Dr Devesh Kaushal

Gallbladder Surgery

Gallbladder disease encompasses a range of conditions that affect the gallbladder, which is a small pear-shaped organ located under the liver.

The gallbladder stores bile, a fluid produced by the liver to digest fat. Gallbladder diseases can interfere with the normal functioning of the gallbladder and can include inflammation (cholecystitis), gallstones (cholelithiasis), polyps, and cancer.

What Causes Gallbladder Disease?

Gallstones are the most common cause of gallbladder disease. They occur when substances in bile, particularly cholesterol and bilirubin, harden into stone-like materials. Cholecystitis is the inflammation of the gallbladder often due to gallstones blocking the ducts that lead to the small intestine, and causing bile to build up.

Other causes of gallbladder disease can include:

  • Gallbladder cancer
  • Biliary dyskinesia, where the gallbladder doesn’t empty bile correctly due to a defect in the gallbladder (eg: nerve damage) or bile ducts
  • Gallbladder polyps
  • Primary sclerosing cholangitis (inflammation and scarring of the bile ducts)
  • Infections, such as in the case of AIDS-related cholangiopathy
  • Female gender
  • Age over 40
  • Obesity
  • Pregnancy
  • High-fat diet
  • High-cholesterol diet
  • Family history of gallstones
  • Rapid weight loss
  • Certain medications (eg: cholesterol-lowering drugs)
  • Diseases (eg: liver disease, diabetes)
  • Chronic use of anti-acid medications (eg: PPIs, H2-receptor antagonists)

Gallstones and Cholecystitis:

  • Sudden and rapidly intensifying pain in the upper-right portion of your abdomen
  • Sudden and rapidly intensifying pain in the centre of your abdomen, just below your breastbone
  • Back pain between your shoulder blades
  • Pain in your right shoulder
  • Nausea or vomiting
  • Fever or chills

Chronic Gallbladder Disease:

  • Indigestion
  • Bloating
  • Intolerance of fatty foods
  • Belching
  • Gas
  • Abdominal discomfort after meals

Advanced Disease:

  • Yellowing of the skin and eyes (jaundice)
  • Clay-coloured stools
  • Dark urine

Gallbladder conditions are typically diagnosed using a combination of clinical evaluation, blood tests, and imaging studies. Commonly used imaging tests include:

  • Ultrasound
  • CT scan
  • HIDA scan (cholescintigraphy)
  • Endoscopic Retrograde Cholangiopancreatography (ERCP)
  • Magnetic Resonance Cholangiopancreatography (MRCP)

Non-Surgical:

  • For gallstones without symptoms, treatment may not be required.
  • Dietary changes to reduce fat intake may help manage symptoms.
  • Oral dissolution therapy is sometimes used to dissolve cholesterol gallstones, though it is not often effective and is used less commonly than other treatments.
  • ERCP may be used to remove gallstones in the bile duct.

Surgical:

  • Cholecystectomy: The standard treatment for symptomatic gallstones is the surgical removal of the gallbladder. This can be performed laparoscopically (minimally invasive) or via an open surgery.
  • Gallbladder Polyp Removal: Polyps larger than 1 cm usually require surgical removal due to the risk of becoming cancerous.

For those with gallbladder disease, maintaining a healthy weight and eating a balanced diet low in fat and cholesterol can help manage symptoms. If surgery is required, most patients can return to normal function without a gallbladder, as bile will flow directly from the liver into the small intestine.

  • Infection
  • Bleeding
  • Injury to nearby structures, such as the bile duct, liver, and intestines
  • Postcholecystectomy syndrome (PCS), symptoms of which can include digestive problems and persistent pain in the upper right abdomen

Post-surgery, patients often return to their normal diet and activities gradually. They may experience some diarrhea initially, which usually improves with time. It is important to follow the surgeon’s specific recommendations for recovery and to attend follow-up appointments to ensure proper healing.

For gallbladder cancer, the treatment depends on the stage of the disease and may include surgery, chemotherapy, and radiation therapy.

Gallbladder disease has a variety of presentations and causes, with gallstones being the most common. The standard treatment for symptomatic gallstones and other complications is surgical removal of the gallbladder, which typically provides relief from symptoms and a return to normal activities.

Dr Devesh Kaushal is a Specialist General Surgeon and a Fellow of the Royal Australian College of Surgeons (FRACS).

Dr Kaushal offers 15+ years of experience and holds a Master of Surgery Degree, as well as being fully certified in gastroscopy and colonoscopy by the Gastroenterology Society of Australia (GESA).

Dr Kaushal takes an empathetic, warm-hearted and friendly approach to patient care and is completely dedicated to patient outcomes.

He consults and operates across Souther-Western Sydney.