The liver, gall-bladder and bile ducts. image created by IC staff using Generative AI.

Overview:

Dr. Sharma answers questions about cholecystectomy or glall bladder removal surgery and how to cope with cholecystectomy.

Rajveer, * a 52-year-old first-generation immigrant businessman who lives in New Mexico, recently had sudden, severe upper right abdominal pain, nausea, vomiting, and pain radiating to the right shoulder and back.  The pain was so severe that he had to rush to the ER. At the ER, and later, with the help of an Ultrasound and CT scan, he was diagnosed with gallstones and advised surgery.  Rajveer never had surgery and was anxious. He approached us for advice.

*Name changed upon request.

Q: What are gallstones?

Dr. Sharma: Rajveer, the gallbladder is a small, pear-shaped organ located in the upper right part of your abdomen, just below the liver. Its main function is to store and concentrate bile (a digestive juice produced by the liver) and release it into the small intestine to help break down fats during digestion. 

Hardened deposits (mostly made of cholesterol, pigment, or bilirubin) can form in the gallbladder, and these are called gallstones. If such a stone gets stuck in the bile duct, it can cause severe pain and inflammation. Inflammation can be acute or chronic and is known as cholecystitis. Gallstones are common, affecting about 10–15 % of the U.S population.

Q: What could have caused this condition?

Dr. Sharma: Rajveer, we may not be able to pinpoint the exact cause. However, there are several risk factors for gallstones (cholelithiasis). Some are non-modifiable, such as family history, genetic predisposition, gender, ethnicity (about 10-22% higher risk among people of Indian descent), and advancing age. 

Among the modifiable factors are obesity, diabetes mellitus, high cholesterol, taking certain prescription drugs, reduced physical activity, rapid weight loss, fasting, and other digestive disorders. 

Q: Is surgery the only option?

Dr. Sharma: No, surgery is not the only option for cholelithiasis, but it is the most common and effective treatment for symptomatic gallstones. 

Laparoscopic cholecystectomy (LC) is the gold standard for uncomplicated gallbladder disease, with over 750,000 cases performed every year in the U.S. Sometimes, open cholecystectomy is also performed, but it is not routine. 

In cases of gallstones that are asymptomatic, one can probably wait and watch. Sometimes, oral dissolution therapy with drugs like Ursodiol is used, but these only work for cholesterol stones, and recurrence is very common. 

In some cases, sound waves may be used to break the stones, but overall, surgery is considered best because it cures the problem.

Q: What should I expect during surgery?

Dr. Sharma: Rajveer, before your surgery, the surgeon or his team will explain the procedure to you and obtain your consent. They will let you know whether it is laparoscopic (typical) or open (less common). 

On the day of surgery, you will receive anesthesia with sedation. In laparoscopic surgery, typically three small incisions are made. From the incision around your belly button, carbon dioxide gas will be filled to create space, and a small lighted camera and tools (the laparoscope) will be inserted. The surgeon will remove the gallbladder and close the incisions, with the whole procedure taking about an hour or so.  You will typically be discharged on the same day.  

In an open cholecystectomy, you may have to remain in the hospital for a couple of days. You can live a completely normal, healthy life without a gallbladder. 

Without a gallbladder, bile drips continuously from the liver directly into the small intestine. Because the bile is no longer concentrated, you will need to make minor adjustments to your diet, such as limiting excessively high-fat or greasy meals, to prevent digestive discomfort. 

Q: How long does recovery usually take?

Dr. Sharma: Complete recovery from gallbladder surgery varies from person to person and depends on the type of surgery and any complications. If you have an open gallbladder removal surgery, recovery could take six to eight weeks. 

If you have a laparoscopic removal, it could be two weeks. The surgery is generally safe, but sometimes infection, bile leaks, injury to surrounding organs, or blood clots may complicate recovery; however, these complications are rare.

Q: Can yoga help with gallbladder surgery?

Dr. Sharma: Practicing some aspects of yoga, such as meditation (dhyana), gentle breathing (selected pranayama), and relaxation (shava asana) after the gallbladder removal can aid recovery by reducing stress, improving mobility, and easing digestive discomfort.  

However, one must avoid deep twists, such as dhanurasana (bow pose), navasaana (boat pose), shirshasana (head stand), etc., heavy lifting, or strenuous abdominal strain for at least six to eight weeks to prevent incisional hernias.

Q: Can you share some additional resources?

Dr. Sharma: Here are some additional resources from which you can find more information:      

If you have questions, reach out to Dr. Manoj Sharma at editor@indiacurrents.com.

Manoj Sharma, MBBS, Ph.D., MCHES® is an Indian-American global public health expert, author, and educator who has written several books and publications on mental health and wellness. He answers queries...