Cholecystectomy – gallbladder removal

<tl;dr>I had my gallbladder out Thursday.  I’m gonna cut back on the bacon, maybe, but am feeling better.</tl;dr>

Exactly 365 days after my kidney stone, I was again experiencing similar symptoms.  I assumed it was one of the tiny calcite terror pre-stones in the inner part of my left kidney.  Kidney stones suck, but for subsequent attacks (in my case), they are not reason to seek medical attention.  I took the horse-pill (800mg) of ibuprofen and stayed up all night as my body purged both ends of the digestive tract (including the horse-pill, sigh) to relieve pressure.  By 5am, the worst symptoms had abated.

Two weeks later, it happened again.   The redux was worse, adding chills, pain in the center of my abdomen, and shortness of breath when walking upstairs.   With two new, worrisome symptoms, I went to the doctor.

Diagnosis: Biliary colic.   One key difference in symtoms was the location of the pain.  In a kidney stone attack, the pain moves fore and aft, sometimes going down towards the groin.   Mine was not being a pain in the aft.  Also, the center of my abdomen was tender, something I didn’t appreciate until the doctor prodded.  He ordered a whole blood count to rule out it being worse (e.g., liver obstruction, pancreas).  However, since I had a gallstone, he referred me to a surgeon with the expectation that I’d likely have my gallbladder taken out.

The gallbladder is a source of black bile, one of the four humors.  An excess can lead to melancholia or, in milder cases, magic squares.

Oops, wrong millenium.

The gallbladder is a sac storing concentrated bile until it’s needed in the small intestine.  It leaps (actually, squeezes) into action when one needs to digest foods I’m most fond of: pizza, bacon, potato chips, hamburgers, guacamole, and peppermint mochas.  The causes of gall (or kidney) stones are not well established, and apparently they’re very common, though only a small percentage of people exhibit symptoms.  In fact, mine was discovered last year incidentally.  Since it was behaving itself, we were going to leave it alone.  However…

The surgeon expressed a general concern of the size of my gallstone as something he would generally recommend be taken out.   He cautioned that because I had two recent incidences, I would expect recurrences, though it did not appear life-threatening.   While I’ve enjoyed the weight loss I’ve experienced, the rest of it was not something I wanted to repeat.  Surgery was scheduled for Thursday.

Cholecystectomy (aka “removing the gallbladder”) is much more common and far less involved than the gnarly adrenal mass I had removed in January.  It’s usually done laparoscopically, and on an outpatient basis, meaning I’d be home the same day.  The downside is they couldn’t reuse my existing scars, thus I would have Stonehenge on my abdomen.

 

My surgeon provided a couple of photos.  In the first one, he indicated the gallbladder was still inflamed.  (To me, it looks like I’m carving a lamb leg.)  This made more work for him, but thankfully doesn’t affect my recovery.

There were four stones.  The largest (probably cholesterol) was 2.7 centimeters.  From a distance, it looks like a Mayan calendar or Oreo cookie.  I didn’t know about the three smaller ones (only one shown) until they came out.

Because gallbladder removal is so common, I found a lot of dubious (read: homeopathy woo) information on gallstones and recovery and… won’t link to any of them because it’s all unsubstantiated bullshit.  Generally there was useful information on pubmed, WebMD and SAGES.   As far as surgeries go, this was a cake-walk.  The worst pain was in my shoulders, caused by the CO2 remaining from abdominal cavity inflation.  On the pain scale, I’d have to rate that a solid 8: bad to the point I was yelping and unwilling to lie down to sleep the first night.  I may have escaped this the first time thanks to the morphine drip in recovery.  Anyway, except for that, my pain level has been around a 3.

It was great to be able to come home the same day, resume solid foods, and shower.  I’m planning to work from home for the next week before trying to go back into the office.  The biggest challenge will be the longish walk (and numerous stairs) I take to/from the bus stop, followed by all the random heavy lifting as I obsessively clean up after my kids.

An interesting comment my mom and wife both had was that they felt I was getting the short rift this year.  I felt quite the opposite.  I feel I am very healthy and consider but an inconvenience, especially as neither procedure seems to have long-term effects.  I am looking forward to doing some kind of week-long bike event in 2013 (something I’ve missed the last two years).  If I have any worries, it’s about my recalcitrant achilles tendon acting up.  And dealing with health insurance paperwork as I’ve recently switched jobs.

Four-week update: I’m feeling great and am glad to have had this done.

	Adrenalectomy	Cholecystectomy
Why it was done	Large mass	Large gallstone + two gallbladder attacks + inflammation = gallbladder warranty expired
Method done	Laparoscopically	Laparoscopically
Hospital stay	Overnight	Outpatient
No solid foods beginning	9am the morning before surgery	midnight, day of surgery
Pre-op poo purge?	Assisted by two bottles of magnesium citrate	Not required.
Catheter	Foley	None
Duration of operation/Unconsiousness /post-op	1.75 h/5.5 hours/4 hours	1h/4 hours/1 hour
Stay in hospital	1 night	None
Walking	About 12 hours after surgery	When anesthesia wore off
Eating	Day on exit	When anesthesia wore off
Worst part	Sharing a hospital room	Shoulder pain the next two days
Incisions	Four, largest was ~3 cm	Four, one 2cm
Back to work	Mentally: one week Physically: 2 weeks	Mentally: next morning; Physically: one week