Gallbladder: Friend or Foe?

The gallbladder is a pear-shaped organ that's 3-4 inches long and located next to the liver. The word `gall' comes from the Greek word for `bile' - appropriate, since the gallbladder is the sac in which bile is stored until it's released to aid digestion. It's the liver that produces bile, a greenish-yellow fluid that breaks down fats during digestion. About half of the bile is delivered directly to the small intestine by way of a duct that runs from the liver, and the other half is stored in the gallbladder until it's needed. The gallbladder and the bile ducts are collectively called the biliary (from `bile') system.

Like all the organs of the body, the gallbladder works in concert with other organ systems to assure the smooth functioning of the body as a whole. "When you eat, the small intestine releases hormones that cause the gallbladder to contract and pump more bile to the small intestine to help digest and absorb fats," explains Doylestown Hospital surgeon Joseph Curci, MD. "But if something is blocking the flow of bile - such as a gallstone, a bacterial infection in the bile duct system, or a tumor - the contractions can be futile and painful." In addition, bile that backs up in the gallbladder can cause a serious infection of the bile ducts, pancreas, or liver, sometimes causing a medical emergency.

Most gallstones form because the chemistry of the bile, for any number of reasons, is out of balance. Components of the bile stored in the gallbladder can then start to crystallize and clump together into a stone-like material. These `stones' can be as small as a grain of sand or as big as an egg. Regardless of their size, gallstones generally don't cause symptoms - such as pain, nausea, or jaundice - and are not considered a problem unless they create pressure or block the flow of bile. Gallbladder `sludge,' a thick substance composed of crystallized bile without stone formation, can also cause problems by impeding the flow of bile through the gallbladder.

"Stone or sludge formation indicates a fundamental dysfunction of the gallbladder," says Doylestown Hospital surgeon Brett Harrison, MD. "For many people, this dysfunction or disease may never produce symptoms if the flow of bile is unobstructed. However, once you have symptoms, whether they be from gallstones or other diseases of the gallbladder, surgical removal of the gallbladder is the only permanent solution."

When it comes to the gallbladder, `surgery' means something far different from what it meant 15 or 20 years ago. "With few exceptions, we perform minimally invasive laparoscopic cholecystectomy [surgical removal of the gallbladder] today, as opposed to traditional `open' surgery, to remove gallbladders," says Dr. Curci. "In fact, only 3 to 10 percent of patients wind up needing an open procedure. Either type of surgery typically offers excellent results, but with laparoscopic surgery, patients feel better faster."

Dr. Harrison concurs. "It is almost always our intention to do the surgery laparoscopically," he says. However, if the gallbladder and surrounding area are not clearly visible through the camera on the laparoscope, the surgeon must perform an `open' procedure requiring a larger incision. "It's generally best to have surgery done earlier rather than later once symptoms occur," says Dr. Harrison. "If the problem has progressed to the point where there's a lot of swelling and inflammation that interferes with what we can see laparoscopically, we have to convert to an open procedure."

Following surgery, bile that used to be stored in the gallbladder is released directly to the small intestine by the liver. The gallbladder, like the appendix, has joined the ranks of expendable organs. And thanks to laparoscopic surgery, its exit is swift and - if not completely painless - at least more comfortable and convenient than ever before.

Dr. Joseph Curci is a surgeon with offices in Doylestown. Dr. Brett Harrison is a surgeon with Derrick and Harrison, PC, Doylestown. Dr. Richard Murray is a surgeon with Doylestown Surgical Associates.

"I thought I was having a heart attack."

With those words, Kathleen McSherry of Doylestown recalls her first gallbladder attack in September of 2006. "The excruciating pain, shortness of breath, lightheadedness, nausea - all the symptoms seemed to be there. It wasn't until they did an EKG and sonogramin the hospital's Emergency Department that I found out that the real culprit was my gallbladder. It was a shock because I'd never had any indication that I had a problem, but it was also a tremendous relief."

Kathleen had laparoscopic surgery at Doylestown Hospital several days later and was back on her feet in no time. "I had surgery at 5:00 pm and was up doing laps in the hallway outside my hospital room at 8 o'clock the next morning while waiting to be discharged. All in all, except for being a bit more tired than usual, I didn't miss a beat."