According to the American Gastroenterological Association, each year nearly one million Americans are affected by gallstones, or gallstone disease. It’s common medical condition that can cause extremely painful symptoms — but fortunately for patients with recurrent gallbladder attacks, a minimally-invasive procedure to remove the gallbladder can lead to long-lasting relief.
All About the Gallbladder
The gallbladder is a small, pear-shaped organ located directly under the ribcage on the right side of the body (near the liver). Its sole purpose is to store bile, a digestive fluid made by the liver. It helps break down fats, so they can be absorbed through the digestive tract. Because the gallbladder isn’t responsible for making anything, it’s not considered essential, and many patients who have their gallbladder removed won’t notice any difference in their daily lives. Without the gallbladder, the liver will simply release bile straight into the small intestine during digestion.
Gallstones & Gallbladder Attacks
Gallstones are small deposits that look much like pebbles that are made up of crystalized bile — and they can range in size from very tiny to the size of a golf ball. While experts don’t know exactly what causes gallstones, we know they are more common in women, and genetics are likely to play a role. They’re also more common in individuals over the age of 40 or in those with Native American or Mexican heritage. In addition, conditions, such as diabetes and Crohn’s disease can raise the risk of a gallbladder attack.
When the gallbladder contracts after a meal, the gallstones move and can block the bile ducts. This creates pressure in the upper abdomen area, which can cause a painful gallbladder attack (also known as biliary colic).
What Does a Gallbladder Attack Feel Like?
The mystery of gallstones is that some people who have them experience no symptoms, while others experience painful gallbladder attacks. The pain from a gallbladder attack is often described as a tightening or squeezing in the upper abdomen area, usually in the middle of the body, below the breastbone.
I’ve heard gallbladder attack patients say ‘It feels like someone is tightening a belt around my upper abdomen.’ Some patients experience nausea and vomiting, too.
Because the pain is located in the chest area, gallbladder attacks are often confused with cardiac pain. Patients may think they are having a heart attack and rush to the emergency room. Gallbladder attacks can also be confused with peptic ulcer disease or gastritis.
In many cases, the pain from a gallbladder attack will subside in a matter of minutes or hours once the gallstones settle. However, when the pain lasts for more than six hours, it’s important to seek immediate medical attention to avoid serious infection.
Other Causes of Gallbladder Attacks
Aside from gallstones, there are a few other causes of gallbladder attacks, including:
- Improper Gallbladder Function — A gallbladder attack can also be brought on by a gallbladder that is not functioning properly. It may not be emptying correctly due to another type of blockage in the bile duct (i.e. inflammation), or the thin gallbladder wall has become irritated.
- Hyperactive Gallbladder — A hyperactive gallbladder contracts too aggressively, which also causes painful attacks.
Gallbladder Evaluation & Testing
The best way to determine the reason for a patient’s gallbladder attacks is to start with an ultrasound. The ultrasound scan is very sensitive to detecting gallstones.
If it is determined that the patient does not have gallstones, the HIDA scan is next used to measure gallbladder function. This scan allows doctors to see how well the gallbladder is contracting and whether each contraction is reproducing the patient’s symptoms. A gallbladder that is functioning at under 40 percent is considered to be functioning too low, while 85 to 90 percent is too high (a hyperactive gallbladder). In either case, gallbladder removal is generally the best course of treatment for long-term relief.
Treatment for Gallbladder Attacks
Unfortunately, people who have had one gallbladder attack are almost guaranteed to have more in the future. There are also no medications that can ease the symptoms of a gallbladder attack; nor can gallstones be removed — the walls of the gallbladder are too paper-thin to be stitched after such a procedure. This means the only way to “treat” gallbladder attacks is to have the gallbladder removed — a procedure known as a cholecystectomy.
While the attacks are not life-threatening, they can create pain and discomfort that may interfere with a patient’s daily life and activities. Therefore, the choice to remove the gallbladder is often left up to the patient.
Patients who choose not to undergo gallbladder removal surgery are advised to follow a low-fat diet and hope that future attacks are infrequent. However, after subsequent attacks, many patients decide to move forward with gallbladder removal.
What to Expect from Gallbladder Removal (Cholecystectomy)
This is a standard outpatient, laparoscopic procedure that takes approximately 45 minutes to complete. It requires just four small incisions — one under the navel for the camera, and three under the ribcage. A gallbladder with gallstones is removed with the stones inside.
This surgery usually involves a one-hour recovery in the outpatient facility, and patients typically need about a week of recovery time at home. After surgery, there are no restrictions with lifting, climbing stairs or showering, and a patient is cleared to drive as long as he or she is not taking any narcotic medications. Side effects, such as bleeding or infection, are very rare.
Life after gallbladder removal typically involves no dietary restrictions or permanent supplementation. Some patients can eat any foods without side effects; however, others may experience gastrointestinal symptoms, such as diarrhea after eating fatty foods. The best news is that 90 percent of patients are permanently free from the pain and discomfort of their gallbladder attacks after gallbladder removal surgery. And, with present-day laparoscopy and high-definition optics, the surgery is safer and more effective than it ever has been before.
About WakeMed General Surgery
WakeMed General Surgery has decades of expertise in addressing gallbladder attacks and gallstone disease. To schedule an appointment, visit us online or call 919-350-7331.
About Eric Duberman, MD, FACS
Dr. Eric Duberman is board-certified in both general and colon and rectal surgery, with clinical interests in hernias, gallbladders, hemorrhoids, diverticulitis and colon cancer. He brings decades of experience to WakeMed, with diverse expertise in colon and rectal surgery, as well as general surgery. Dr. Duberman consistently strives to perform each surgery with care and precision, treating patients as if they were members of his own family.
