877-659-0011

SURGICAL SPECIALISTS, P.C.

GALLBLADDER SURGERY

Gallbladder disease is very common. Don't let it put limits on your
life and affect your lifestyle.
You can prevent painful attacks by
having your gallbladder removed and also prevent future problems.
After the surgery you will still be able to enjoy your favorite foods
and activities. You will be able to feel good again.

If you've experienced a painful attack it is most probable that stones or
delayed emptying of the gallbladder is the cause of it. This problem is
usually treated with the removal of the gallbladder and it will eliminate
pain and prevent future attacks. Gallbladder removal is one of the most
commonly performed surgical procedures in Connecticut and the United
States. It is possible to live a healthy life without having a gallbladder.

The gallbladder is a small pear shaped organ located directly under the liver
on the right side of the abdomen. A healthy gallbladder will store and
concentrate bile that is produced by the liver. After a meal the gallbladder
squeezes bile through a series of tubes called ducts and the bile travels
through the ducts to the small intestine where it helps with digestion. Bile
helps with the digestion of fats. It contains substances that allow fat to be
emulsified. It also stimulates the secretion of an enzyme that deals with the
breakdown of fats.

Normally bile moves smoothly through the digestive system. Should stones
form in the gallbladder they could block the release of bile which can cause
pain and serious complications.

The gallbladder is not an essential organ and removal of it will not cause
any observable problems with health or digestion. When the gallbladder is
removed bile will go directly from the liver into the small intestine. There is
however, a very small risk of diarrhea and fat malabsorption.

SYMPTOMS

Gallbladder disease can cause painful attacks. Generally, they will
occur after having a meal. Some people may experience one attack, while
others can experience many. Symptoms of gallbladder attacks include:

  • Severe pain or ache in the right or middle of the upper abdomen
  • A dull ache beneath the ribs or breastbone
  • Back pain, or pain in the right shoulder blade
  • Nausea, upset stomach, heartburn, or vomiting
GALLBLADDER DISEASES

GALLSTONES (CHOLELITHIASIS)

The most common disorder affecting the gallbladder is
gallstones.
When the gallbladder is not operating properly
substances in the bile can crystallize, become solid and form
gallstones. This can occur when the bile's chemical makeup
becomes out of balance or when bile is not completely emptied
from the gallbladder and becomes concentrated within the sac.

The majority of the stones are composed of cholesterol. There
are cases where bile salts and bilirubin are also included in their
composition. The other type of gallstone only contains the bile
pigment bilirubin and they are formed when the bile contains too
much bilirubin. The stones can be as small as a grain of salt or as
large as a golf ball. There can be as few as one or as many as
hundreds.

It is uncertain why some people form gallstones and there is no
known means to prevent it. Gallstones do not go away on their own.
Drugs as well as dietary adjustments, such as reducing fat intake,
can be used to temporarily manage some stones. However, this
treatment has a low, short-term success rate. Eventually symptoms
will continue unless the gallbladder is removed. Removal of the
gallbladder has been proven to be the safest treatment of gallbladder
disease.

In some instances it has been found that gallstones can develop from
a diet consisting of high fats and refined carbohydrates and low fiber.
They are most often found in 10 – 20 percent of the population over
40 and are generally left untreated if there are no symptoms.

In some cases gallstones do not cause symptoms. When they do
they will irritate the wall of the gallbladder. If the stones move into
nearby ducts and cause blockage, serious problems can occur. The
blockage will stop the flow of bile and can lead to pain, nausea and
infection. One in five people will experience symptoms and require
treatment. Those symptoms include chronic indigestion and sudden
attacks of pain accompanied with nausea and vomiting. Jaundice
(a buildup of bile chemicals in the blood) can occur. Symptoms of
jaundice includes yellowing of the skin and eyes, dark urine and
itching. It is critical that complications from gallstones be treated
because of the seriousness of this condition and the potentially fatal
consequences resulting from it.

GALLSTONES IN THE BILE DUCT (CHOLEDOCHOLITHIASIS)

The common bile duct is formed by the junction of ducts
leading from the liver to the gallbladder.
The problem occurs
when the stone moves from the gallbladder and blocks a section of
the duct. This can cause bile to back up into the liver, causing
jaundice. If a gallstone blocks the junction with the pancreatic duct,
the pancreas can become inflamed and causes the condition known
as pancreatitis. Pain symptomatic of this condition often appears in
the upper abdomen, back or beneath the breast bone. This is a
serious condition requiring immediate treatment.

If the patient has asymptomatic gallstones and is having an
abdominal operation for some other reason, then the gallbladder
may also be removed at the time of the operation or prior to it.

