What is Gallbladder & Its Function
It is a pear type structure located on the undersurface of right lobe liver inferiorly, that’s why pain of gallbladder disease is located on right upper abdomen; Liver produces bile and part of it get stored in the Gallbladder; function of bile is fat digestion; in the absence of gallbladder, bile produced by the liver trickle in continuous fashion and help in fat digestion that’s why post-operatively after removal of it our body gets adapted and after 4-6 months there is no much difference in fat digestion process.
Gallstones formation is common, there are various theories about there formation but there is no preventive method; Patient most commonly present with right upper abdomen pain, 20-30% can have dyspeptic symptoms; Ultrasound done for these symptoms detects stones in the gallbladder
For symptomatic patients Surgery (Laparoscopic Cholecystectomy in which whole of the gallbladder is removed ) is preferred; It is a day care surgery in which patient is operated in the morning and can be discharged in the evening and from next day onwards patient can do normal day to day activities Because of Complications of Gallstones such as Jaundice/ Cholangitis/Pancreatitis/Cancer even in asymptomatic patients, Surgery is preferred
Gallbladder Cancer is common in North India and patient most commonly present with right upper abdomen pain, other symptoms can be loss of appetite/weight loss/jaundice/vomiting; Vomiting and Jaundice occur when the tumor spread locally and involve duodenum or pylorus and biliary system respectively
USG abdomen is the first modality of investigation whenever patient present with pain abdomen; USG in these patients show irregular GB wall thickening/GB mass; CECT abdomen is done in suspected Gallbladder Cancer on USG, as CT gives more idea about the mass/thickening, local and distant spread; FNAC is not done as it may cause seedling of tumor cells along the needle tract, MRCP is done when patient present with jaundice; Upper GI Endoscopy is done in suspected duodenal/pylorus involvement
Surgery is the treatment of choice if tumor is resectable and patient is fit for surgery, role of chemo or radiotherapy is less; First Staging Laparoscopy is done and if no distant metastases is detected in staging laparoscopy then right subcostal incision is given, first inter aorto-caval lymph node sampling is done and if negative for malignancy then radical cholecystectomy with lymphadenectomy is performed in which segment IV B and V of liver is resected; Intra-op cystic duct margin is sent for frozen section if it is positive then CBD exicision with Roux-en-Y Hepatico-jejunostomy is done
Locally advanced tumors can involve duodenum/pylorus/hepatic flexure/Biliary system; In these cases tumor is removed en-bloc with involved organs; when the tumor involve biliary system and patient has jaundice and a major liver resection is planned pre-operative biliary drainage is done to lower down the bilirubin level before surgery