Preparation for the operation
Various examinations are carried out to make an exact diagnosis and determine the cause of the symptoms. This includes ultrasound and, if necessary, a computer tomography, an MRI or a gallbladder endoscopy.
As with any operation, general preparations are necessary, such as blood tests, blood pressure measurements and an ECG. Blood-thinning medication must be discontinued in good time. Gallbladder surgery is performed under general anesthesia, which is why you must be fasting for the procedure.
Gallbladder surgery: what are the options?
There are two main procedures available to remove gallstones: removal of the gallbladder (cholecystectomy) and endoscopic removal of gallstones by means of gallbladder endoscopy, known as endoscopic retrograde cholangiopancreatography (ERCP). ERCP is also used to determine the exact location of the stones or to clarify diseases of the bile ducts. Gallbladder removal may also be necessary in the case of cancer of the gallbladder.
Gall bladder removal (cholecystectomy)
Nowadays, gallbladder removal is usually performed using minimally invasive laparoscopy or robot-assisted surgery. Four small incisions are made through which a camera and surgical instruments are inserted. To improve visibility, the abdominal cavity is filled with CO₂ gas.
If gallstones are suspected in the bile ducts during the operation, an X-ray contrast agent is introduced to make the stones more visible (intraoperative cholangiography). These can then be removed if necessary. The blood vessels and bile ducts of the gallbladder are then clamped and closed before the gallbladder itself is carefully removed. At the end of the procedure, the CO₂ is drained again and the wound in the navel is sutured. The entire operation takes about an hour.
Gallbladder endoscopy (ERCP)
Endoscopic retrograde cholangiopancreatography or gallbladder endoscopy is used to inject contrast medium into the bile ducts and examine the bile ducts with a small camera. This can be used to clarify diseases of the bile ducts and pancreatic duct or to remove smaller stones. If the bile ducts are narrowed, for example by tumors, tubes (stents) can be inserted to keep the bile ducts open.
ERCP is usually performed under light anesthesia. The endoscope is passed through the mouth into the duodenum. There, either contrast medium can be injected for X-rays of the bile ducts or the cholangioscope (the camera) can be advanced into the bile ducts to examine the gallbladder and bile ducts directly.
Conservative treatment options
Extracorporeal shock wave lithotripsy (ESWL) can be found in textbooks as an alternative to surgery. In this method, the gallstones are shattered from the outside with high-energy sound waves. However, as the gallbladder remains intact during this treatment, there is a risk of stones forming again over time. This procedure is therefore very rarely chosen.
If gallstones get stuck in the bile ducts, they can be removed endoscopically. This method is known as endoscopic retrograde cholangiopancreatography (ERCP). An endoscope is passed through the esophagus, stomach and duodenum to the bile ducts in order to remove the stones.
After the procedure: What should I bear in mind?
The endoscopic examination is usually performed on an outpatient basis so that you can go home the same day. After a gallbladder removal, however, a hospital stay of about 1 – 3 days is necessary. The body can function without a gallbladder without any problems, but as the bile now flows continuously in small quantities into the duodenum, a large quantity cannot be released at once for the digestion of fatty foods. It is therefore advisable to eat high-fat meals in smaller portions after the operation.
After gallbladder removal, you should avoid physically strenuous activities for about 2 to 3 weeks. The duration of the incapacity to work is between 1 and 2 weeks, depending on the type of work.