GALLSTONES AND PREGNANCY

Gallbladder problems can develop during pregnancy because
hormone changes can make bile more likely to form stones.

In some cases, if the gallbladder removal can be delayed until
childbirth. However, if the symptoms are severe, surgery may be
advised during pregnancy in order to protect the patient's health and
the baby's health. The safest time to remove the gallbladder is the
second trimester, 13 – 24 weeks into the pregnancy.

CHOLECYSTITIS

This is an inflammation of the gallbladder most often resulting
from the presence of a gallstone.
The majority of patients who
suffer with symptoms are suffering from chronic cholecystitis.

The gallstone gets stuck in either the junction of the gallbladder and
the bile duct or in the duct itself. In an effort to move the stone the
muscles in the wall of the gallbladder and ducts contract Cholecystitis.
This can cause severe pain under the V of the ribs or it may extend
across the abdomen and spread to the back. It can cause vomiting
and fever. After several hours the stone is passed down the bile duct
into the intestine as a result of the muscle contractions or it will fall
back into the gallbladder. Often patients will complain of discomfort
and flatulence after a fatty meal and can also suffer from a constant
dull ache in the upper abdomen.

Cholecystitis will become acute when inflammation occurs. In over
50% of the cases a bacterial infection will occur. Severe and constant
pain will come on suddenly. The pain radiates across the right and
central parts of the upper abdomen and under the right shoulder
blade. Vomiting and fever occur and the patient can become very ill.
Jaundice might even occur if the bile duct becomes swollen and bile
from the liver is prevented from passing into the intestine, and
instead it enters the bloodstream, When inflammation continues or
recurs it can require surgery.

GALLBLADDER CANCER

Cancer can affect the gallbladder but it is rare when it does.
It is difficult to diagnose gallbladder cancer. It is usually found at the
late stages when symptoms occur. Symptoms generally resemble
those of gallstones.

GALLSTONE PANCREATITIS

An impacted gallstone will block the ducts that drain the
pancreas.
In this instance, pancreatitis will occur. It is recommended
that the gallbladder be removed as soon as pancreatitis (swelling of
the pancreas) resolves.

DIAGNOSIS

The majority of people with gallstones experience no symptoms.
The existence of gallstones can remain undetected unless tests
are performed.
When detected and symptoms are not present,
treatment is usually not performed. It may be recommended for some
patients to have their gallbladder removed.

When symptoms are prevalent the following can be used to aid in the
diagnosis:

  • Medical Examination – An exam is performed to ook for
    abdominal tenderness and jaundice and a review of the patient's
    medical history.
  • Blood Tests – Bloodwork such as bilirubin and liver enzyme levels.
    If they are elevated it could suggest a problem.
  • Abdominal Ultrasound – An imaging procedure using reflected sound
    waves to examine the internal organs of the abdomen and produce
    photos of them. This is non-invasive. A probe placed on the skin
    bounces high frequency sound waves off structures in the belly. It
    can detect stones, thickening of the wall of the gallbladder, and fluid
    around the gallbladder.
    ultrasound
    Ultrasound of the
    gallbladder can
    diagnose acute
    gallbladder problems
    such as acute
    clolecystitis
  • CT Scan - Computerized tomography scan. A computer creates
    pictures of structures within the body, takes the data from multiple
    X-ray images and turns them into pictures on a screen. A CT scan
    can only detect stones in 15% of the patients and it is not the best
    test for detecting stones.
  • HIDA – Hepatobiliary scan. A HIDA scan uses a radioactive fluid
    (marker) to check gallbladder function. It can also show whether
    any bile ducts are blocked. After the test, the fluid safely passes
    from the body. It can also measure whether the gallbladder empties
    correctly as in biliary dyskinesia.
  • Cholangiography - Radiographic examination of the liver and bile
    ducts accomplished by inserting a thin needle through the skin into
    the liver and injecting a medical dye to detect duct blockages. This
    procedure can also be performed at the time of surgery.
  • ERCP – Endoscopic Retrograde Cholangiopancreatography. This is
    a technique performed by a gastroeneterologist that combines the
    use of endoscopy and fluoroscopy to diagnose and treat certain
    problems of the biliary or pancreatic ductal systems. An endoscope
    is inserted through the mouth and into the stomach to the bile ducts.
    Dye is sent through the tube into the bile duct systems. The dye
    makes the ducts show up on an x-ray. It is also possible for small
    stones to be removed during this procedure with a basket.
  • MRCP - Magnetic Resonance Colangiopancreatography. An MRI
    scanner provides high-resolution images of the bile ducts, pancreas
    and gallbladder. The test can determine if there is a stone in the
    common bile duct
    .
TREATMENTS

