Gallbladder removal surgery (Cholecystectomy) caused by Choledocholithiasis

EJ
Emeh Joy

A case of gallbladder stones or bile duct stones (Choledocholithiasis) can result in the surgical removal of the gallbladder (cholecystectomy). Do you know where your gallbladder is located and its role?

Here, we will break down the seemingly strange medical jargons (choledocholithiasis, cholecystectomy), talk about the gallbladder and its roles, gallbladder removal, gallbladder purpose and of course where you can locate it in the body and other anatomical correlations.

What is Choledocholithiasis, cholecystectomy?

Choledocholithiasis is a condition commonly referred to as 'stones in the bile duct' or 'bile duct stones'. It is characterised by the presence of gallstones in the common bile duct.

Gallstones are hard deposits of digestive fluid which accumulates and form a mass in the gallbladder. They vary in size from as small as a grain of sand to as large as the size of a golf ball.

While some people develop just one gallstone, others develop many gallstones at a time.

Stones in the gallbladder can be painful and discomforting, hence the need to get get rid of the 'stones' or seek some other form of relief. This is where cholecystectomy which is gallbladder removal via surgery comes in.

Typically, gall stones form in the gallbladder. However, according to research published in Medical Clinics of North America, about 15% of people with gallstones have it in their bile duct (the duct or channel that moves bile from the gallbladder into the duodenum).

Gallstones formed in the gallbladder

There are different ways of treating Choledocholithiasis such as stone extraction, stone fragmentation, biliary stenting and then cholecystectomy. Cholecystectomy is the surgical removal of gallstones through an incision in the abdomen.

Doctors generally resort to surgery as a way of providing permanent relief to patients with gallstones and other gallbladder related problems.

What is the role of the gallbladder?

People often wonder, what is the purpose of the gallbladder? The primary purpose of the gallbladder is to store bile which is produced by the liver. Bile is a substance which plays a vital role in the digestion of fats.

Bile helps the body break down and absorb fats. The purpose of the gallbladder is to store the extra bile the liver makes so that each time you consume fatty meals, it releases bile that will help digest the fatty food.

Anatomy of the gallbladder

The gallbladder is a small organ located laterally underneath the liver. It can also be said to be located within the right hypochondria region of the abdominal area. It is pear-shaped and lies within a fossa between the right and quadrate lobes of the liver.

Ventral view of the gallbladder lying on the right side of the abdomen, just underneath the liver

It lies in close proximity to:

  • the inferior border of the liver (anteriorly and superiorly)
  • The transverse colon and proximal duodenum (posteriorly)
  • The biliary tree and remaining parts of the duodenum (inferiorly)

The gallbladder is considered an accessory digestive organ as it is an organ found in the digestive tract which facilitates the absorption of micronutrients from macromolecules which have been ingested.

Diagram showing parts of the gallbladder, its parts and the biliary system

The gallbladder is made up of three major parts- the fundus (the rounded distal portion), the body (the largest part) and the neck (the part that tapers to continue with the cystic duct).

Components/features of the gallbladder

You can't talk about the gallbladder without mentioning the biliary tree. The biliary tree consists of several gastrointestinal ducts that allow bile which is synthesised in the liver to be stored in the gallbladder before it gets released into the duodenum.

Left and right hepatic ducts

Initially, bile is secreted from hepatocytes (liver cells) and gets drained from lobes of the liver. The right and left hepatic ducts collect the bile secreted by the liver and channels it into the common hepatic duct.

Common hepatic duct

This is form by the amalgamation of the left and right hepatic duct. It runs alongside the hepatic vein. It runs downwards to be joined by the cystic duct.

Cystic duct

This duct runs from the gallbladder to join the common hepatic duct. It allows the inflow and outflow of bile from the gallbladder.

Common bile duct

The common bile duct is formed at the point where the cystic duct and the common hepatic duct joins. It descends and passes posteriorly into the first part of the duodenum and then the pancreas where the main pancreatic duct joins it.

Vasculature of the gallbladder

Vasculature of gallbladder refers to the blood supply to the gallbladder. What are the arteries and veins that drain the structure? Let's look at the gallbladder blood supply.

The gallbladder, related structures, arterial supply and venous drainage

Arterial supply (blood supply) to the gallbladder is via the cystic artery (a branch of the right hepatic artery).

Venous drainage of the gallbladder neck is through the cystic veins, which directly drains into the portal vein. On the other hand, venous drainage from the fundus and the body of the gallbladder are emptied into the hepatic sinusoids.

Lymph drainage from the gallbladder is via the cystic lymph nodes which are located at the neck of the gallbladder. The cystic nodes further empty into the hepatic lymph nodes, which then drains into the coeliac lymph nodes.

Innervation of the gallbladder

Innervation of the gallbladder refers to the nerve supply to the gallbladder. Which nerve runs through it?

The gallbladder receives sympathetic, parasympathetic as well as sensory innervation. The coeliac plexus provides the sympathetic and sensory fibres while the vagus nerve supplies parasympathetic innervation.

The parasympathetic nerve stimulation causes the contraction of the gall bladder and then the secretion of bile into the cystic duct.

Risks of cholecystectomy

The surgical removal of the gallbladder rarely comes with serious complications. However, just like every surgical operation, there are small risks of complications such as:

  • Bleeding
  • Bile leak
  • Infection
  • Risk of general anaesthesia
  • Injury to nearby structures like liver or small intestine

What causes the formation of gallstones?

Gallstones form when substances contained in the bile crystallise or hardens. There are typically two types of gallstones named according to what causes its formation- cholesterol gallstone and pigment gallstones.

Cholesterol gallstone is caused by an excess of cholesterol. This type of gallstones consist mostly of cholesterol and is the most common type of gallstone.

Pigment gallstone is mostly composed of bilirubin and calcium salts as it is formed when they are in excess in bile. They form the smaller and darker stones.

What happens when the gallbladder is removed?

Now, we know that gallstones can be formed in the gallbladder (Choledocholithiasis) and that gallbladder can be surgically removed via cholecystectomy.

The question is: Can you live without your gallbladder?

Don't fret; humans very much survive without the gallbladder. What the gallbladder basically does is to store the extra bile the liver produces for release when you eat food that contains fat.

This doesn't mean your body can't function without the gallbladder. Normal digestion still takes place without the gallbladder.

Bile will also get to your small intestine in the absence of the gallbladder. The only thing is that it won't be stored along the way in the gallbladder.

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