There are different operative procedures, endoscopic procedures and lithotripsy methods available to treat gallbladder cancer and gallbladder inflammation or gallbladder stones. They include gallbladder removal (choleocystectomy), gallbladder cystoscopy (endoscopic retrograde cholangiopancreatography) and shock wave therapy (extracorporal shockwave therapy).
Gallstones are the main reasons for surgical procedures on the gallbladder. Constrictions or blockages in the bile duct caused by tumours are further, rarer reasons for a surgery on bile ducts or the gallbladder. Gallbladder stones can often exists unnoticed and without symptoms for many years. However, they can also lead to infections in the gallbladder and to constriction of the bile ducts. The consequences are typical gallbladder colic. Jaundice occurs in a run-off area of the gallbladder. In such cases, often only surgical treatment can provide relief.
What preparations are carried out before the procedure?
Different examinations are carried out to precisely clarify the symptoms and determine the reasons. An ultrasound examination and depending on the situation a computer tomography, an MRI and a gallbladder cystoscopy are also involved.
All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement, and an ECG. All blood-thinning medication must be discontinued prior to surgery. Gallbladder operations are carried out under general anaesthetic. Patients should have an empty stomach for the procedure.
How is the operation performed?
Basically, there are three different procedures available to remove gallstones. Gallbladder removal (choleocystectomy), the destruction of the gallstones with shock waves (extracorporal shock waves) and the endoscopic removal of gallstones via a gallbladder colonoscopy (endoscopic retrograde cholangiopancreatography). Gallbladder colonoscopy is also used diagnostically to localise the gallstones and to clarify gallbladder diseases. Gallbladder removal is also carried out in patients with gallbladder cancer.
Gallbladder removal, cholecystectomy
Gallbladder removal is nowadays practically only carried out with minimally invasive laparoscopic technology. Several small skin incisions are required for laparoscopic surgery to be able to insert the camera and surgical instruments into the abdomen. Currently, however, a procedure is becoming increasingly established which requires only a skin incision at the depth of the navel. During this procedure, the camera and the surgical instruments are inserted over a single incision in the navel into the abdomen. The abdominal area is then inflated with CO2 to gain a better view and more space for the procedure to occur.
If necessary, an endoscopic application of x-ray contrast agent takes place in the bile ducts (endoscopic retrograde cholangiopancreatography). In this way, gallstones can be exactly located on the x-ray image. If there are stones in the bile ducts, these are thus removed. Then the blood vessels of the gallbladder and the bile duct are pinched off and closed with clips. Afterwards, the gallbladder is carefully detached and removed from the liver. Finally, CO2 is discharged and the operation wound in the navel is sutured. The operation takes approx. one hour.
Gallbladder colonoscopy, endoscopic retrograde cholangiopancreatography
Gallbladder colonoscopy is a method used to inject contrast agent into the bile ducts and to examine them with a camera (cholangioscope). It serves to clarify diseases of the bile ducts and the pancreas duct. However, the technology can also be used therapeutically. Smaller gallstones can be removed in this way. In the event of constrictions or blockages of the bile ducts by tumours, gallbladder colonoscopy is used to expand the bile ducts or to lay metal or plastic tubes (stents).
The examination usually takes place under general anaesthetic. The endoscope inserted via the mouth is fed through until it reaches the duodenum. There an x-ray contrast agent can be applied in the bile ducts to illustrate the bile ducts in the x-ray image. Or the cholangioscope can be fed into the gallbladder via the bile duct to examine the bile duct and the gallbladder.
Shock wave therapy
Extra corporal shockwave therapy is a gentle procedure to destroy gallstones. High energy shock waves are intermittently focused on the body over water cushions from the outside. These destroy the gallstones. If the stones are in the gallbladder, no anaesthesia is required. Stones in the bile ducts are usually destroyed under regional anaesthetic or under general anaesthetic. Patients who undertake shock wave therapy must have an empty stomach for 12 hours. Patients who are taking blood-thinning medication may not undertake any shock wave therapy. A treatment takes approx. one hour. However, several treatments are usually required.
What is the success rate of this procedure?
Removal of the gallbladder rectifies gallbladder stone disease. During another procedure with shock wave therapy or endoscopic removal, it can result in recurrences as new stones can form in the gallbladder.
The success rates for surgery due to cancer depend on the type of the cancer and the stage it is in.
What are the possible complications and risks of this procedure?
Gallbladder removal is a routine operation. As with all surgery, the operation may occasionally lead to infections, nerve damage, post-operative haemorrhaging or growths. In very rare cases, this can result in a peritoneal inflammation due to leaky bile ducts.
What happens after the operation?
Shockwave therapy and the endoscopic examination are usually carried out on an outpatient basis. After the gallbladder removal, a hospital stay of two to three days is required. The removal of the gallbladder does not limit the body in any way. The bile now flows continuously in small amounts into the duodenum. The submission of a one-off larger amount of gallbladder fluid to digest particularly fatty food is on the other hand no longer possible. Therefore, care is recommended when eating high-fat foods. It is better not to consume overly rich food and in smaller portions.
After the gallbladder removal, major physical exertions should be avoided for two to three weeks. Depending on their work, the patient will not be able to work for between one and three weeks.