The gallbladder is a small organ that stores bile produced by the liver and releases it after food intake. The bile emptied by the gallbladder into the duodenum is used for the digestion of fats.

Why do gallstones form in the gallbladder?

The substances in bile are found in specific proportions to create a balance with each other. Changes in these proportions lead to the formation of stones. Additionally, genetic factors, infections in this area, factors that obstruct bile flow, high cholesterol levels, etc., can contribute to stone formation. In our country, cholesterol stones are the most common.

What are the types of gallstones?

Cholesterol stones are usually green, but sometimes they can be white or yellow. They are mainly composed of cholesterol. The green-brown color of the stones indicates that they are cholesterol stones. Pigment stones are small dark-colored stones composed of bilirubin and calcium salts found in bile. They make up 20% of gallstones. Risk factors for pigment stones include genetic blood cell disorders such as cirrhosis, bile duct inflammation, and sickle cell anemia. Stones of mixed origin can also occur.

How are gallstones detected in the gallbladder?

The most suitable diagnostic method is abdominal ultrasound. Its main advantages are its ease of application and lack of side effects. Abdominal ultrasound can detect gallstones with a success rate of 98%. This test, performed on an empty stomach, provides information about many features of gallstones, such as their number and size. However, ultrasound may not provide sufficient information in the presence of gallbladder sludge or functional disorders.

What symptoms does the presence of gallstones in the gallbladder cause?

The majority of patients with gallstones in the gallbladder have no symptoms. Stones are detected during an abdominal ultrasound examination. These are also called silent stones. Gallstones in the gallbladder can remain silent for many years without causing any problems, but sometimes they can suddenly appear with very severe symptoms. Patients with gallstones in the gallbladder may experience abdominal pain accompanied by complaints such as nausea and vomiting. The pain often occurs in the upper abdomen and right side but can sometimes occur in the middle and may radiate to the back between the shoulder blades. The pain usually subsides within a period ranging from 15 minutes to 4 hours after onset. If it continues uninterrupted and reaches a duration of 6 hours, then either an inflammatory process caused by the stone has begun or is about to begin. Gallstones in the gallbladder can also lead to more serious problems. Depending on the stones falling from the gallbladder into the main bile duct, more serious conditions such as obstructive jaundice or pancreatitis may occur.

How is gallbladder surgery performed?

The gold standard method for the treatment of gallstones is laparoscopic cholecystectomy, which is the removal of the gallbladder by a closed method. This surgery is performed by entering the abdominal cavity with trocars, which are two 1 cm and one 0.5 cm incisions. The operation is completed within an average of half an hour.

Robotic surgery for gallbladder surgery is another option today. Like laparoscopic surgery, the surgery is performed by entering the abdominal cavity with trocars, and the robotic arms' working arms are entered into the abdominal cavity.

Is the gallbladder or stones removed during surgery?

When stones form in the gallbladder, it also indicates a problem with the gallbladder's function. If only the stones are removed, new stone formation will be inevitable after a while. Therefore, during gallbladder surgery, not only stones but the entire gallbladder are removed.

Is surgery necessary for stones that fall into the main bile duct?

A procedure called endoscopic retrograde cholangiopancreatography (ERCP) is performed to enter the main bile duct and remove the stones in this area. Subsequently, the gallbladder is removed with a closed surgery. Thus, a significant reduction in the size of the surgery is achieved. However, if ERCP cannot be performed on the patient or if the stones cannot be removed with ERCP, stones in the main bile duct are removed by surgery.

What are the advantages of laparoscopic (closed) and robotic surgery?

Compared to the large incision in open surgery, laparoscopic surgery provides a much more comfortable postoperative period. Patients are discharged after one day of observation and return to their daily lives within two to three days. Also, the development of incisional hernias is much less common in laparoscopic surgery compared to open surgery.

Will there be digestive problems after gallbladder removal?

Bile is produced by the liver and stored in the gallbladder. Therefore, there will be no problem with bile production after surgery, and it will continue to be secreted into the duodenum. On the contrary, the patient's complaints such as indigestion and pain before surgery will disappear.

What should be considered in nutrition after surgery?

For a few days after surgery until gas discharge occurs, a diet rich in fluids and low in fat and carbohydrates should be preferred. In the following week, transition can be made from fibrous to solid foods that are not calorie-dense. Patients can eat whatever they want from the tenth day after surgery. Our team and dietitian provide detailed information to our patients about postoperative diet and other issues.

Obesity and Gallstone Relationship

While cholelithiasis is seen in 5% of the general population, it increases to 45% in the obese population. Increased secretion of cholesterol by the liver and decreased gallbladder contraction function due to increased cholesterol concentration and increased mucin concentration in bile play an important role in the formation of gallstones.

Asymptomatic gallstones may become symptomatic 6-12 months after surgery. It is known that symptoms are seen in 30-52% of patients with gallstones in the gallbladder after obesity surgery, and serious complications are observed in 2-3% of patients. We know that the risk of gallstone disease and cholecystitis after obesity surgery is 5.5 times higher than the general population.

In light of this information, simultaneous cholecystectomy (removal of the gallbladder) is recommended during obesity surgery in patients with detected gallstones to minimize the risks associated with possible gallstones and avoid a second surgery.

If there are characteristics that would put simultaneous cholecystectomy at risk in the patient, such as a BMI over 60, porcelain gallbladder, anatomical difficulties, etc., cholecystectomy is planned for 6 months later.

Regular ultrasound checks for cholelithiasis should be performed every six months in all patients who have undergone obesity surgery with or without simultaneous cholecystectomy. Ursodeoxycholic acid preparations can be used for the prevention of stone formation in the gallbladder and bile ducts after obesity surgery.