Gallbladder Removal: Will I Need It?

The gallbladder is a pouch-like, small organ on the upper right side of your abdomen. Its job is to store and release bile, a fluid made by the liver to help digest fat. Bile can be thick and create blockages along the way. Sometimes patients also get gallbladder disease due to too much cholesterol or bilirubin, which is a liver pigment in your bile. This can lead to gallstones, chronic or acute inflammation caused by gallstones and bile duct stones. 

If they interfere with your life or become too uncomfortable, your doctor might suggest to have your gallbladder removed. Fortunately, you can still live a healthy life without your gallbladder and normal digestion is still possible. Bile will still move to your small intestines for digestion, so your quality of life will not be drastically reduced. The procedure to remove your gallbladder is not complicated too.

When to remove the gallbladder

Surgery is usually carried out if you have painful gallstones. Gallstones are small stones or hard substances that form in the gallbladder due to an imbalance of materials that make up bile. Gallstones often do not present symptoms and you may not know you have them, but they can occasionally blow the flow of bile and irritate the pancreas or gallbladder, leading to symptoms like:

  • Sudden and intense pain in the right upper portion of your abdomen that can spread to the middle of your abdomen, back or right shoulder 
  • Nausea and vomiting
  • Fever
  • Bloating 
  • Jaundice, which is a yellowing of the skin that typically indicates a bile duct blockage

Apart from painful gallstones, the following conditions could also require the need for a gallbladder removal:

Biliary dyskinesia
This occurs due to a defect in the gallbladder’s motion, causing bile to be emptied inefficiently

Choledocholithiasis
When gallstones move to the common bile duct and get tuck, this causes a blockage which doesn’t allow the gallbladder to drain

Cholecystitis
This is caused by an inflammation of the gallbladder

Pancreatitis
This is caused by an inflammation of the pancreas

Before deciding on surgery, your doctor may recommend reducing your overall fat intake and watchful waiting to see if your symptoms get better. In some cases, tablets might be prescribed to dissolve the gallstones. However, if symptoms persist, then surgery is needed.

How the gallbladder is removed

There are two ways to surgically remove the gallbladder:

Laparoscopic surgery
Several small incisions are made by your belly button and abdomen to access and remove your gallbladder. During this surgery, carbon dioxide is pumped into your stomach via a small tube to better access your gallbladder. A laparoscope (long and thin telescope with a light and camera) is then inserted so the surgeon can look inside your tummy through a monitor while he/she removes your gallbladder through surgical instruments.

Recovery takes about 2 weeks, but patients can usually go home on the same day.

Open surgery
Open surgery requires a single larger incision to be made in your tummy instead. This option is usually recommended for patients who can’t have keyhole surgery due to reasons like accumulated scar tissue from a previous surgery. During this procedure, an incision about 10-20cm is made underneath your ribs, with surgical instruments used to remove your gallbladder.

Recovery takes about 6-8 weeks, and patients usually need to stay in the hospital for a few days. The likelihood of requiring open surgery is usually quite low — about less than 1 percent in healthy and young individuals. However, males over the age of 50 with risk factors like acute gallbladder inflammation have a 30 percent chance of needing open surgery.

How to prepare for gallbladder removal surgery

Before your operation, your surgeon may ask you to:

  • Undergo blood tests and a general health checkup to ensure you’re fit for surgery 
  • Stop smoking to reduce your risk of complications after surgery 
  • Stop taking certain supplements and medications as they may increase your risk of bleeding. With that said, be sure to inform your doctor about any medications or supplements you consume so he/she can advise accordingly 
  • Avoid eating and drinking at least six hours before your surgery 
  • Shower using a special antibacterial soap

Life after gallbladder removal surgery

Most patients go on to lead normal lives after removing their gallbladder and do not really need to follow a special diet. However, you may need to follow a low-fat diet for the first few weeks after surgery, and preferably eat small meals to start with. 

Following the surgery, you may experience some side effects such as:

Diarrhea and flatulence
You might experience indigestion which can cause diarrhea and flatulence. This is often made worse by too little fiber or too much fat, as there is an insufficient amount of bile in the intestines to digest fat.

Constipation
While removal of a diseased gallbladder will rarely cause constipation, surgery and anaesthesia used during the surgery can lead to short term constipation. Hence, it’s all the more important to hydrate regularly.

Harder to digest fat
Your body might need some time to adjust to its new way of digesting fat. During this time, you may experience some indigestion. This doesn’t last long, but some patients develop other side effects caused by bile leaking into other organs or gallstones left behind in the bile ducts.

Jaundice
Stones that remain in a bile duct after surgery can cause severe pain, infection or jaundice. If you experience this, see a doctor immediately. 

To minimise side effects from the surgery such as indigestion and diarrhea, apart from reducing fat intake, it may help to make some small changes to your diet, including:

  • Avoid caffeine-containing drinks, such as coffee or tea 
  • Avoid spicy, highly salty or sweet foods as they may cause the side effects to worsen 
  • Gradually increase your intake of fiber and consume food like wholegrain rice, whole wheat bread, fresh fruits and vegetables, nuts, seeds and oats.

On the whole, aim to have a healthy and balanced diet, even long after your surgery. If you notice that certain food or drinks can trigger your symptoms or discomfort, then it’s best to avoid them.