Q: I have been having on and off abdominal pain for the past one year. This is particularly severe after meals. My doctor told me that I have gallstones and that the only way to deal with them is through surgery to remove the gallbladder.
What are the risks of having surgery? Can someone become pregnant afterwards? Which is the best hospital for this procedure? How much does it cost?
Gallstones are a common problem in Kenya. Most occur in women above the age of 30. In fact, for the longest time, gallstones were popularly referred to as a disease of the 4 Fs because it occurred mainly in fat, fertile, females aged over 40.
Other risk factors for the development of gallstones include:
-Family history of gallstones -Rapid weight loss -Eating a high-fat, low-fibre diet -Use of hormonal therapy (especially use of oestrogen) -Liver disease -Sickle cell disease (sickle cell anaemia) -Having diabetes -Pregnancy.
Treatment options for gallstones
There are several options for managing gallstones:
Watch and wait: One can opt to do nothing about the gallstones. This is reserved for non-symptomatic stones (those that are not causing pain). Most people with non-symptomatic gallstones do not need any intervention.
Medication: There are drugs that can be given to dissolve the gallstones. This, however, is not considered an ideal solution because gallstones recur upon discontinuation of treatment. Use of drugs is best for patients who are not fit for surgery.
Surgery: This involves removal of the gallbladder. The procedure can be done through either keyhole surgery (laparoscopy) or open surgery (the more traditional approach). For keyhole surgery, the recovery is much faster and patients are discharged on the same day (or a day after the procedure). Most people can return to work within two weeks of having the procedure. If the procedure is performed through open surgery (where the surgeon makes a long cut on the belly), recovery is much slower.
Shock wave lithotripsy: Shock waves are sent to the gallbladder using a special machine to break down the stones in the process. Although this procedure is successful in dealing with kidney stones, it is not effective in managing gallstones.
Can I live without my gallbladder?
This is the most common concern among people. The gallbladder is a little pear-shaped pouch found below the liver. Its sole purpose is to store digestive juices produced by the liver. When you eat, the body sends a signal to the gallbladder to release the juices into the intestines. If you remove the gallbladder, the liver still continues to produce the digestive juices and deposits them directly into the intestines each time you eat.
Risks of surgery
Anaesthetic: Just like any other medication, anaesthesia can have side effects. In addition, certain medical conditions increase risks of getting these side effects. For example, it is riskier to give anaesthetic drugs to a person with heart or lung problems than it is for a healthy person. For this reason, you will require a review by a doctor.
Bleeding: This usually occurs due to damage of blood vessels in the area of the operation. Most of the time, the bleeding can be controlled by the surgeon.
Infection: It is possible to develop infection (either internally — where the gallbladder was located — or externally at the skin wounds made during the surgery).
Accidental damage to internal organs: Occasionally, the organs surrounding the gallbladder may be damaged during surgery. This includes injury to the intestines, stomach, liver or bile ducts (little tubes connecting the liver to the intestines).
Possible long-term complications
Persistent abdominal discomfort: Some people report persistent abdominal pain and bloating after the procedure.
Hernia: The incisions used by the surgeon to enter the abdomen during the procedure remain as areas of weakness throughout one’s life and they can open up several months or years after the surgery. If this happens, the resultant defect is known as an incisional hernia. Incisional hernias occur more commonly in people who had infection in the surgical wounds, overweight people (or after rapid weight gain) or during pregnancy. Usually, hernias require surgery to close them.
Where can the procedure be done?
This procedure can be done in most government, private and mission hospitals. In public hospitals, the procedure is done through open surgery whereas in the private sector, it can be done through laparoscopy. The cost of the procedure varies greatly in the different hospitals. In private hospitals, it can range from Sh50,000 to Sh400,000.
Pregnancy after gallbladder surgery
Gallbladder surgery does not interfere with one’s ability to get pregnant or sire children. You can become pregnant once you fully recover from your surgery. (Some doctors advise waiting at least one year to try and reduce the risk of incisional hernia formation).