Surgery best option for gallbladder attacks

That pain in your abdomen may be more than indigestion; it could be pain from a gallbladder attack.

The gallbladder is a small organ that sits just under the liver. It performs the important role of retaining and releasing bile (a fluid produced by the liver) to help digest fatty foods passing into the small intestine.(See a diagram of the digestive system.)

Pain may arise when the bile contained in the gallbladder is not released, becomes thick and starts to clump together. This may result in what is called a gallstone, which can number from one ormore stones and can vary in size.

When you eat, the stimulation of hormones causes the gallbladder to contract and release bile. This may cause a gallstone(s) to move around and block the passage of bile into the duct, resulting in pain. When pain arises from this condition, it is often referred to as a gallbladder attack.

“From a surgeon's point of view, we would generally consider a gallbladder attack to be pain that lasts for 20 minutes or longer,” says Dr. Lloyd Smith, Chief of Surgery and Program Medical Director at North York General Hospital (NYGH). “The pain has to be in the right location — in the right upper quadrant or midline of the abdomen, sometimes radiating through to the back, sometimes accompanied by fever, chills and nausea, and usually comes on after eating fried/ fatty foods or a very heavy meal.”
Dr. Lloyd Smith, Chief of Surgery and Program Medical Director, North York General Hospital
Dr. Lloyd Smith, Chief of Surgery and Program Medical Director, North York General Hospital

Statistically, women are more likely to develop gallstones than men as hormones during and after a pregnancy can interfere with the flow of bile.

Why surgery is the best option

While more than 50% of gallstones are asymptomatic, meaning they produce no symptoms, they can be an excruciatingly painful condition for others.

“There is really only one good treatment for symptomatic gallstones which is surgery,” says Dr. Smith. “Generally when gallbladder pain starts, surgery is recommended before it progresses into cholecystitis representing severe inflammation of the gallbladder.” About 30% of people who come to NYGH's Charlotte and Lewis Steinberg Emergency with abdominal pain have gallbladder-related pain.

Medication is available which can help dissolve gallstones but may take years to work, and only works in about 25-30% of cases. The stones may return when you stop taking medication.

A typical laparoscopic cholecystectomy, surgery to remove a gallbladder, takes between 60-90 minutes on a day surgery basis, and the patient can resume their regular routine in one to two weeks.

“North York General is somewhat unique as the hospital reserves protected surgery time during the regular day to deal with urgent surgeries, says Dr. Smith. “If a patient arrives here in the emergency department with acute cholecystitis, they can usually have the surgery done the same day or the next — providing the patient with immediate relief and eliminating the chance of it recurring.”

About 30%of peoplewho cometo NYGH's Charlotte and Lewis Steinberg Emergency with abdominal pain have gallbladder-related pain. The hospital performs over 500 gallbladder surgeries annually.

The body adapts

After the gallbladder is removed there is an adjustment period, but the body compensates for the missing organ.

“The body is an amazing thing,” says Dr. Smith. “The bile duct gets a little bigger and increases its capacity. Bile also drips from the bile duct into the small intestine and sits there until you eat, helping to digest food and allowing the passage to open and move food along the digestive tract.”

In the first few weeks after surgery, a patient may experience bloating and looser stools. However, in the long term, the body adjusts as the patient continues to monitor and limit their consumption of fatty foods.

July 6, 2017

This article first appeared in the July-August 2017 issue of The Pulse, North York General Hospital's community newsletter. Subscribe to receive 10 issues per year.

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