After the completion of a thorough medical exam, medical history
review and completion of tests, our surgeons will evaluate your
condition and discuss the treatment options available for it at
FCB Surgical Specialists in Connecticut.
You can be seen by one of our
surgeons in our office, at Norwalk Hospital or St. Vincent's Medical Center.
If you have had one or more painful attacks, removal of your gallbladder
will probably be the route chosen. This will prevent the formation of more
stones and help prevent complications. While gallstones are not always an
immediate health risk, choosing to delay surgery may lead to serious complications that include:

  • Continued pain and worsening of symptoms
  • Gallstones moving to the common bile duct and causing
    blockage, infection or jaundic
  • Gallstones obstructing the pancreatic duct and causing
    pancreatitis

REMOVAL OF THE GALLBLADDER (CHOLECYSTECTOMY)

Removing the gallbladder is the best way to remove gallstones and
prevent new ones from forming. The gallbladder can be removed
laparoscopically (several small incisions) or laparotomy (traditional
open surgery requiring a five to seven inch incision). Laparoscopy is
the procedure that is most often used. There are cases where the
laparoscopy procedure may not be appropriate for some patients who
have had previous upper abdominal surgery, or who have a pre-existing
medical condition. A thorough evaluation by one of our surgeons at
FCB Surgical Specialists will determine the final decision.

PREPARING FOR SURGERY

Preoperative preparation includes blood work, medical
evaluation, chest x-ray and an EKG depending on your medical
condition and age. These tests can be ordered by our general
surgeons at FCB Surgical Specialists or by your medical doctor.
Our surgeons will discuss the entire procedure with you prior to
the actual surgery including the potential risks and benefits.
They will ask that you follow their instructions implicitly and it
may include the following:

Our surgeons will discuss the entire procedure with you prior to the
actual surgery including the potential risks and benefits. They will
ask that you follow their instructions implicitly and it may include
the following:

  • You may be requested to completely empty your colon, cleanse
    your intestines, and drink clear liquids only for one to several
    days prior to surgery.
  • It is important to discuss all the medications, supplements and
    herbs that you take, This includes prescription and over the
    counter medications.
  • You will be asked to stop taking aspirin, ibuprofen, Naproxen,
    blood thinners, and vitamin E as directed; usually several days
    to a week prior to surgery.
  • Arrange to have someone drive you home from the hospital
  • Don't eat or dink after midnight the night before surgery.
    This also includes coffee and water.
  • You make take certain medications with a sip of water the
    morning of the surgery after consulting with your surgeon.
DAY OF SURGERY

It is imperative that you arrive on time. You will be asked to
change into a patient's hospital gown. You will be given an IV to
provide fluids and medication. Prior to the surgery you will meet and
talk to your anesthesiologist. Gallbladder surgery (laparoscopic or
laparotomy) requires general anesthesia.

SURGERY
When the surgery is performed laparoscopically a few small
incisions are made in the abdomen.
The laparoscope (a tiny
telescope) and cannulas (narrow tube-like instruments) are inserted
through the incisions. The scope provides video images on a high
definition screen in the operating room and aids our surgeon in
carefully guiding the other instruments to the gallbladder. After the
gallbladder is removed, the incisions are closed with sutures or strips
of surgical tape. This procedure takes less than an hour.

  • Carbon dioxide is inflated into the abdomen to lift the abdominal
    wall away from the internal organs. This enables our surgeon to
    clearly view the gallbladder through the laparoscope.
  • Small clips or stitches are used to close off the bile duct and
    blood vessels to help prevent bleeding and bile leaks. When
    the clips are in place, the gallbladder is separated from the liver.
    The clips are made of titanium or plastic that does not harm
    the body and they are left in place.
  • The gallbladder is separated from the liver and placed in a bag.
    It is removed through one of the small incisions in the abdomen.
  • If one or more stones are found in the common bile duct, they
    may be removed with a special scope, or the decision might be
    made to remove them at a later date by ERCP (Endoscopic
    Retrograde Cholangio Pancreatography).

The possibility exists that our surgeon may decide to switch from a
laparoscopic procedure to an open procedure. This is not considered
a complication; but it is rather sound surgical judgment and is based
on patient safety. This occurs in only a small number of cases that
this decision is actually made. The factors contributing to it may
include obesity, a history of prior abdominal surgery causing dense
scar tissue, inability to visualize organs, or bleeding problems during
the operation.

If the open method is performed, the same procedures with the clips
and stitches are used to close off the ducts and blood vessels. The
significant difference between the open procedure and the
laparoscopic procedure is that there is a larger incision in the
abdomen with the open procedure and it requires a longer hospital
stay and recovery period.

