Surgical Department at Saint Barnabas Medical Center

Gallbladder & Gallstones



Many people think that the gallbladder makes bile. It doesn't. The liver makes bile and delivers that bile to the first part of the small intestine called the duodenum.

The bile travels through a duct called the "common duct" to reach the duodenum entering through a small nipple inside of the duodenum.
Bile drips in like a leaky faucet. When fatty food from the stomach enters the duodenum, the bile serves to emulsify the fat (like dishwasher detergent), making it water soluble and ready for digestion. Since we are not constantly eating, God gave us a gallbladder to store the bile until the next meal presents itself for digestion.
The gallbladder is simply a side pocket off the common duct and serves to store bile. When fatty food, such as French fried potatoes, enters the stomach, the stomach sends a message to the gallbladder telling it to contract and deliver the stored bile to the duodenum.
In this way the bile and the food arrive in the same place at the same time. Even if there is a stone in the gallbladder the system works fine.
In fact, many people have gallstones and never have any problems. But when there are many stones or when a stone blocks the outlet of the gallbladder, a signal from the stomach for the gallbladder to contract will result in a gallbladder attack.

The gallbladder cannot contract because the outlet is blocked. The patient will then have pain in the upper mid-abdomen, sometimes radiating to the back and often associated with belching or vomiting. The attack usually occurs in the evening after a heavy meal and may last 4 to 6 hours. Once the problem

is confirmed by an ultrasound examination of the gallbladder, removal of the gallbladder (cholecystectomy) is recommended.


In the operating room a tube is inserted into the abdomen through the belly button. This tube carries the images to the TV camera and from there to the TV monitor. A second tube in inserted just below the breastbone and serves as the port through which operating instruments can enter the abdomen.

Two other smaller tubes are used but are of less importance, serving only to push or pull the gallbladder.

One might think that the gallbladder would fall lose like a pear from a tree when the stem is cut. But the gallbladder is attached to the liver. This further attachment is separated using a "harmonic scalpel". We used to use a laser scalpel (light waves), but we have found that the harmonic scalpel (sound waves), is safer. In any case, once the gallbladder is detached from the liver and common duct it can be easily removed from the abdomen through one of the port sites.

The operative field is re-inspected to insure that there is no bleeding or bile leakage. Following this the port sites are sutured closed with dissolving stitches which do not need to be removed. Patients usually go home on the same day as the surgery and can go back to work a few days later.

That’s the good news…what about the bad news? We can’t always complete the laparoscopic surgery and may have to convert to the old fashioned "open" operation.

Bleeding. We can usually control bleeding through the scope using clips and cautery but if bleeding persists we will open the abdomen to get control.

 Adhesions. Sometimes adhesions from a previous operation in the upper abdomen will obscure the view and make the laparoscopic surgery impractical.

 Anatomy. We do not all have ideal anatomy. Some have double ducts, two gallbladders, misplaced gallbladders, etc. If we can’t figure out the anatomy, it may be necessary to enter the abdomen and get a better look.

Obesity. In patients who weigh over 300 lbs, we may not be able to get the necessary exposure to conduct the laparoscopic surgery safely. Nevertheless, we will usually give it a try with the laparoscope before converting to an open operation.

Injury to the common duct. This is probably the most serious complication. It usually occurs at the time the surgeon is placing a clip on the small gallbladder duct. That’s when there is maximum traction on the junction of the gallbladder duct and the common duct. Even a very small injury may require converting to an open operation to repair the tear and drain the common duct. The drainage tube is left in place for 4 to 6 weeks.

CO2. During surgery the abdomen is inflated with carbon dioxide. Some of the carbon dioxide is absorbed into the blood stream, traveling from there to the heart and lung where it exits with the exhaled air. The anesthesiologist measures the carbon dioxide in the exhaled breath. If it gets too high, he has veto power and can demand that the surgeon convert to an open procedure. At this point we don’t have a discussion we simply do as we are told in the interest of safety.

If it is necessary to convert to open surgery, the patient will usually remain hospitalized for 4 to 7 days and will not be able to return to work for two weeks. What are the chances of converting to an open operation? About 5%. That means you would have a 95% chance of waking up with a few small puncture sites and going home the same day. On the other hand, you have a 5% chance (1 in 20) of waking up with a bandage and drains. You will stay in the hospital for a few days and you won’t be able to return to work for a few weeks.

Laparoscopic removal of the gallbladder is a major advancement in surgery and offers relatively quick and safe treatment for the inflamed gallbladder (cholecystitis), and gallstones (cholelithiasis). It is a lasting tribute to the pioneer surgeons who developed these techniques. It is also a tribute to the industries that continue to develop the high-tech instruments and optics that make the surgery practical.

Dennis Filippone, MD

Phone: (973) 322-5195

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Surgical Department
(973) 322-5195


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