Q: I am a 75-year-old female. My doctor found that I have gallstones and has suggested that I go for surgery to remove the gall bladder. It will be day surgery because they do not have to open me up. Is this really necessary? I am having no pain, and no other symptoms that I know of. What are the risks?
A: The surgery that you are referring to is known as a cholecystectomy. The gall bladder is a small pear shaped sack on the right side of the body, underneath the liver and just below the ribs. This organ stores bile that is used in the digestive process to break down fats. Although this is useful, it is not essential to the body and you can live without it.
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Gallstones are often present in the gall bladder, sometimes many small ones, or just one big stone. They are made up of cholesterol, calcium and bile salts.
It is often the smaller stones that can cause problems because they may become stuck in one of the bile ducts located in the liver. This can be extremely painful, often leading to a visit to the hospital emergency department.
Stones can also become stuck and lodged partway in a duct, causing a backlog of bile, which eventually ends up in the blood stream and body tissues. You may then become jaundiced and turn a bright yellow colour.
This can sometimes be confused with infectious hepatitis, but blood tests can determine the difference.
If not removed, gallstones can also lead to a
potentially serious and painful inflammation of the gall bladder known as acute cholecystitis. Emergency surgery might then be required. There is also some risk of developing pancreatitis, which is another painful and serious condition.
Most patients who require a cholecystectomy have laparoscopic surgery. This is much less intrusive than open surgery and the recovery time is quicker. It is generally performed as a day surgery procedure. The surgeon makes four small cuts instead of one large one.
A general anesthetic is still required so you will have to undergo the usual preoperative procedures, such as blood tests, and not eat or drink anything after midnight prior to the surgery. Any medications you take should be discussed with the surgeon ahead of time, and it is particularly important to avoid taking any blood thinners such as Coumadin or Aspirin for several days before.
Most patients can return home the same day, about five hours after the surgery, although some require an overnight stay. You may need to take some prescription painkillers, but often over-the-counter painkillers are sufficient.
You should arrange for a family member or friend to be with you for the first day, as you will still be drowsy until the general anesthetic has worn off. This could take a little longer at your age. Working people can generally return to work within a week, but should avoid heavy lifting and strenuous exercising for four to six weeks.
Open surgery is much more painful and often requires postoperative narcotic medication. Hospitalization is from three to seven days, and it takes about three weeks to recover to the same point that a patient having laparoscopic surgery would be at in less than a week.
The risks of surgery are the same as for any other procedures that require general anesthetic – accidental injury to other internal organs, bleeding, leakage of bile or wound infection. However, these risks are small.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