AFTER SURGERY
You will be taken to a recovery area after the surgery. There
will be surgical tape, tagaderm or glue over the incisions and you
may have special boots on your legs to prevent blood clots.

The removal of the gallbladder is a major abdominal operation and
you can expect to experience a certain amount of postoperative
pain. Nausea and vomiting are not uncommon.

For a few hours you may experience some pain in your shoulder
which can be a result of the gas used during the surgery. You will
be asked to get up and move after the surgery as this helps prevent
blood clots in your legs. You may be given some medication to
relieve discomfort. Once you are feeling better, often within a few
hours, you may go home. Sometimes a one-night stay in the
hospital is required.

Rest is required upon returning home. Try to move around as much
as possible and begin easing back into your routine. Regular exercise
will improve circulation and will be good for your whole body.

You most likely will feel tired, have some abdominal cramping after
a few days, and experience some bruising around the incisions. It is
not uncommon to have some pain during the recovery period. Your
surgeon will prescribe some pain medication to use at home. Take
the medications on time as directed and don't wait for the pain to
get bad. We may also suggest a laxative and stool softener
because some pain medications can cause constipation.

Most people are able to return to work 3 to 10 days after surgery.

You will be able to eat everything once you have recovered from the
surgery. It often takes a few weeks for your digestion to fully adjust.
You may experience some indigestion, loose stools, or diarrhea; but
they should all go away in time. Eating a balanced diet that is high in
fiber will help digestion.

It is important that you see our surgeon for follow-up care to check
your progress and make certain that you are healing properly. He will
answer your questions and address your concerns. Be sure to alert
him to any new or unusual symptoms you may have.

WHEN TO CALL THE DOCTOR AFTER SURGERY
If you experience any of the following during your recovery,
call us:

  • Persistent fever above 101 degrees
  • Chills
  • Increasing bleeding, redness or draining from an incision
  • Increased abdominal swelling and pain
  • Pain that is not relieved by the medications given you
  • Vomiting or nausea that extends more than 12 hours
  • Shortness of breath or persistent cough
  • Pain or swelling in the calf
  • Symptoms of jaundice
  • Prolonged diarrhea
  • Inability to eat or drink liquids

RISKS AND COMPLICATIONS OF GALLBLADDER SURGERY
Gallbladder surgery is very common, but as with most surgeries
some risks do exist.
The majority of laparoscopic gallbladder patients
experience few or no complications and quickly return to normal activities.
The risks include:

  • Bleeding
  • Infection
  • Injury to the common bile duct or nearby organs
  • Blood clots in the legs
  • Prolonged diarrhea
  • Bile leaks
  • Pneumonia
  • Heart problems

TREATMENT WITH ANTIBIOTICS
Antibiotics can be used if the patient is suffering from cholecystitis. It won't cure it, but will prevent an infection from spreading.

LOCATIONS


148 EAST AVENUE, SUITE 3A
NORWALK, CT 06851
203-899-0744

2 TRAP FALLS ROAD, SUITE 100
SHELTON, CT 06484
203-256-9707

778 LONG RIDGE ROAD, SUITE 101
STAMFORD, CT 06902
203-348-0589

52 WASHINGTON AVENUE, SUITE 3
NORTH HAVEN, CT 06473
203-285-2861

831 BOSTON POST ROAD, SUITE 202
MILFORD, CT 06460
203-647-0140

Dr. Craig Floch

the founder and senior partner of Fairfield County Bariatrics & Surgical Specialists, P.C. His commitment has enabled us to become one of the most prominent, dedicated, personal and highly respected practices serving Connecticut, New England and New York.

Learn More

Dr. Neil Floch

the Director of Minimally Invasive Surgery at Norwalk Hospital as well as the Bariatric Director of the Hospital. He is the first fellowship trained advanced Laparoscopic Surgeon in Fairfield County.

Learn More

Dr. Peter Ingraldi

is a partner of Fairfield County Bariatrics & Surgical Specialists, P.C. He joined our practice in 2007. Dr. Ingraldi specializes in general surgery and surgical critical care and is Board Certififed in both fields.

Learn More

Abe Fridman

joined our practice September 1, 2012. Dr. Fridman specializes in general and bariatric surgery.

Learn More

Dr. Marko Lujic

is the newest member of Fairfield County Bariatrics & Surgical Specialists, P.C., having joined our practice in October 2017. Dr. Lujic will lead our initiative in Milford and will provide comprehensive general surgical services, including breast surgery, thyroid surgery and melanoma in addition to managing traditional general surgery consultations.

Learn More