The gall bladder sits just underneath the liver and its job is to store bile that is produced in the liver (or 'gall') to help the body breakdown, or emulsify, fat that is ingested. The way it does this is to allow a small quantity of bile into the small intestine when it detects the presence of fat in the gut that needs to be broken down. The gall bladder itself is generally around 8cm long and 4cm wide and can hold about 100ml of bile.
The main reason for gall bladder surgery is the formation of gallstones. When gallstones are present they can block the 'neck' of the gall bladder and cause a lot of pain, which is mainly felt as a sharp pain under the ribs on the right hand side of the body. This pain can also extend to the back and shoulders, and is sometimes confused with a heart attack.
It's not known exactly what causes gallstones to form, but one theory is that when the gall bladder is doing its job of concentrating the bile before releasing into the intestine, excess cholesterol in the bile forms crystals that then naturally grow into stones.
Gallstones are twice as common in women as in men and generally occur between the ages of 20 and 60. Apart from gender, risk factors for gallstones include obesity, high levels of oestrogen (either naturally or from birth control pills or hormone replacement therapy), cholesterol lowering drugs, diabetes and rapid weight loss. To reduce the likelihood of getting gallstones, current medical advice is not to smoke, get plenty of exercise and eat a balanced diet with lots of vegetables. Drinking a cup of coffee a day may also help.
Around 70-80% of people with gallstones notice no ill effects at all, but where there is severe and/or regular pain, or where an infection sets in, gall bladder surgery is necessary. Gall bladder surgery is also very common – around 18,000 gall bladder operations are carried out in Australia every year.
In almost all cases, gall bladder surgery involves the complete removal of the gall bladder, and this is due to the complexity and risks associated with attempting to remove individual stones and the high likelihood that stones will form again. In practice the human body can manager perfectly well without the gall bladder – what then happens is that bile drips continuously into the small intestine, which is perfectly adequate for the way that food is consumed today. The gall bladder was more important for earlier hunter/gatherer humans who would eat very large quantities of fat at one sitting (nonetheless it's advisable not to eat large high fat meals once you have had your gall bladder removed).
Gall bladder surgery is often carried out using keyhole surgery (laparoscopic cholecystectomy). In this procedure a series of small incisions are made in the abdomen and the surgeon inserts a device incorporating a tiny camera and light source and cuts away and removes the gall bladder after removing the stones. Keyhole surgery is the best options for short recovery times, but is not always possible, especially in cases where infection has set in or where other factors affecting the surgeon's ability to identify and operate on the gall bladder mean that conventional surgical techniques need to be used.
After keyhole surgery most patients are able to return home the next day and go back to work within a week to 10 days. After conventional surgery, patients generally need to stay in hospital for up to five days, with a home rest period of 4-5 weeks before returning to normal activity.