes, of course.” We do it all the time.
What ends up happening is the bile trickles down the bile tubes, in a continuous fashion and it trickles out of that sphincter. It overcomes the pressure, that sphincter, and it trickles into the small bowel. What ends up happening is a change in the concentration and the timing of the bile. Eventually, your body gets used to that. Sometimes people have diarrhea. Typically, you don’t have it for more than a couple weeks. Every once in a while you see somebody that has it for two, three months but then it goes away so that’s usually not an issue but you do have a change in the concentration and the timing of the bile. So it might change your digestion a little bit and your bowel habits a little bit as well.
I think that’s all I wanna talk about with gallbladder surgery. I hope you got an understanding, a little better understanding of what we do, why we do it, what the alternative treatments are, and complications and recovery.
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