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Seven Things You Should Know About Gallbladder Attacks and Removal

Gallstones and inflammation can cause recurrent unwelcome pain. A general surgeon explains why this happens and what to expect if you need surgery.

Abdominal pain can be startling at any age. Often, the location of the pain is a good indicator of the underlying cause. And if you’ve ever experienced a sharp, cramping pain in the upper right side, there’s a good chance the culprit is your gallbladder.

Gallstones, gallbladder sludge (or bile) and inflammation of the gallbladder – also known as cholecystitis – affect more than 10% of adults in the United States, often leading to surgical removal through a cholecystectomy.

To better understand what causes the gallbladder to dysfunction, when you might need surgery and what to expect throughout recovery, we spoke with general surgeon Dr. Roy Sandau.

What does the gallbladder do and what causes complications?

The gallbladder is a small pouch attached to the liver and bile ducts that stores bile before it passes into the small intestine to help digest fats, explains Dr. Sandau. Usually, a diet high in fatty, processed foods, as well as high cholesterol, can cause gallbladder sludge and gallstones – which in turn block ducts and keep the gallbladder from emptying, causing inflammation.

Aside from dietary behaviors, you may be more at risk for these complications if you’re female, overweight, on hormone therapy, over the age of 40, lead a sedentary lifestyle or are of certain ethnicities, particularly Native American or Hispanic.

What does a gallbladder attack feel like?

Most people experience gallbladder pain in waves, says Dr. Sandau. It can come and go, lasting for a few minutes to several hours and is often triggered by a fatty meal. While the pain typically strikes in the upper right side, below the rib cage, some people have stinging pain similar to heartburn or GERD (gastroesophageal reflux disease) in the upper-middle abdomen. This pain can also radiate to the upper back and shoulder blades.

Because GERD and gallbladder symptoms overlap – and can even be triggered by the same foods – gallstones can go overlooked for years, explains Dr. Sandau. “You may think you can stay home and pop more antacids because it’s your reflux acting up, but this isn’t always the case.”

When do you need your gallbladder removed?

If gallbladder pain is severe, persists for several hours or is accompanied by nausea, vomiting or fever, you should go to the emergency room, urges Dr. Sandau. Some small stones or sludge can resolve on their own by passing through the bile duct and bowel, while others are treated with medicine. However, others are too large and can lead to swelling and infection. In this case, an emergency cholecystectomy is needed.

Whenever you have recurrent and worsening pain, it could indicate a larger problem, says Dr. Sandau. It’s important to follow up with your primary care provider or gastroenterologist to address the need for further testing and discuss whether an elective cholecystectomy is right for you.

How does a cholecystectomy work? 

Most cholecystectomies are laparoscopic, same-day procedures and take less than an hour. Robotic surgery also helps minimize complications and allows for a shorter recovery time and less pain.

[Editor’s Note: Read more about robotic systems, such as the da Vinci® XI Robotic Surgical System here.]

With a robotic cholecystectomy, three to four small incisions are made to place ports into the abdomen. Instruments can then identify and separate structures with incredible precision using a clear 3-D visual, explains Dr. Sandau.

How long does pain last?

With minimally invasive procedures, robotic or not, pain is typically short-lived for about two to three days. Most people can move around easily and return to normal daily activities within three to five days, says Dr. Sandau. Depending on your type of work, you should be able to return to your job this quickly too. If your job requires significant physical labor, discuss with your surgeon when it is safe to return.

“If pain doesn’t subside and worsens after a few days, accompanied by nausea, vomiting, fever and chills, it could be a sign of infection – a risk with any surgery – and should be brought to your surgeon’s attention as soon as possible,” says Dr. Sandau. Another rare risk after gallbladder surgery is jaundice, which causes yellowing of the skin and eyes and needs to be closely monitored.

How can you relieve bloating after surgery?

“A little bloating and pressure from gas after surgery is normal, especially after a procedure where we fill the abdominal cavity with carbon dioxide to see clearly,” explains Dr. Sandau. Anesthesia can also slow gastric and bowel motility for about two to three days.

The best way to relieve bloating and gas after surgery is to walk around – to encourage bowel movement – take deep breaths and avoid carbonation.

Do you have to go on a special diet once your gallbladder is removed?

Dr. Sandau recommends resuming a normal diet after surgery, unless you experience nausea from the anesthesia, in which case sticking with light, soft or liquid items may be wise until the nausea subsides.

While there’s no set diet after gallbladder removal, keep in mind that the body will need time to recover from surgery and it may take longer to tolerate fatty, greasy and fried foods. Everyone responds differently to them, but they may cause some discomfort, diarrhea or weight gain.

[Main photo credit: iStock.com/ben-bryant]

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