The Gallbladder

The gall bladder is a small, pear-shaped sac that sits under the liver on the right hand side of the abdomen.  The liver produces bile and the gallbladder stores it between meals. When you eat the gallbladder squeezes and the bile flows to the first part of the small intestine (duodenum) where it aids in digestion.

Causes of Gallbladder Problems

Gallbladder problems are usually caused by the presence of Gallstones - Cholelithiasis

Other problems include:

  • Infection or inflammation of the gallbladder (cholecystitis)
  • Cancer of the gallbladder.


Gallstones are small, hard masses consisting primarily of cholesterol and bile salts that usually form in the gall bladder.

Common symptoms include:

  • Pain in the upper right abdomen that is severe and constant, and may last several hours or even for days.
  • Pain may also radiate to the back or occur under the shoulder blades,
  • Fever, sweating and chills, nausea and vomiting
  • Abdominal bloating or recurring intolerance of fatty foods

If gallstones move into and block the bile duct, pain and serious complications can occur:

  • Jaundice - Yellow discolouration of the skin or eyes
  • Infection of the bile ducts - Cholangitis.
  • Inflammation of the pancreas - Pancreatitis


Gallstones are usually diagnosed by ultrasound. This is very similar to the scan used in pregnant women to look at their babies. Occasionally the stones can be seen on a plain x-ray or CT scan

Other tests include:

  • MRI - Magnetic Retrograde Cholangiopancreatography (MRCP): A non-invasive procedure that uses a magnet to examine the gallbladder and biliary ducts.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP): This is a procedure performed under anaesthetic. The patient swallows a telescope, enabling injection of a special dye that outlines the biliary ducts (pipes). It is used to locate and remove gallstones in the bile duct. It cannot remove gallstones from the gallbladder
  • HIDA scan: Used to assess the function of the gallbladder. Using a low level radioactive dye it measures the gallbladders ability to contract and push the bile into the small intestine after a meal.

Blood tests to look for signs of infection, liver abnormalities, jaundice or pancreatitis may also be required.


The type of treatment you receive will depend on the particular problem your gallstones are causing.  Often Surgery or an ERCP will be the best approach.

It is vital that you discuss the options with your surgeon so you can make an informed decision about how to proceed.

Your surgeon will discuss the various treatment options available with their pros and cons. In patients with symptomatic gallstones who are fit for surgery the best option is usually removal of the gallbladder and gallstones - Cholecystectomy.

Surgery - Cholecystectomy

Surgery to remove the gallbladder (cholecystectomy) is performed under a general anaesthetic. It is usually performed Laparoscopically using small incisions and a telescope. Occasionally it is not possible to complete the operation this way and conversion to an open cholecystectomy is required.

Laparoscopic/Keyhole Surgery

Involves the insertion of a camera through a small incision in the belly button (umbilicus).  This allows visualisation of the internal organs on a video monitor. Three smaller incisions are used for insertion of other instruments. Most patients require only 1-2 nights in hospital and are able to return to their normal duties within 1-2 weeks

Open Surgery

Involves an 8-12cm incision in the right side of the abdomen, below the ribs. Conversion to open is for safety and to avoid complications. It is required in less than 5% of patients, but is more common if the gallbladder is infected or if there have been infections in the past. Recovery is longer requiring 4-5 nights in hospital and return to normal duties takes 4-5 weeks

Risks you Need to Know About

  • Infections and bleeding are the most common complications
  • Bile leak may occur from where the cystic duct is clipped or from where the gallbladder is removed from the liver. It occurs in approximately 1% of patients.  Management usually requires a minor operation and or an ERCP
  • The most serious complication that can occur is a bile duct injury. This is a serious problem and requires a major operation to fix it, Fortunately it is an uncommon problem (1 in 300)
  • There are other possible risks that are less common. For more information talk with Mr. Cullinan

After surgery

  • After your procedure, you will receive IV fluids (drip) until you are able to tolerate food and liquid orally – 6-12 hrs
  • You will be given regular pain relief, so you remain comfortable
  • You may have a small drain tube coming out of one of the incisions. This will usually remain in for 24-48 hours
  • More than likely your sutures will be dissolvable. If not they will need to be removed 7-10 days post-operation.
  • Remaining mobile, with frequent walks, will aid in your recovery

Discharge instructions

  • You will need to organise someone to pick you up from hospital on the day of discharge.  Discharge time ~ 9.30am
  • Wounds - Monitor them for any signs of infection, these include
    • Increased pain or temperature
    • Redness and swelling
    • Excessive discharge

You should contact the office if you have any concerns

  • Dressings - They are usually changed before discharge and you should leave them intact for 7 days. They are water resistant so you can shower. If the dressings become mucky or come off early please replace them
  • It is recommended you eat small light meals for 2-3 weeks after surgery
  • Avoid heavy lifting or strenuous activity for 2-4 weeks following surgery. Excessive straining can result in a hernia
  • Pain killers If required take 1-2 Panadol every 4-6 hours.  Do not exceed 8 per day. You may have been given a script for stronger pain killers. It is vital you follow the instructions carefully
  • Driving – You should not drive for 7 days after your surgery. If your recovery is slow or you have had an open operation this will be longer