What is the Gallbladder?
Gallbladder is an organ which produces bile, an important fluid in the digestive system. If the gallbladder is diseased, including with cancer, acute inflammation (cholecystitis), complications with gallstones or trauma [1, 2].
The removal surgery can be performed using two approaches: open surgery and laparoscopic.
The laparoscopic surgery is the more common method due to it being less invasive. In this approach, multiple small incisions are made into the abdomen and thin tubes with illumination, cameras and surgical instruments are inserted. The abdomen is inflated with gas to give the surgeon more space to operate. The surgeon navigates the surgical field on a monitor using the inserted camera. The gallbladder is then removed through the incisions [3].
The open surgery is usually opted for when the gallbladder disease is more advanced, or when the patient has areas of inflammation around the gallbladder. In this approach, a larger incision is made in the abdomen, the gallbladder is exposed and removed [4].
Possible Complications of Gallbladder Removal Surgery
Gallbladder removal is a routine and safe procedure, however, like all surgeries, carries some risks of potential complications. These include:
- Bleeding, either from the incision site (with the open surgery approach) or internally [5, 6, 7, 8];
- Infection following the surgery [5, 6, 7, 8];
- Bile leakage into the abdomen, though this is relatively rare [9, 10, 6, 7, 8];
- Injury to the bile ducts, intestines or blood vessels - this may require additional time in surgery to be repaired [6, 11];
- Digestive problems after the surgery including such as indigestion, diarrhea, or flatulence. These often resolve after some time following the surgery, as the body adjusts to digesting fats without the gall bladder [7].
- Obstruction of the bile duct if a gallstone remains stuck in the duct during the surgery. This may lead to pain, jaundice (yellowing of the skin) or infection [7];
- In some rare cases, gallstones may spill into the abdominal cavity during the surgery, leading to complications such as abscesses or fistulas. On imaging later, these can even mimic cancers [9, 10].
Can you die from gallbladder surgery?
While gallbladder removal is a safe procedure, complications, including death, happen from time to time. However, the mortality rate is relatively low.
Patient data indicate that within 30 days, the mortality for all patients undergoing gallbladder removal (regardless of the reason and/or approach) was 0.4% [12]. Another study supported this low number by concluding an overall mortality of 0.307% [13]. However, it is important to note that some factors influence the mortality in a way that it is higher in certain patient groups. For example, in cancer patients the 90-day mortality can be 2.3-fold higher than the 30-day mortality (17.1% vs 7.4%) [14].
Minimising Mortality in Gallbladder Surgery
Naturally, healthcare professionals aim to minimise the risk of complications and death with gallbladder removal, as well as any other procedure. Therefore, these are the considerations to reduce the mortality:
- Patient selection and timing of the surgery - patients that are older and have other illnesses (comorbidities) are at a higher risk [15]. Therefore, careful preoperative assessment, and perhaps delaying the surgery until other issues are resolved (if possible) is essential.
- Secondly, the type of surgical approach matters. Minimally invasive surgery is increasingly used for gallbladder removal, especially in cancer patients, as it has been associated with lower mortality rates compared to open surgery [14].
- Completeness of surgical resection is important - the surgeon must ensure that the removal was complete, as incomplete surgical resection has been associated with increased 30- and 90-day mortality [14].