Gall Bladder Surgery
Surgical removal of the gall bladder is
called cholecystectomy. Most of us have heard of gall bladder surgery
in people. It is not as common a surgery in animals.
Heather, an 11 year old Silky Terrier,
came to us with some significant symptoms. They included anorexia for
several days and lethargy. Her initial blood panel showed high
elevations in Alk Phos., AST, and bilirubin. We could see hepatomegaly
on her radiograph. Initial treatment consisted of antibiotics, fluids,
vitamin supplements, and I/D food. Heather rapidly got better on the
treatment.
She had a recurrence of the problem 3
weeks later. at that time an ultrasound was performed and it was
determined that she had a "porcelain bladder". Her gall bladder was
thickened and mineralized, and it contained gall stones. She responded
well to treatment with antibiotics and actigoll. When her enzyme test
were almost back to the normal range we removed her gall bladder.
This is a specialized surgery that is
tedious and requires an experienced surgeon. In Heather's case we
called in Dr. Linda Larsen, a specialist in surgery.
Monitoring of anesthesia is critical in
an older pet with liver disease. Monitoring Heather's blood pressure is
an important aspect of anesthesia.
Once the initial incision was made in
Heather's abdomen we worked on exposing the liver. In this picture we
are removing normal fat, called falciform fat. Removing it greatly aids
in visualizing the gall bladder. In most surgeries of the abdomen we do
not need to do this.
After the fat is removed we start to
get better visualization of the gall bladder (arrow).
We isolated the gall bladder and traced
it down to the common bile duct. The arrow points to the gall bladder
under our surgeon's finger. The vertical bluish structure below the
gall bladder is the common bile duct.
After we viewed the gall bladder and
common bile duct we placed stay sutures in the gall bladder (GB). This
helps in the removal of the gall bladder.
Several stay sutures are placed. They
aid in the dissection by keeping gentle tension on the gall bladder as
we dissect it off the liver. They also help minimize the trauma of the
dissection.
When the stay sutures are in place the
actual dissection begins. The gall bladder's attachment to the liver is
highly vascular. You can see this as Dr. Larsen gently dissects with a
sterile cotton-tipped applicator.
As the surgery proceeds you can see the
gall bladder (GB) being slowly pulled away from the liver.
Eventually we dissect the gall bladder
down to the common bile duct. Several sutures are placed around the
junction of the gall bladder and common bile duct.
After the sutures are secure we cut the
gall bladder at its base and remove it.
All that remains are the sutures at the
common bile duct.
Our next procedure is a liver biopsy.
The first aspect of the biopsy is the placement of a suture around the
tip of one of the liver lobes. The liver is a highly vascular organ, so
control of bleeding (called hemostasis) is critical.
The suture is pulled snug and a piece
of the liver is cut away with the scissors.
There is no bleeding at the biopsy site
with this technique.
We never pass up the opportunity to
check all the abdominal organs during abdominal surgery. This is the
spleen. Even though it is large, it is normal.
The inside of the gall bladder after
removal. The chronic thickening is apparent.
These are the gall stones that were
found in the gall bladder.
The pathology report on the gall bladder.
This is the analysis of the stones found
in the gall bladder.
Our last page on
Liver Disease goes over specific diseases:
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