Gallbladder - a small pear shaped organ
Gallbladder disease includes stone formation and infection. In many instances gallbladder has to be removed surgically to prevent complications. Removal of gallbladder in turn can lead to various complications and hence most often avoided. The various reasons to avoid getting gallbladder removed include development of diarrhea and injury of the bile duct during surgery which may cause obstruction to the flow of bile.
Gallbladder, liver and bile
Liver is the largest organ in the body. It does multiple functions like synthesis, excretion, detoxification and storage. It is connected to the small intestine by bile ducts through which bile flows from the liver to the intestine. At the lower border of the liver, the pear shaped gallbladder is present which is attached to the bile duct by cystic duct. It stores and concentrates bile.
When a person is not taking food, the bile from the liver flows in to the gallbladder and gets stored and concentrated there. When a person eats, especially a fatty meal, the gallbladder contracts and the bile from it flows in to the small intestine where it helps in the digestion of fat. After assisting fat digestion, the bile gets reabsorbed at the terminal portion of small intestine and reaches liver from where it is secreted again. A little quantity of bile is lost in the stools. Gallbladder is not a vital organ as it performs the function of only storing bile and hence a person can live without a gallbladder.
Diseases of gallbladder
Though gallbladder is not a vital organ, it is involved in a number of diseases some of which can result in serious complications. Gallbladder disease can occur in both sexes though it is more common in women. The two most common diseases involving gallbladder are gallstone disease and cholecystitis.
In gallstone disease, stones are formed in the gallbladder. It usually does not cause any symptoms. But sometimes it causes symptoms and can lead to serious complications when it obstructs the flow of bile from the gallbladder by blocking the cystic duct or by moving in to the bile duct and cause obstruction. The symptoms include abdominal pain, fever and jaundice.
In cholecystitis, the gallbladder is inflamed. It can be due to gallstone disease and can occur in conditions other than gallstone diseases also when it is called acalculous cholecystitis. The symptoms include abdominal pain and fever.
Removal of gallbladder
Gallbladder is not a vital organ and a person can live without it. It can be removed by surgery. This procedure is called cholecystectomy. It can be done by laparoscopic method and by open method (by opening the abdomen). Gallbladder is usually removed if a person suffers from cholecystitis or is having painful gallstone disease. There are other less common indications as well. Approximately 700,000 cholecystectomies are performed for gallstone disease in the United States each year. Most of these are laparoscopic cholecystectomies.
Reasons to avoid gallbladder removal
There are many reasons to avoid getting gallbladder removed. The reasons could be the complications arising during surgery and complications due to absence of gallbladder. The following are some of the reasons to avoid getting gallbladder removed.
Complications during cholecystectomy
Cholecystectomy can be done both by open method and laparoscopic method. Complications are more with open method. The complications during surgery include:
- Bile leak
- Injury to bile duct
Of these, injury to bile duct is most important and the most serious. The rate of bile duct injury is one in every 200 to 600 cases. When the bile duct gets injured, it heals over a period of time with some amount of narrowing of the duct. When the duct gets narrowed, it obstructs the flow of bile from the liver. This could lead to fever, abdominal pain and jaundice. When there is complete obstruction, it affects fat digestion and absorption of fat soluble vitamins like vitamin A, D, E and K. When vitamin K is not absorbed, it could lead to bleeding from various sites. When the obstruction is not relieved in appropriate time, it can in turn affect the liver causing secondary biliary cirrhosis. Bile duct injury can be treated endoscopically and rarely surgical treatment is needed.
Bile leak can lead to bile peritonitis with symptoms like fever in the postoperative period, severe abdominal pain and vomiting. Bile peritonitis needs surgical treatment. Pancreatitis causes severe abdominal pain that may radiate to the back. Pancreatitis can be treated medically.
Complications due to absence of gallbladder
As previously mentioned, gallbladder performs the function of storing and concentrating bile. It releases bile in to the small intestine in an orderly manner in response to food intake. When gallbladder is removed, this function is lost. The bile from the liver enters the small intestine directly. There is no control mechanism to regulate this flow of bile. Some amount of bile stay in the upper small intestine till it is involved in the digestion of fat. Since there is no regulation of bile flow, most of it flows to the terminal part of small intestine from where it is absorbed. But because of overload not all of it is absorbed. The bile that is not absorbed reaches the colon where they act on the colon causing diarrhea. Diarrhea is one of the most commonly reported complications of removal of gallbladder. It subsides over a period of time. But in some individuals it may persist for a longer time.
There are a few controversial studies which state that persons who undergo gallbladder removal develop cancer of the right colon later. The studies showed that after a period of about 10 years signs of cancer appear on the right colon. They attributed this to the presence of the bile acids some of which are toxic which escape absorption in the terminal small intestine. But there are other studies which have found no such association. So it remains a controversial issue.
Postcholecystectomy syndrome refers to the occurrence of symptoms after the removal of gallbladder. It is seen in as many as 5-40% of those who have their gallbladder removed. The symptoms include abdominal pain, upper abdominal discomfort, flatulence and abdominal bloating. Most often it is due to stones present in the bile duct which were not removed during the removal of gallbladder.
All the above mentioned factors are to be taken in to consideration while planning removal of gallbladder. Though these are some of the reasons to avoid gallbladder removal, one should remember that gallbladder removal should be avoided only when there is no clear indication for it as in asymptomatic gallstones. But removal of gallbladder should not be avoided when the person gets repeated attacks of pain due to gallstone disease and in case of severe inflammation of gallbladder and large polyps of gallbladder (which leads to cancer).