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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 are 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 are 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 for 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 by nausea and vomiting. Jaundice (a buildup of bile chemicals in the blood) can occur. Symptoms of jaundice include 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 breastbone. 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 from 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 in 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 look 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 of the gallbladder can diagnose acute gallbladder problems such as acute cholecystitis
  • 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 gastroenterologist 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 Cholangiopancreatography. 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 jaundice
  • 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:

  • 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 drink 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, Tegaderm 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

SURGICAL SPECIALISTS OF CONNECTICUT
4920 MAIN STREET
BRIDGEPORT CT 06606
203-371-2986

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.

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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.

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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.

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Abe Fridman

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

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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.

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