The gallbladder is an organ located in the right upper abdomen, underneath the liver. The gallbladder collects and stores the bile that is produced by the liver. Bile is sent into the intestine by way of the common bile duct and is used to digest fats.
The most common disease of the gallbladder is gallstones, also known as cholelithiasis.
Gallstones are solid formations made of bile salts, cholesterol (fats) and the breakdown product of red blood cells (bilirubin). The stones may become trapped in the neck of the gallbladder and block the flow of bile, which can cause inflammation or swelling of the gallbladder. This inflammation is known as cholecystitis.
Gallstones can range in size from very small to very large (approximately the size of a golf ball). Patients can have one stone or many small stones.
Risk factors for gallstones include:
The swelling of the gallbladder causes pain in the right upper abdomen, usually after eating, especially after eating foods high in fat. Patients may also have nausea, vomiting, and fever. The gallbladder can become infected (cholecystitis) or the gallstone can block the entire biliary system, causing jaundice (yellow skin and eyes), dark urine, and light stools. This can lead to cholangitis (inflammation of bile ducts) and pancreatitis (inflammation of the pancreas).
The symptoms of gallstones can be similar to the pain caused by another gallbladder condition, in which gallstones are not present, known as biliary dyskinesia. Biliary dyskinesia is a motility disorder that affects the ability of the gallbladder to release bile. It is characterized by altered tone of the sphincter of Oddi (the sphincter which opens to allow flow of bile). The altered tone causes a disturbance in the coordination of contraction of the biliary ducts and/or a reduction in the speed of emptying of the gallbladder.
Gallstones and related gallbladder disorders are typically diagnosed by ultrasound but may also be diagnosed by:
Gallstones are typically treated by removing the gallbladder with a surgical procedure known as a cholecystectomy. In most cases the gallbladder surgery is performed by a minimally invasive method known as laparoscopic cholecystectomy. Some children might require an open cholecystectomy. Both procedures are performed in the operating room under general anesthesia.
Laparoscopy, a minimally invasive surgical technique, may be used to remove your child’s gallbladder via the abdomen. In a laparoscopic cholecystectomy, the surgeon makes several small incisions in your child’s abdomen. In one incision, a small scope (or camera) is placed to allow the surgeon to see all of the abdominal organs. Small surgical tools are placed in 2 to 3 other incisions. The abdomen is filled with gas during the procedure to allow the surgeon to see easily.
The surgeon then uses these tools to remove the gallbladder through a small incision inside your child’s belly button. DERMABOND (skin glue) will cover the incisions. When this minimally invasive method is used, your child should have less pain after surgery and a shorter stay in the hospital than when having open gallbladder surgery.
In some situations your child may require an open cholecystectomy. The surgeon will make an incision in your child’s right upper abdomen and remove the gallbladder. Your child’s incision will be closed with dissolvable stitches under the skin edges. A strip of tape or DERMABOND (skin glue) will cover the incision. Compared to the laparoscopic cholecystectomy, open gallbladder surgery will require a slightly longer hospital stay. During this time, our surgical team and nursing staff will monitor your child closely to manage any post-operative pain and ensure a smooth recovery.
After the operation, your child will go to the recovery room until she is awake and comfortable. She will then go to a hospital room. Your child will receive IV fluids until she is able to drink clear liquids without nausea or vomiting, and will slowly advance to a regular diet. We may give your child antibiotics through an IV to prevent infection. Pain medication will also go through the IV at first. When your child is eating, she can take pain medication by mouth.
Soon after surgery your child will need to get out of bed and begin to walk and move around. This helps to relieve gas pain that is common after gallbladder surgery. It also helps your child heal faster. If the procedure was done laparoscopically, your child will go home the next day. If your child had open gallbladder surgery, she will be discharged from the hospital in approximately 2 to 4 days. Your child’s surgeon and care team will discuss her recovery and expected discharge with the family.
Please call the Division of Pediatric General, Thoracic and Fetal Surgery at 215-590-2730 if your child has any of the following symptoms:
Once home, your child can gradually return to her normal activities as tolerated. Children without a gallbladder are able to digest foods normally, but they may have loose, softer stools for a short time.
To make an appointment to have your child evaluated by CHOP’s Division of Pediatric General, Thoracic and Fetal Surgery, please call 215-590-2730.