Gallbladder problems are generally easy to treat. Since the gallbladder is not a vital internal organ, you can lead a completely normal life even without it. Gallbladder surgery, or biliary surgery, is a subspecialty of visceral surgery—that is, the surgical treatment of all organs of the digestive tract. Gallbladder surgery focuses on the surgical treatment of the gallbladder. Here you will find further information as well as a selection of gallbladder surgeons and gallbladder centers.
Definition: What is biliary surgery?
Specialists in gallbladder surgery are medical specialists in the field of visceral surgery. Visceral surgeons perform surgical procedures on the abdominal organs. Gallbladder surgeons have particular expertise in treating the gallbladder.
In the vast majority of cases, gallbladder surgeries are minimally invasive procedures that can be performed through very small incisions. For certain types of gallbladder conditions, the doctor may decide to completely remove the gallbladder. After the surgery, the patient is usually symptom-free.
The gallbladder measures about eight centimeters and is located as an elongated sac just below the liver. It serves as a temporary storage site for bile, which is produced by the liver. Very fine bile ducts collect the bile and carry it through the common bile duct into the intestine. There, the substances contained in the bile break down dietary fats.
Range of Treatments in Biliary Surgery
The most common gallbladder disorder is gallbladder inflammation (cholecystitis). If the bile duct or the opening of the gallbladder is blocked, bile accumulates in the gallbladder. This can trigger inflammatory reactions.
The cause of this bile congestion is usually a gallstone that has entered the bile ducts and is blocking them. About 25 percent of people who have gallstones experience this at least once in their lives. If there are no gallstones present, the risk of gallbladder inflammation is very low. It usually occurs only after an accident or in the presence of severe infections.
In addition to cholecystitis, there are other diseases of the gallbladder and the hepatobiliary system that require medical treatment. The hepatobiliary system refers to the functional unit comprising the liver (including the hepatic lobes), the bile ducts, and the gallbladder.
Gallstones
Gallstones are often the cause of severe pain in the upper abdomen. If you experience such pain, you should definitely see a doctor. Gallstones that cause pain can lead to further complications and diseases.
If left untreated,
- biliary colic,
- biliary inflammation, or even
- bile duct tumors
develop unchecked.
Doctors distinguish between
- cholecystolithiasis—that is, stones located in the gallbladder—and
- choledocholithiasis, which refers to stones in the bile duct.
Gallstones can also be harmless. Many people with gallstones have no symptoms for years or even their entire lives.
It is only when a stone becomes lodged that pain occurs. This results in biliary colic and the associated pain in the upper right abdomen. During biliary colic, the pain comes and goes in waves. An episode of biliary colic can last for hours.
Those affected also often suffer from a high fever, accompanied by
- nausea,
- chills, and
- nausea.
If bile backs up into the liver, it can cause yellowing of the eyes and skin (jaundice).
The diagnosis and treatment of gallbladder diseases are handled by specialists with expertise in gallbladder surgery. The doctor determines the diagnostic procedure based on the location of the stones. In most cases, palpation and ultrasound are sufficient to reliably diagnose a gallbladder disorder. In some cases, however, a cholangioscopy is necessary.
Based on this, the gallbladder specialist determines an appropriate form of treatment.
Biliary colic
Ultrasound is the method of choice for diagnosing biliary colic.
Both diagnosis and treatment are performed using endoscopic retrograde cholangiopancreatography (ERCP). During this procedure, the doctor inserts a thin tube with a small camera through the throat into the duodenum, where the bile duct system opens. With the help of an injected contrast agent, pathological changes—such as a gallstone causing an obstruction—can be clearly identified on the X-ray image.
If the colic is caused by small gallstones, it can sometimes be treated with medication. If that is not sufficient, the gallstones or the entire gallbladder must be removed. Medical instruments are inserted through the endoscope (ERCP) during this procedure.
This minimally invasive treatment is a form of laparoscopic surgery, also known as keyhole surgery. Large abdominal incisions are rarely necessary to remove the gallbladder.
A stent or small tube can also be used to widen narrowings in the bile ducts.
Bile Discharge Disorder
A chronic bile flow obstruction causes symptoms similar to those of a biliary colic, though usually in a milder form.
It is characterized by nonspecific symptoms such as
- abdominal pain,
- a feeling of fullness,
- bloating,
- diarrhea, and
- belching.
These symptoms are caused by inflammatory changes in the bile ducts.
A specialist diagnoses the obstruction based on elevated blood levels of the yellow blood pigment bilirubin. In addition to a complete blood count, ultrasound is also used to diagnose a bile flow obstruction.
The choice of treatment depends on the cause of the biliary disorder. If the obstruction is caused by gallstones, the treatment options mentioned earlier are used. However, if the pain is caused by a tumor of the bile ducts or the gallbladder, more extensive treatments are necessary.
Gallbladder Cancer
Tumors of the bile ducts and gallbladder are less common than gallstones and gallbladder inflammation. Symptoms do not appear until the later stages of cancer, so the disease is usually already quite advanced at the time of diagnosis.
It can be recognized, for example, by a backup of bile into the liver and the resulting yellowing of the skin and eyes. It can also cause
- itching,
- discoloration of the stool, and
- discoloration of the urine
.
Endoscopic imaging using injected contrast agents (ERCP) plays an important role among diagnostic tools. Other diagnostic procedures include
- ultrasound,
- computed tomography (CT), and
- magnetic resonance imaging (MRI).
In the early stages of development, it is usually still possible to halt the spread of the tumor. To do this, the gallbladder or the bile ducts must be removed at an early stage. Sometimes, partial removal of the liver is also necessary.
If the tumor has already progressed to an advanced stage, a cure is no longer possible. In such cases, treatment is aimed solely at alleviating symptoms and prolonging life.
Relieving pressure on obstructed bile ducts through endoscopic drainage and stent placement plays an important role in this process. For patients in good general health, chemotherapy is also an option.
Specialists in Biliary Surgery
As a patient, where can you find specialists in biliary surgery or gastroenterology?
It is not possible to name a single clinic or just one specialist as the best place to go in the event of a biliary disorder. However, there are clinics, specialized centers, and private practitioners who specialize in the surgical treatment of biliary diseases and have extensive experience in this field.
When treating tumors, also make sure there is close coordination between gallbladder specialists, gastroenterologists, oncologists, and radiologists.
Conclusion
Cramp-like pain in the upper abdomen that may even radiate to the back or shoulders—gallbladder problems and their effects are not only unpleasant and distressing but can also be dangerous.
The form of treatment depends on the specific symptoms: it could involve gallstones that are easily removed, but it could also involve life-threatening cancers. In any case, you should consult a specialist if you experience pain or other symptoms.
